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Medicare-For-All was a bedrock of Bernie Sanders 2016 campaign and almost every single Democratic 2020 hopeful has since signed on to the policy. Which is good, because Medicare-For-All is a clear and easy to articulate policy goal that politicians who support can be held to account on. Which is why Democrats recent effort to roll out Medicare-For-More is so troubling. Medicare-For-All will be the biggest policy achievement of the last four decades, but it will take a herculean effort, and Democrats already seeking to water down the policy is not a good look.

Bernie Sanders is so successful because his message is succinct and easy to understand. Medicare-For-All is simple, government healthcare for everyone, when pressed on the details, it looks a lot like the Canadian healthcare system placed in an American context. The baseline goal though, healthcare for all via government mandate, is simple. Medicare itself is a policy people are familiar with and therefore extending it to everyone is inherently easy to grasp. There is a reason the policy has such popular support, because the sort of half steps the Democrats Medicare-For-More initiative represents has consistently failed.

Medicare-For-More is Just Another Failed Half-Step of the Kind that Necessitates Medicare-For-All

Medicare-For-More will simply introduce more of the restrictions which make programs like the Affordable Care Act so unpalatable to begin with. Medicare-For-More has a vision akin to a public option, make Medicare an option for more people alongside the private insurance market. The appeal of such a vision is clear and Democrats who back the proposal, like Hillary Clinton’s former VP pick Tim Kaine, may have been inspired by a recent Washington Post poll that found “Medicare-For-More” to be more popular language than “Medicare-For-All.” Which is all good and well, until the policy must be implemented and the shortcomings of yet another half-step make themselves known.

It’s easy to imagine a Medicare buy in not gaining early traction as many Americans stick to their original plans. It’s easy to imagine Medicare buy in plans being incredibly ineffective at the lower price range. It’s easy to see Medicare-For-More becoming another Affordable Care Act like policy initiative that gives a few million more people access to health insurance which in theory only costs a few hundred a month but in practice doesn’t allow adequate access to regular preventative care and in emergency situations doesn’t really alleviate the bankruptcy inducing nature of American healthcare markets. All these negative consequences come from one thing, selling out the baseline principle of Medicare-For-All that makes it so popular in the first place, the fact that it’s for everyone.

People like universal programs, there is a reason Social Security has survived every conservative attempt to do away with or privatize it. Old people, even incredibly conservative ones, love their Medicare. Which is why Republicans don’t prioritize gutting it in the same way they have every facet of the welfare state that helps poor people. Giving every single person a stake in the healthcare of the least among us is incredibly important as a moral goal, it’s incredibly important in giving the policy staying power, and that’s the very reason it’s the foundation of Medicare-For-All. That goal is more important than the private insurance industry, plain and simple.

It’s Not Just a Matter of Morality, Medicare-For-More Makes for Worse Policy

Medicare-For-All gains a lot of its power as a policy initiative because of the nature of single payer healthcare. Giving the government primary control of health insurance allows them to be a single negotiator for pharmaceuticals and procedure pricing. Inherently by capturing the entire country, the government gives itself the bargaining power to reduce prices. Which is why every single country in the industrialized world that utilizes some form of single payer healthcare also spends less per capita on healthcare.

Medicare-For-More might outcompete the private market. It could eventually gain enough of a share of the American insurance market that it effectively has the same level of bargaining. But that is an open question, which is not the case in a Medicare-For-All system. If the main appeal is cost saving, Medicare-For-All will bring healthcare expenditures to $30 trillion or $32 trillion depending on the study, down from the current expenditure of $34 trillion. It’s not at all clear that a Medicare-For-More system will ever be able to deliver those same results.

Medicare-For-All also puts every American on the same system. For many people the benefit of private insurance is the ability to spend thousands of dollars to artificially improve health care outcomes at the expense of people who can’t access those services. People are able to spend their money on better insurance, better doctors, and better outcomes. Medicare-For-All inherently means those resources are used for everyone equally, so if wait times are a concern, to the extent we don’t have wait times now, those are simply a product of pricing people out of the market to begin with. Which ultimately results in higher healthcare costs when those people end up in the emergency room without insurance and those costs are offloaded on local governments, hospitals, and patients who come later down the line.

Medicare-For-More doesn’t fix these problems, but most importantly, as discussed earlier, it likely still artificially leaves millions who can’t afford care out of the market. It removes all incentives to make the program work well for everybody and it doesn’t solve the fundamental moral-ill that is privatized healthcare. It’s simply not enough.