Medicare-for-All is the most practical option, says leading health insurance expert

Access to affordable health care has been a recurring topic in current political discussions. Merton C. Bernstein, leading health insurance expert and law professor emeritus at Washington University in St. Louis says that Medicare is the most practical platform for both extending coverage to everyone and taming medical cost inflation.

“Medicare has been on the job for more than four decades and has resolved hundreds of practical problems that any large-scale health program must address. In contrast, any step-by-step program, even one that purports to be “Medicare-like,” must start from scratch. It does not make sense to keep reinventing the wheel.”

Bernstein is available to discuss the candidates’ health care proposals. His current comments follow:

Democratic plans

“Plans that call for steps toward universal coverage, such as those put forth by the leading Democratic presidential rivals, would, by their proponents’ own calculations, increase total costs $60-$120 billion dollars annually,” Bernstein says.


“These anticipated additional costs come from a major common design feature. They would provide individually determined, means-tested subsidies to make costs appear affordable. Yet those tests, which must be done for tens of millions of participants, substantially increase outlays. For example, means-tested Medicaid incurs administrative costs that are some four percentage points higher than those of the original Medicare.”

Republican plans

“Senator McCain proposes to eliminate tax subsidies for employers that provide health insurance and for employees who receive such coverage,” he says.

“That is almost surely a political non-starter because of employer and employee opposition. His subsidies to recipients would not meet the costs of adequate plans. The elimination of employer tax breaks would lessen the willingness of employers to provide medical care insurance, enlarging the ranks of the uninsured.”


“We must move to a system that reduces per capita costs and pays for expanding coverage from those savings, and that’s where Medicare-for-All shines,” Bernstein says.

“Much of its savings derive from simplifying medical care insurance. With everyone eligible, there is no need to trudge through data to ascertain eligibility. With only one regional set of provider reimbursement rates, there is no need to match a claimant’s bill with hundreds or thousands of possible rate schedules.

Bernstein notes that Medicare-for-All and other single-payer plans are frequently disparaged as one-size-fits-all programs.

“We all need the same protection in the event of illness or injury, and many of us want that for everyone else as well,” he says. “Medicare-for-All is the most practical reform option. It would greatly reduce non-benefit outlays and lessen employment discrimination against women of child-bearing years and older men and women. Those features should translate into powerful political support.

“Our economic situation requires that we pursue less wasteful policies; reducing health care costs that exceed what other developed nations spend heads that agenda. We need the economies of Medicare-for-All as much for the well-being of American enterprise as for the adequate medical care of our people.”

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