I'm a Democrat but Medicare for all is not the answer -- Here are four suggestions

Every election cycle, candidates role out their plans to address the challenges of our nation’s health care system. Voters get bombarded with catch phrases like “quality coverage” and “affordable access.” Complex policies are boiled down to 30-second ads or a few sentences that fit on the back of a postcard. I find it endlessly frustrating.

That’s because I spent the better part of two decades on the front lines of health care and social service delivery, in just about every capacity – as a licensed social worker, as a family caregiver to my grandfather who struggled with Alzheimer’s disease for eight years, and as a state senator who co-authored numerous bipartisan laws in Ohio impacting both private health insurance and Medicaid.

I have experienced health care policy from the perspective of the provider, the consumer and the policymaker. So when concepts like “Medicare for all” get thrown around, I pay attention. And I think it’s time for a reality check on how a single-payer system is perceived by both the left and the right.


Progressive leaning Democrats such as Senators Kamala Harris, D-Calif, and Bernie Sanders, I-Vt., have embraced the idea of a single-payer system commonly referred to as “Medicare for all.” Supporters of this policy claim that it will reduce consumer costs while allowing everyone access to health coverage.

Conversely, opponents are quick to note that “Medicare for all” is tantamount to a government takeover of our health system.

Frankly, I don’t think either side has it right. “Medicare for all” is not the cure for our health care woes, but it is also not “socialized medicine” as some in the GOP have suggested.

The right has tried to describe everything – from ObamaCare to a single-payer system – as big government overreach that would lead to long wait times and rationing of care. Some liken these plans to the United Kingdom’s National Health Service. But these assessments are not really accurate.

For one thing, neither of these policies calls for providers to be employed by the federal government, as they are in Britain or in the American VA system, for example. Long wait times are usually the result of government being the provider of both health insurance and health care.

I recognize that the single-payer system would replace everything, but it also takes time to accrue enough revenue to provide the coverage to the public. What happens in the interim? Chaos, confusion and instability.

The ObamaCare health insurance marketplace is regulated in part by the federal government, but the government is not acting as the insurance company. ObamaCare is a patchwork of private health insurance products offered on the individual market. So, the private sector, not the government, remains the primary source of health insurance under ObamaCare.

A single-payer system, on the other hand, would create one publicly-run health insurance model, similar to the current Medicare system available to those who are 65 and older or disabled. Single-payer is closer to a government takeover of health care than ObamaCare, but is still not exactly what some on the right try to portray. Doctors are not employed by the government in a “Medicare for all” system. Hence, it is a government health insurance plan, but not government health care.

I recognize that our health care system is flawed and most Americans agree with that. But unlike some of my fellow Democrats, I do not think “Medicare for all” is the way to fix our problems. I admit, it sounds great, but it is also unrealistic for a number of reasons.

For starters, providers would have to be paid enough in reimbursements to make taking patients worthwhile, which is barely happening in our current system.

There is also the staggering price tag. Studies show that “Medicare for all” would cost over $3 trillion a year while also kicking people off of their current coverage.

Furthermore, while Medicaid and Medicare are rooted in government, the private sector still plays a major role in providing insurance products for these programs. Roughly 22 million Americans are enrolled in Medicare Advantage, a managed-care version of traditional Medicare. And 81 percent of Medicaid beneficiaries are covered through managed-care plans. That’s over 65 million Americans who would lose coverage just in Medicaid.

I recognize that the single-payer system would replace everything, but it also takes time to accrue enough revenue to provide the coverage to the public. What happens in the interim? Chaos, confusion and instability.

So, I have a few suggestions for 2020 hopefuls who may be looking to strike out from the “Medicare for all” crowd, and present some creative, pro-patient, financially prudent policy solutions for our health care conundrum.

1. Streamline the prior authorization process for private health insurers. We did this in Ohio and while it is an issue that is usually governed at the state level, it potentially could be applied to private insurers on the federal ObamaCare exchange.

2. Expand the primary care provider workforce by offsetting medical school costs after serving in a designated-shortage area for a minimum of 5 years. This should include physicians and advance practice nurses.

3. Build upon the models that pay for health outcomes. When providers are incentivized by enhanced reimbursements to improve their patients’ health outcomes, Americans become healthier and in turn, cost the system less money.

4. Align services with a patient’s appropriate level of care. This includes designing reimbursements for wraparound services such as transportation and food assistance. It also means diverting patients from unnecessary emergency room use, which has become habit for uninsured and underinsured Americans.


I want every American to be able to access the health care services they need without going broke in the process or being denied care because they have a preexisting condition. But, in order to work toward that goal, we must be realistic about where we are now and pragmatic about strategies to move forward.

I think the American public would welcome a candidate that offered tangible solutions rather than pie-in-the-sky ideas. Our system is far from perfect, but we have a lot to build upon. Let’s focus on improving the system we have without destroying it in the process.