(Bloomberg Opinion) -- “Medicare for All” continues to be a top issue in the Democratic presidential campaign, and President Donald Trump isn’t waiting to see who wins to start attacking it. So far, the Democratic debate has centered on how a huge expansion of Medicare would affect private health insurance and middle-class taxes. But Trump is raising another big issue: wait times. “Medicare-for-All would force patients to face massive wait times for treatments and destroy access to quality care,” declares the White House website.
Like everything else in the health-care debate, this is a disputed point. Thomas Waldrop, a health-care analyst with the Center for American Progress, a liberal group, has responded to Trump: “Wait time concerns amount to little more than fearmongering by those who oppose expansion of coverage.”
We won’t know for sure who’s right, of course, unless we actually implement Medicare for All. But Trump’s concern should not be so easily dismissed.
As Waldrop notes, the White House bases its pessimism largely on data from the U.K. He rejects that comparison because “no candidate currently running for president is proposing nationalizing health care providers like the U.K.’s National Health Service.” He then does an able job of showing that other countries have achieved higher levels of coverage than the U.S. has without suffering higher wait times across the board. Two-thirds of patients in Australia say they can see a medical provider within a day, for example, while only half of Americans do.
But that’s not a good comparison either. The Medicare for All legislation endorsed by two of the leading Democratic candidates - Bernie Sanders and Elizabeth Warren - would create a single-payer system that effectively prohibits private health insurance. That’s not what Australia has. It’s not what several of the other countries the CAP website mentions have, either.
The question Trump is raising is not whether high coverage can be achieved without long wait times. (Waldrop is right to say that it can.) It’s whether the specific way of achieving higher coverage levels that has become popular on the American left will increase wait times.
In a forthcoming review of the international evidence for the conservative Manhattan Institute, Chris Pope finds that the single-payer systems “deliver consistently lower quality and access to high-cost specialty care or surgical procedures.” Looking at the various systems across different countries, access to care is higher the larger the percentage of the population with private insurance.
The effects of Medicare for All could be significantly worse. Senator Sanders often argues for the idea by pointing out that other countries spend less while covering more people and having better health outcomes than we do. But no country has ever tried to socialize and downsize a health sector as large as ours.
The Medicare for All legislation Sanders and Warren support stipulates that health-care providers will be reimbursed at the rates used by Medicare today, which amounts to a reduction of up to 40% from what private insurers pay. Only by slashing payment rates can proponents promise to cover so many more people, and provide more extensive coverage to those who now have insurance, at no additional cost.
It’s hard to believe that such cuts wouldn’t reduce the supply of medical services, even as the new benefit promises increased demand. Waldrop himself writes that as part of a transition to a new system, payment rates for primary care should be raised in order to avoid long wait times. Even that expensive adjustment would not prevent wait lists for specialty care.
If Sanders, Warren and other advocates of Medicare for All adjusted their plan by specifying that provider payments would not be cut, then their opponents’ wait-list argument would have considerably less force. But if they did that, the price tag would be much higher; both senators are already struggling to explain how the federal government would pay for even the lower-cost version.
So long as Democrats are saying that overall costs won’t rise, or will even fall, it’s fair to warn that Medicare for All will mean many patients have reduced access to care. Because it probably will.
To contact the editor responsible for this story: Tobin Harshaw at tharshaw@bloomberg.net
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Ramesh Ponnuru is a Bloomberg Opinion columnist. He is a senior editor at National Review, visiting fellow at the American Enterprise Institute and contributor to CBS News.
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