'Medicare for All' and the Free Market

Medicare for All is a single-payer, government-controlled health care system. It’s promoted as the solution to America’s high health care costs because it will eliminate competition. According to Senator Bernie Sanders’s version, all insurance-based health care plans will be eliminated and replaced by a monolithic, centrally-controlled plan that would cover the entire population. Insurance companies won’t be allowed to cover any services already covered by the government plan. Paradoxically, though, if Sanders’s plan is implemented, its shortcomings could drive patients toward free-market health care options.

If Medicare for All is implemented, wait time for testing and procedures will increase dramatically. Nurse practitioners, physician assistants, and pharmacists will help cover the deluge of demand -- since there simply aren’t enough physicians to go around. That means your visit with a medical professional will be shorter than ever, not to speak of the dropoff in care quality.

It’s unlikely that patients will accept the long waits endemic in single-payer systems. They won’t wait months for an MRI or a specialist visit. Many patients will turn to the private market. That’s where they can enjoy meaningful, thorough physician visits in a short time frame -- and receive reasonably priced tests and procedures.

Many countries, after grappling with slow and inadequate single-payer systems, develop a parallel, vibrant, free, and private health-care market.

The U.S. will most likely follow this trend. In recent years, the growing burden of regulations and reporting requirements has already led many doctors to break ties with the insurance industry altogether. They are paid in cash or operate retainer-based clinics, such as direct primary care practices. More and more imaging and surgical centers accept cash for their services.

The private market -- free of government regulations, convoluted electronic medical records, and reporting requirements -- offers reasonably priced services, competing for patients the same way any business competes for customers. Patients can receive unlimited primary care visits with a direct primary care physician for less than $100 a month and get an MRI for less than $300. This innovative private market is primed to flourish, and the implementation of Medicare for All will increase demand for these services.

Under Medicare for All, many patients won’t wait over a year for knee replacement or cataract surgery. They will pay out of pocket to get the treatment they need -- on their timeline, not the government’s.

Private surgical centers, like the Surgical Center of Oklahoma, will thrive. The government might prevent new private hospitals and surgical centers from opening, but it can’t prevent patients from getting surgeries elsewhere.

Just as some Canadian citizens come to the U.S. for timely treatment, Americans will go abroad for the services they desperately need. Private hospitals in Mexico will expand, and new ones will be built. Those who can afford it will travel there for elective surgeries. Mexican hospitals, unburdened by electronic health records, complex billing, Centers for Medicare and Medicaid Services (CMS) reporting requirements, and the administrative staff these burdens require, will offer lower prices and compete for patients. Affluent people who already travel to the Cayman Islands, Thailand, and other countries for care will have more choices at better prices.

Government-run hospitals in America will also suffer from a shortage of doctors and experienced staff. This is already the case in other countries saddled with single-payer systems. France has “medical deserts,” areas where doctor shortages are so severe that patients don’t have access to medical care. The Guardian reported that by 2030 the British NHS might be short 350,000 staff. Others put the shortfall at “only” 250,000.

Talented physicians and staff in our country will leave a government-run system, not tolerating lower pay and administrative tasks that will dominate most of their time. They will work in private centers or move close to the Mexican border, commuting to hospitals there. 

Ironically, implementing Medicare for All would cause government-run health care to atrophy -- thereby incentivizing the development of free-market health care solutions that deliver cheaper prices, better care, and less bureaucracy. Physicians and facilities will compete for patients based on price and quality of care. Prospective patients will be free to comparison shop, making their own health care decisions on their own schedules. 

Perhaps the most fervent free-market advocates should support a single-payer system after all. Instead of eliminating competition, Medicare for All will unintentionally unleash it.

Gabriela Eyal, Psy.D., is a policy fellow at the Docs 4 Patient Care Foundation (D4PCF) and a licensed psychologist in Lansing, Michigan. Chad Savage, M.D. (info@d4pcfoundation.org) is a D4PCF policy and the founder of the DPC practice YourChoice Direct Care in Brighton, Michigan.

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