The political posturing in Congress over "Medicare for All" continued Wednesday at the latest hearing on the implications of a single-payer system.
The House Ways and Means Committee hosted a panel of health policy experts and advocates to discuss Washington Democratic Rep. Pramila Jayapal’s bill that would establish a government-run health system that’s fashioned after Medicare.
Many of the same common questions emerged: How much would this system cost, and how would it be paid for? Will it lead to access problems? Do patients even want a change like this?
Don Berwick, M.D., president emeritus of the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services, pushed back on the cost concerns.
Opponents of Medicare for All have referenced a $32 trillion price tag, which comes from a 2018 Mercatus Center study, but Berwick said that wouldn’t be trillions in new spending. Instead, it’s more appropriate to view that cost as a “transfer of payment from the current channels” that would offer greater leverage to push back on low-value care, Berwick said.
“The current, fragmented system cannot articulate, cannot execute a plan for the true improvement of healthcare,” he said. “An expanded Medicare program could do that.”
Centralizing the system also promotes greater accountability, Berwick said. At present, “no one owns the problem,” and no individual private insurer has the leverage to address cost issues and access disparities in the way that Medicare does.
However, Grace-Marie Turner, president of the Galen Institute, a free market think tank, warned that healthcare has continued to grow more unaffordable for many even as the government’s role in the sector has increased under the Affordable Care Act.
In her testimony (PDF), Turner said that increased compliance requirements put a higher burden on providers, which can in turn boost costs and limit the face-to-face time between doctors and patients.
Proponents of a single-payer system have argued that a centralized insurer would ease many of these requirements and would streamline administrative work into one system.
Turner said that, instead, legislators should focus on policies that boost competition in healthcare markets and allow patients greater choice in their own care.
“Rather than dramatically expanding the role of government through Medicare for All or other new taxpayer-supported programs, I believe we need to target appropriate solutions that empower consumers to get covered, provide incentives for more choices of affordable coverage and care, increase transparency and build on what works,” she said.