Nearly nine years ago, the Democrats in Congress supported by President Obama enacted the thousand page long Affordable Care Act.  At the time the U.S. had a patchwork of programs to provide coverage to various categories of Americans. Those government programs stood alongside the reliable employer sponsored market and the troubled individual market. Instead of combining the patchwork 90s era Children’s Health Insurance Program and the 60s era Medicaid program with the new exchange or marketplace created by the ACA (Medicare was too sacrosanct to be folded in) Congress added the new individual and small business marketplaces to the existing patchwork and chose to disrupt the reliable employer sponsored market including the FEHBP with a boatload of mandates / consumer protections.

Nine years later, a large cadre of Democrats in Congress including several Senators who are running for the  Presidential nomination for the Democratic party are pushing ahead with a proposal known as Medicare for All that ironically would repeal the Affordable Care Act in favor of a single payer program known as Medicare for All. No more employer sponsored coverage, no more FEHBP, no more Medicaid, no more CHIP. The healthcare providers would be put under heavier cost controls than Medicare currently imposes.

Medicare already imposes mandatory pricing on hospitals, doctors and other Medicare providers which shifts costs onto the private sector because the Medicare payments are so low. What happens when there is no private sector to receiving the cost shift? The bill whose text is not yet available would create regional hospital price czars.

In return, Americans would receive coverage that is known to be inadequate. Medicare coverage is not comprehensive. Its traditional hospital coverage is subject to a limited number of days per spell of illness. Most Medicare beneficiaries find it necessary to supplement Medicare coverage with private Medigap plans or purchase more generous Medicare Advantage coverage. It’s not clear how the bill would address this serious problem. In all Medicare for All is in the FEHBlog’s view a half baked idea at best.