By Adam Gaffney, March 3, 2019

Does achieving “Medicare for All” mean mostly eliminating private health insurance? Single-payer proponents say yes: After all, if a public plan provides comprehensive, no-deductible coverage for everyone, nobody would want—much less be willing pay for—duplicative private coverage.

Yet candidates who previously embraced single-payer sometimes seem a bit unsure. For instance, Senator Cory Booker, who co-sponsored Senator Bernie Sanders’s single-payer plan back in 2017, was asked whether he would “do away with private health care” recently, and he responded, “Even countries that have vast access to publicly offered health care still have private health care, so no.”

There are actually two distinct questions wrapped into one here. First is whether we want a universal public plan for everyone, or a hodgepodge of public and private plans that cover different parts of the population according to age, income, workplace, disability, and so forth, but that together cover everyone. Last year in Dissent, I made the case that a nation like ours—with enormous unmet medical needs, an inadequate safety net, and galling inequality—is a poor fit with a multi-payer system that divides the population into a hierarchy of public and private plans with inequitable levels of access, varied copays and deductibles, and unequal benefits and provider networks. This would never achieve the equity, universality, or efficiency of a public plan that provides complete coverage to everyone. …

Continue reading ...