Although [Rep. Pramila] Jayapal’s plan would allow for the creation of a secondary market for supplementary coverage in addition to the government-run plan and direct cash payments to doctors, the market for the private health coverage that tens of millions of Americans currently have would be eliminated. Employers and insurers would be prohibited by law from providing the same benefits as the the government plan, a prohibition that goes further than some other countries with national health care systems. Private insurance as we know it today would be illegal.
And while the federal government would neither own hospitals nor employ doctors directly, it would be in charge of the vast majority of the nation’s health care financing. That would include setting a “national health budget”—essentially, a federally imposed cap on total health care spending—and divvying up those funds by region. The federal government would also determine the budgets for capital improvements at medical facilities and set up a fee schedule imposing rates paid to doctors in private. In addition, the government would also specify staffing levels for physicians, and determine the preferred ratio of nurses to patients at any given facility.
It’s true that the government already sets rates for Medicare in its current form, and those rates exert a significant influence on the administration of health care throughout the country. But today’s Medicare exists alongside multiple private payers that would be eliminated under single-payer, leaving the government as the sole payer for most services.
So while doctors and hospitals would not technically be state owned under Medicare for All, the federal government would determine how the vast majority of the nation’s health care dollars would be spent, making providers even more reliant on federal funds—and more susceptible to the influence and incentives of federal payment schemes—than they are today. Some practitioners might avoid this by accepting only cash payments, but it’s reasonable to assume most would not. As a consequence, doctors and others in the health industry would become de facto federal employees, with significant staffing and payment decisions made by the federal government, according to formulas set by federal agencies.
Medicare for All, as envisioned by single-payer proponents like Jayapal and Sen. Bernie Sanders (I–Vt.), would thus bring about an explicit nationalization of health care financing and a tacit nationalization of health care delivery.
[Peter Suderman, “Medicare for All Would Actually Be a Government Takeover of Health Care,” Reason, February 28]