Negative repercussions tank solvency.

What Are the Possible Negatives? A system that sounds too good to be true usually comes with some issues.

This system would replace all private health insurances. This could have a significant impact on the economy. In 2020, the health insurance industry had $31 billion in net earnings and an increase in their profit margin by 3.8% (National Association of Insurance Commissioners, 2021). Eliminating these plans would also eliminate jobs. The health and medical insurance industry employed almost 600,000 people in 2022 (IBISWorld, 2022), so losing these jobs would have a huge impact. It’s possible Medicare for All could create replacement jobs, but to what degree is unknown.

There could be an impact on provider and patient satisfaction. In today’s world, doctors can choose which networks to join and can opt in or out of accepting Medicare assignment. With a single-payer system, there are concerns about more government oversight affecting patient care decisions. (However, today’s system has prior authorization, which is insurance oversight affecting the decisions.) Likewise, patients have several options. If they don’t like their current plan, they can change during open enrollment or open season. In a single-payer system, there are no options.

The cost estimates for Medicare for All are all over the map. Just as with cost savings, there are all kinds of numbers. A report from the Congressional Budget Office (2019) projects that federal subsidies for health care would be $1.5 trillion to $3 trillion higher in 2030 under the illustrative single-payer options than they would be in that year under current law (Swagel, 2020). Economists estimate that Bernie Sanders’ Medicare for All proposal would cost somewhere between $30 trillion and $40 trillion over 10 years (Luthra, 2020).

That money would have to come from somewhere. A study by the Committee for a Responsible Federal Budget (2020) noted that paying for Medicare for All could require raising payroll taxes by 32% on workers and businesses. Other options that on their own could fund Medicare for All, according to the study, include a 25% income surtax; a 42% value-added tax on consumption; a 100% increase in individual and corporate tax rates; or, more likely, a combination of taxes (Committee for a Responsible Federal Budget, 2020).

Why Is This Called Medicare for All? This proposed system carries the name “Medicare,” but when you start digging into the facts, today’s Medicare is not anything like the Medicare for All proposals. Medicare is not a single-payer system. Some of the payers include:

• Payroll taxes and other sources—such as income taxes paid on Social Security benefits and interest on trust fund investments—fund the Hospital Insurance Trust Fund, which covers many Part A (hospital insurance) benefits.

Then, premiums paid for Part B (medical insurance) and Part D (prescription drug coverage), along with funds authorized by Congress, pay for Part B and Part D benefits.

Funding for Medicare Advantage (Part C) plans comes from the Part A and Part B accounts. Medicare pays a fixed amount each month to the private insurers that administer Medicare Advantage plans. Medicare supplement insurance plans (Medigap policies) do not receive any federal funding.

Healthcare providers receive payment from the federal government for services delivered to Original Medicare beneficiaries and from the Medicare Advantage plans for care to their members.

Healthcare providers receive payment from the federal government for services delivered to Original Medicare beneficiaries and from the Medicare Advantage plans for care to their members.

In 2022, the monthly premium for Part B is $170.10 a month. Everyone pays this. • Those who have not earned 40 Social Security credits must pay for Part A. That adds $274 to $499, depending on how many credits the person has.

• Part D drug plans and Medigap policies, along with some Medicare Advantage plans, come with monthly premiums.

• Higher-income beneficiaries subject to IRMAA (income-related monthly adjustment amount) can pay anywhere from $180 to $486 a month more for Part B and Part D, on top of the premiums.

• There are out-of-pocket costs in the form of deductibles, copayments, and coinsurance. For those with Medicare Advantage plans, the maximum out-of-pocket limit is $7,550 in 2022. (Plans can offer lower limits.)

• And we can’t forget late enrollment penalties. Missing the window to enroll in Part A, Part B, or Part D can cost more every month for life (Medicare.gov, n.d.).

Pre-existing medical conditions can jeopardize one’s ability to get Medicare coverage. The Affordable Care Act eliminated the impact of these conditions in many situations, but it did not have an impact on Medicare supplement plans. Insurers can use medical underwriting when someone applies for CSA JOURNAL 89 / VOL. 4, 2022 / SOCIETY OF CERTIFIED SENIOR ADVISORS / WWW.CSA.US PAGE 13 a plan. Pre-existing conditions can lead to a denial of the application or higher premiums (Omdahl, 2018). So, if it’s not anything like Medicare, why is this proposed system called Medicare for All? It may be that including “Medicare” in the title removes the negative connotations “single-payer for all” carries.

What are Obstacles to Medicare for All Implementation? There are many opinions about what it would take to implement this system, but these barriers must be considered. Opposition by big players. These three groups could present formidable challenges. • Health insurance companies would be left out in the cold with just one payer. There is little doubt that the health insurance industry has considerable clout. In the Medicare Advantage industry, there are 3,834 plans available this year: that’s 284 more than last year (Damico et al., 2021).

• The Partnership for America’s Health Care Future (PAHCF), an alliance of American hospital, health insurance, and pharmaceutical lobbyists, spent over $140 million in 2018. The alliance’s goals include protecting patient choice, expanding access, lowering costs, improving quality, and fostering innovation. And, according to the “Our Mission” statement on the PAHCF website, “whether it’s called Medicare for All, Medicare buy-in, or the public option, one-size-fits-all health care will never allow us to achieve those goals” (n.d.).

• The American Medical Association is opposed to Medicare for All. It believes the best way to expand health care is through a mix of private and public health insurance options (Finnegan, 2018).

Putting the system in place. What would implementation involve and how long would it take? Because everything is proposed, there are no details available. But stop and think about this. Today, there are hundreds, maybe thousands, of different insurance options. And, then tomorrow, everyone has the same coverage. Establishing a single-payer system would involve substantial changes in coverage, provider payment rates and systems, financing methods of health care, and patient behavior and expectations.

Healthcare veterans who have survived at least one implementation of a new government payment program are probably shaking in their boots. To understand their concerns, consider the government’s distribution of new Medicare cards (Centers for Medicare and Medicaid Services, 2017). A 2015 law mandated the replacement of Social Security numbers with unique identifier by January 2020. It took five years to give new cards to approximately 62 million beneficiaries. Granted, this was a big task, but it was not nearly as big as changing a payment system for everyone in the country. Replacing today’s mishmash with one government program means new systems for enrollment, claims submission, payments, coverage, appeals, education—the list goes on, for 333 million people (United States Census Bureau, 2022). What would that timeline look like?

History. Our country’s efforts to implement universal health insurance started over 80 years ago when President Roosevelt realized that including health insurance would jeopardize the entire Social Security Act (Healthcare-Now, n.d.). A 1960 national debate topic was “Resolved: that the United States should adopt a program of compulsory health insurance for all citizens” (Wake Forest University, n.d.). (If you ever debated, you know most topics have little chance of seeing the light of day.) A slew of proposals have come and gone since then, without the government approving even one demonstration project.

Giving up what you’ve got. Change is difficult; many don’t want to deal with it. Medicare for All would be a major upheaval. It would replace all insurance options available today, throwing everyone into an unknown world.

There is so much uncertainty surrounding Medicare for All, but there are two things we know for certain.

1. Medicare for All is not today’s Medicare. 2. Medicare for All would be the end of Medicare as we know it.