Maggie Mahar is more pessimistic on these issues than I am, but her commentary on what we don't know about "Medicare for All" is worth reading. Opening Medicare is commonly considered the "safe" route to single payer because it's a known quantity. But when you take a program with 44 million beneficiaries, all of whom are in the same age range, and scale it to 300 million beneficiaries across all age demographics, a lot of uncertainty is introduced Medicare. For instance: low reimbursements to primary care providers have made it so 30 percent of Medicare patients report problems finding a physician willing to see them. Does that number go up? Down? And how much is the tax assessment for the new program? Do we continue with scheduled rate cuts? And so forth. That's not to say that Medicare-for-All is a bad idea. Any universal plan will face these sorts of questions. But don't be fooled into thinking that Medicare is such a known quantity that there'll be nothing to demagogue. Indeed, one wrinkle of this is how the elderly would react. It's not hard to imagine widespread elderly opposition to opening Medicare to the general population, as they worry that an open Medicare will produce political pressure to orient the program to the average beneficiary (who is cheaper, younger, and healthier), rather than the average elderly beneficiary.
