How Medicare-For-All Would Politicize Health Coverage

Last week the Trump administration announced that it would give health care workers greater leeway to refuse, on religious grounds, to provide services that enable birth control use, abortion, sterilization, or assisted suicide.

by Arielle Kane, Director of Health Care | Progressive Policy Institute

Last week the Trump administration announced that it would give health care workers greater leeway to refuse, on religious grounds, to provide services that enable birth control use, abortion, sterilization, or assisted suicide. Specifically, the rule bars employers from requiring their employees to participate in delivering health care services they believe their religion proscribes. Such services could include scheduling a vasectomy, prepping a room for a sex change surgery or billing for an abortion.

Democrats slammed the move, which they described as a political plum tossed to religious conservatives who form an important part of President Donald Trump’s base. If they take back the White House in 2020, it won’t take them long to reverse the rule issued by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR).

Well, that’s democracy, you might say. But the ping-pong nature of today’s deeply polarized politics highlights an underappreciated risk of adopting a “single payer” or Medicare-for-all health care system: it could politicize key health care decisions, including the basic question of what gets covered and what doesn’t.

Don’t get me wrong, like Medicare-for-all proponents, I also support a universal health care system that leaves no one behind. But upending employer-based coverage may not be the best or most politically feasible way of getting to where all progressives want to go.

Abortion coverage is illustrative of how Medicare-for-all could be unnecessarily politicized. Medicare became law in 1965, before the Supreme Court had ruled on Roe v. Wade. Back then, abortion wasn’t quite the polarizing issue it is today. Many Catholic Democrats opposed it while more liberal Republicans often favored legalizing it. Since then, however, things have changed. After Roe v. Wade was decided, there was no longer legislative give-and-take on the issue but rather it became a ‘winner take all’ as presidents could appoint “pro-life” or “pro-choice” judges. What’s more, all health care legislation became an opportunity to reiterate those values. The Hyde Amendment bars the use of federal funds for abortion. It was first passed in 1976 but the language is often added into new health care legislation to appease anti-abortion advocates. The language can derail otherwise bipartisan health policy efforts — such as last year’s bill to shore up the exchange marketplaces.

Private insurance avoids some of these pitfalls in two ways: first, people can select plans that don’t cover some of the services they disagree with and secondly, because people don’t see tax dollars paying for care they oppose, they can be more amenable to it. However, because Medicare-for-all is implacably opposed by Republicans, it’s likely that the benefits would become an opportunity for political posturing. Every time the two parties rotated in government, they would change the benefits covered based on their values or constituents’ demands. It could destabilize health insurance and breed enormous uncertainties and costs. You can easily imagine the kinds of medical services that would become partisan footballs:

• Abortion coverage
• In Vitro Fertilization (IVF)
• Sex reassignment surgery
• Birth control
• Vasectomies
• Undocumented immigrants’ coverage
• End of life care

Leading single payer supporters like Sen. Bernie Sanders routinely oversimplify the task of transitioning from our present private-public hybrid to a unitary government health care system. Last week, the Congressional Budget Office (CBO) released an analysis that outlines many of the design considerations that would need to be decided in a single payer system. Questions like: Who would decide the benefit package? How could it be changed? How would a person access services not covered by the benefit package? These are just a few of the undiscussed details that a complete insurance overhaul would require.

One can recall that the majority of Americans once disapproved of Obamacare, which entailed disruptions in existing coverage that were miniscule compared to the massive shift of 150 million Americans from private to public plans that Medicare-for-all would require. It’s even possible that public opposition could stop a conversion to single payer in its tracks, leaving those with high health care costs no better off than they are today.

Progressives could instead push for more politically feasible changes that would have immediate impacts on high costs:

• Price regulation for commercial health plans
• A Medicare buy-in for certain groups
• Greater subsidies for those in the individual market

The Democratic presidential field is divided on single payer and yet they are united in the moral imperative of universal, affordable coverage. When debating the merits of a single payer program, progressives would be wise to keep their sights on the goal they have in common — and that presents a sharp and favorable contrast with the Trump-Republican crusade to roll back health care coverage for millions of Americans.