Last week, Paul Krugman argued that a Medicare for America system would have the political advantage of letting people keep their healthcare if they want to do so. Leaving aside the problem that the polls used to determine if people think this aren’t asking what Krugman thinks they are*, I don’t know what world Krugman is living in.
In over two decades (until I was 26, I was very fortunate in being on my parents’ insurance), I have been on ten insurance plans, been forced to switch by my employer twice (counted in the ten plans), and had to switch GPs twice due to insurance plan changes. Simply finding a GP who is available is difficult. For me, Medicare for All means I could finally have some stability. Of course, at least all of my employers offered insurance (which is better than too many people). I imagine Krugman has had somewhat more stability (first, a tenured professor at Princeton for a long time, now in NYC), but most people’s experience is probably closer to my own, if not worse (again, at least I had healthcare insurance). One thing that would help considerably would be for discussants to reveal what their healthcare travails have been like–I’ll go out on a limb and suggest that people with my experience probably aren’t too fond of the ‘you can keep your healthcare argument.’
Personal biases aside, there are also some conceptual problems with the argument (boldface mine):
Medicare for America has a lot of moving parts, but the relevant part for our discussion here is the one that creates a new public health plan and then lets employers forcibly switch all their employees to that plan. This is an option that the vast majority of employers are expected to exercise. Under prior analyses of this type of plan (previously called “Americare”), almost all employers switch over to the public plan because it has a much lower price.
What this means is that, under Medicare for America, most people with employer-sponsored insurance will not be allowed to keep private coverage if they chose. Instead, their employer will force them on to the new Medicare plan. If they like their current insurance, they will not be able to keep it.
The only difference for them between Medicare for All and Medicare for America is that they will be informed that their insurance has changed via a letter printed on company letterhead instead of a letter printed on government letterhead. That, and the fact that the financing for Medicare for America will rely on the head taxes we call premiums instead of payroll taxes, which draw more from the rich than the poor and middle.
That Medicare for America will result in at least tens of millions of people on employer insurance being forced onto the new public plan is undeniable. But one response you might hear to this characterization is to say that employers can already force employees to switch plans, so this is nothing new. And that’s true of course.
But what that response reveals is that the entire premise of the “forced switching” critique of Medicare for All is bankrupt.
Like I said, the argument won’t find much traction with those who already have switch frequently. But for those who want to keep their plans, a major objective is to have many of them leave their plans. So most people won’t be able to keep their plans, rhetoric notwithstanding.