The problem with dubbing single-payer plans 'Medicare for All'

Medicare enrollment form and pen
A new report examines the potential positives and negatives of a single-payer healthcare system. (Getty/zimmytws)

As the debate around a “Medicare for all” approach continues to heat up, a new report warns that name doesn’t necessarily fit the plan. 

Policy analysts at the Urban Institute dove into the positives and negatives of a potential single-payer healthcare system, and in their analysis note that there’s a problem with dubbing such a system “Medicare for all”: Medicare isn’t actually a single-payer system. 

Linda J. Blumberg, Ph.D., a fellow at the institute and one of the report’s authors, told FierceHealthcare that naming gives the idea that everyone would move into Medicare, when the goal is to eliminate and replace that program as it exists today.  


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But a political slogan of “Medicare for all” does take advantage of the popularity and cachet of Medicare, she said. 

“It’s kind of a convenient name, but it really is a misnomer,” Blumberg said. “The idea behind these bills is to eliminate the current Medicare program and put them in something new.” 

RELATED: What is ‘Medicare for all’? A look at 4 of the different possibilities 

Many of the pros and cons identified in the analysis are intertwined and play off of one another and may switch columns depending on how one approaches them, Blumberg said. For example, moving to a single-payer system would require the government to establish a massive administrative entity to process claims, monitor quality and efficiency and set any consumer cost-sharing.  

Though the process to establish this administrator would likely be a negative, it could be viewed positively as well, as it would likely be less administratively taxing than the complex current system of private and public insurance and could ultimately prove less costly over time, according to the report. 

Or, certainly, universal coverage means greater access to care for people who were previously uninsured or who had skimpy benefits or high cost-sharing, a clear positive. However, if demand increases significantly in tandem and payments are on par with current Medicare rates, then the financial pressures on providers could chip away at those access gains, creating an ultimately negative outcome, Blumberg said. 

“For anyone to say, ‘Listen, this is all good or all bad’ … they’re not being honest with the people that they’re speaking to or with themselves,” she said. “The conversation has to be more nuanced than it has been up to this point.” 

RELATED: Hospitals could sustain 10% cut under Medicare public option proposals—report  

A major factor is also the debate around healthcare reform itself, which the Urban Institute did not put as a pro or con but an element that’s layered on top of those categories. Blumberg said that all sides of this debate are particularly passionate, and there are so many stakeholders in the conversation that would be significantly impacted by an overhaul of the healthcare system of this magnitude. 

By contrast, progressive politicians and voters have mobilized strongly around supporting this issue, the report notes. 

“There’s a lot of almost religious fervor about this in one direction or another,” Blumberg said. 

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