Jon Cohn writes:
Ramesh also invokes an argument that I've always found a bit unfair: the suggestion that those of us who champion Medicare as a model of successful government-run health insurance ignore its huge cost. Nothing could be further from the truth. We're well aware of the huge costs Medicare imposes on our society. It's just that we're also aware of the even huger cost private insurance imposes.
And let me go a step further and mention the huge cost private insurance imposes on Medicare. Medicare is a Very Expensive Program for the same reasons that American health care is Very Expensive. So long as it operates within a fragmented, patchwork system that largely exists to amp up insurance industry profits, Medicare will largely act as a private insurers whose costs are borne by taxpayers. It will suffer from most all the inefficiencies endemic to the system, save the few where Medicare can act in a self-contained manner (i.e, administrative costs, where they pay 3% compared to the 14% of your average private insurer).
The idea of expanding into Medicare for All is laced with arguments about the cost savings a move towards a nationalized, integrated health system will bring. Lower administration, of course, but also better chronic disease management, and savings from lower prices extracted through government bargaining, and comparative pharmaceutical trials that direct treatment regimens more cost-effectively. Medicare is currently expensive, but less so than private insurance. In a Medicare-for-All structure, in which our health system more closely mimics that of other countries (who pay much less, as Ramesh admits), the savings could well be substantial. The fact of Medicare's cost is an argument for reform, not against, because what's so costly is our health care system, and that's what's being targeted.
