Medicare Buy-In, Public Option Proposals Would Harm Our Health Care System

When it comes to their health care, Americans want control over their coverage, treatments, doctors, affordability and peace of mind. Every American deserves access to quality care, and with more than 90 percent of Americans currently covered, including 180 million who receive coverage through their employers, we have made real progress toward that goal.

But while there is more to be done, recently, some leaders have embraced “Medicare-for-all” proposals such as “buy-ins” and public options that would do more harm than good and are the wrong path forward for our country.

One such proposal, called Medicare-X, which is “Medicare-for-all” by another name, would create a government-run plan where Americans could “buy in” to Medicare in lieu of traditional employer-based health coverage. While Medicare-X would pay physicians and hospitals at lower rates than private coverage, the proposal does nothing to address the actual cost of providing health care — and as a result it would affect providers’ ability to continue to offer services, endangering patients’ access to doctors and care.   

While proposals such as this are being touted by some as a more moderate approach, Americans should understand the consequences. These would drastically change health care in our country. They are nothing less than a slippery slope toward one-size-fits-all, government-run health care.

A study released this month by the American Hospital Association and the Federation of American Hospitals found that implementation of Medicare-X would result in nearly 4 million fewer Americans receiving health care coverage than if our existing health care system were simply shored up. In fact, the study found that our nation already has the framework in place to increase access to health insurance for more than 9 million Americans through realistic solutions that improve upon our current system, such as expanding Medicaid and boosting Affordable Care Act enrollment.

Further, the AHA-FAH study found that under Medicare-X, hospitals would be hit by $774 billion in cuts, which would “compound financial stresses already faced by the nation’s hospitals, potentially impacting access to care and provider quality,” hurting vulnerable patients throughout the country.

Already, America’s hospitals are under pressure, and a significant cut in funding could exacerbate hospital closure rates and further strain the nation’s hospital network. In fact, a separate study released by Navigant Consulting found that “Medicare-for-all” proposals could force hospitals to limit the care they provide, cause significant layoffs and “potentially force the closure of essential hospitals.” Because the “capacity to reduce/manage cost will vary markedly from system to system and hospital to hospital,” the report finds single-payer proposals “appear to have financial effects that exceed the capacity of hospital managements to reduce their expenses.”

The cuts could be especially harmful in rural areas, where 21 percent of hospitals are currently at risk of closure unless their financial situations improve dramatically. Since 2010, at least 85 rural hospitals have had to shut down, and according to The New York Times, these consequences could lead to medical services becoming dangerously distant for women as “ewer than half of the country’s rural counties still have a hospital that offers obstetric care. With rural hospitals already facing record losses in profit and mass closures throughout the country, Medicare-X could lead to more hospital closures, leaving millions who need care the most at risk.

While on their face, Medicare-X and other “Medicare-for-all” proposals might seem to simply add another choice to the mix, this unnecessary government intervention actually limits choice by pushing Americans into a government-run plan and risking provider closures. In the end, this approach would not provide additional options for people who need them — it would eliminate choice for people who like what they have, causing more of our health care decisions to be made by politicians and bureaucrats in Washington instead of by patients and doctors.

We know that the greater choice and control Americans have in our health care system, the better it is for everyone. Through constructive, common-sense changes to our existing health care system, we can increase the number of Americans covered by more than 9 million, while also ensuring competition, choice, patient control and our quality of care remain strong — and without disrupting coverage for people who have what they like.

Let’s improve what is working, fix what is broken and avoid proposals such as Medicare-X, which inevitably lead to government-run health care eliminating patient choice and control altogether, and forcing massive tax and cost increases on American families.


Lauren Crawford Shaver, the executive director of the Partnership for America’s Health Care Future, was previously the deputy assistant secretary for public affairs in health care at the U.S. Department of Health and Human Services and has worked on numerous Democratic political campaigns over the last decade.

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