Single-Payer Prescribes Trouble For Medicare Recipients

- September 11, 2018


Under Democrats' Dream Of A Single-Payer Health Care System, Medicare Recipients Would Lose Out On Quality And Coverage



  • More and more Democrats have endorsed the idea of a single-payer health care system, which could lead to drastic changes for the 59 million Americans currently enrolled in Medicare.
  • A single-payer system would cause seniors enrolled in Medicare and Medicare Advantage to face detrimental changes to the quality of care they currently receive.
  • A single-payer system would completely eliminate Medicare Advantage, a program relied upon by 19 million seniors.
    • Medicare Advantage is a "lower-cost alternative" to the original Medicare program that offers seniors lower premiums and more comprehensive health care plans.
    • Without Medicare Advantage, seniors can face Medicare premiums in the triple digits.
  • Medicare already faces challenges with doctors facing lower reimbursement rates and stringent rules, which has resulted in the departure of physicians that offer Medicare services.
    • A single-payer system would put immense pressure on the current Medicare system by drastically increasing the number of patients in the system, leaving current Medicare beneficiaries in competition for services they once easily accessed.
  • A single-payer system would also worsen the quality of care delivered to current Medicare recipients.
    • With the "unwanted and unnecessary oversight by government in health care decisions" health care recipients face potential cuts in what are non-revenue generating services provided by physicians.
    • The implementation of a single-payer system could force seniors to endure long wait times for a lower quality care.

Medicare Is A Program That Primarily Serves Americans 65 Years Or Older

Medicare Is The Country's Health Insurance Program For People Age 65 years Or Older. "Medicare is our country's health insurance program for people age 65 or older." ("Medicare," Social Security Administration , Accessed 9/10/18, p.1)

  • People Younger Than Age 65 With Certain Disabilities, Permanent Kidney Failure Or Lou Gehrig's Disease Can Also Qualify For Medicare. "People younger than age 65 with certain disabilities, or permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig's disease), can also qualify for Medicare." ("Medicare," Social Security Administration , Accessed 9/10/18, p.1)

As Of July 2018, There Were At Least 59 Million Medicare Recipients Nationwide. ("Medicare Enrollment Dashboard," Centers For Medicare And Medicaid , Accessed 9/10/18)


In January 2017, Then-Representative John Conyers Introduced A "Medicare For All" Bill That Has Gained The Support Of 123 House Democrats

In January 2017, Then-Representative John Conyers (D-MI) Introduced "H.R.676 - Expanded & Improved Medicare For All Act" Which "Establishe[d] A Medicare For All Program." "This bill [H.R. 676] establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care." ("H.R.676 - Expanded & Improved Medicare For All Act," Congress.Gov , Accessed 6/25/17)

  • On March 7, 2018, Rep. Keith Ellison (D-MN) Asked For Unanimous Consent To Be Considered The First Sponsor Of H.R. 676 And It Was Agreed To "Without Objection." "House - 03/07/2018 ASSUMING FIRST SPONSORSHIP - Mr. Ellison asked unanimous consent that he may hereafter be considered as the first sponsor of H.R. 676, a bill originally introduced by former Representative Conyers, for purposes of adding cosponsors and requesting reprintings pursuant to clause 7 of rule XII. Agreed to without objection." ("H.R. 676 - Expanded & Improved Medicare For All Act," , Accessed 6/27/18)
  • As Of September 10, 2018 The Bill Has 123 Democratic Co-Sponsors Which Include Representatives Keith Ellison (D-MN) And Ted Lieu (D-CA). ("H.R.676 - Expanded & Improved Medicare For All Act," Congress.Gov , Accessed 6/25/17)
  • Ellison Is The Deputy Chair Of The DNC. "Tom Perez used his first motion as chairman of the Democratic National Committee (DNC) on Saturday to appoint his top rival for the position, Rep. Keith Ellison (D-Minn.), as deputy chair of the DNC." (Jesse Byrnes, "Perez Appoints Ellison Deputy DNC Chair," The Hill , 2/25/17)
  • Representative Ted Lieu (D-CA) Is The Regional Vice Chair of The Democratic Congressional Campaign Committee (DCCC). ("About Us," Democratic Congressional Campaign Committee , Accessed 9/10/18)

In September 2017, Senator Bernie Sanders Introduced A Single Payer Bill That Has Garnered The Support Of 16 Senate Democrats

On September 13, 2017 Senator Bernie Sanders (I-VT) Introduced S.1804, Which Would Establish A Single-Payer Health Insurance Program. ("S.1804," , Accessed 9/14/17)

At Least 16 Democratic Senators Have "Embraced The Health Care System" Proposed By Sanders. "At least 16 Democratic senators have embraced the health care system proposed on Wednesday by Senator Bernie Sanders of Vermont, which would expand Medicare to all Americans." (Wilson Andrews and Haeyoun Park, "One-Third Of Democratic Senators Support Bernie Sanders's Single-Payer Plan," The New York Times , 9/13/17)

Two Former Democratic Presidents And One Former Vice President Have Announced Their Support For Single-Payer

In July 2017, Former Vice President Al Gore Claimed He Supported "Single-Payer Health Care." "'The private sector has not shown any ability to provide good, affordable healthcare for all,' Gore said Tuesday at an event at Borough of Manhattan Community College in New York, The Huffington Post reported. 'I believe we ought to have single-payer healthcare.'" (John Bowden, "Gore Calls For Single-Payer Healthcare," The Hill , 7/19/17)

In July 2017, Former President Jimmy Carter Claimed The United States Will Eventually Have "A Single-Payer System." "Former President Jimmy Carter said he believed the U.S. would in time adopt a fully government-run health insurance system, or 'Medicare for all,' in remarks ahead of his Sunday school class here. 'I think eventually we'll have a single-payer system,' said the former U.S. leader, a Democrat, speaking in front of a full congregation and hundreds of visitors." (Louise Radnofsky, "Jimmy Carter Believes U.S. Will Eventually Go To Single-Payer Health System," The Wall Street Journal , 7/23/17)

In September 2018, Former President Obama Called "Medicare For All" A "Good Idea." "Former President Obama on Friday called 'Medicare for all' a 'good' idea during a speech in Illinois where he launched his midterm campaign efforts for Democrats. 'Democrats aren't just running on good, old ideas like a higher minimum wage. They're running on good, new ideas like Medicare for all,' Obama said." (Jesse Hellmann, "Obama Calls 'Medicare For All' A 'Good' Idea," The Hill , 9/7/18)


Medicare's Low Reimbursement Rates Have Forced Doctors Out Of The Medicare System, And A Large Influx Of New Patients Under A Single-Payer System Could Cause Current Medicare Recipients To Have To Compete For A Limited Number of Providers

In The U.S., Physicians And Practitioners Can "Opt-Out" Of The Medicare Program Which Results In A Beneficiary Paying Out-Of-Pocket For Care Rendered To The Physician Without Either Parties Reimbursed By Medicare. "Physicians and practitioners who do not wish to enroll in the Medicare program may 'opt-out' of Medicare. This means that neither the physician/practitioner, nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician/practitioner out-of-pocket and neither party is reimbursed by Medicare." ("Opt Out Affidavits," Centers For Medicare And Medicaid , 9/10/18)

The Wall Street Journal : " Fewer American Doctors Are Treating Patients Enrolled In The Medicare Health Program For Seniors, Reflecting Frustration With Its Payment Rates And Pushback Against Mounting Rules." "Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts." (Melinda Black, "More Doctors Steer Clear Of Medicare," The Wall Street Journal , 7/29/13)

In 2013, Some Doctors Claimed That Medicare's Low Reimbursement Rates Have Forced Them To "See 30 Or More Patients A Day To Make Ends Meet." "Some doctors say Medicare's reimbursement rates-as low as $58 for a 15-minute office visit-force them to see 30 or more patients a day to make ends meet." (Melinda Black, "More Doctors Steer Clear Of Medicare," The Wall Street Journal , 7/29/13)

Even Lower Physician Payments Under A Single-Payer System Would "Drive Many Physicians Out Of Business, Further Restricting Access To Care." "Even lower physician payments under single payer will drive many physicians out of business, further restricting access to care." (Michael A Diamond, "Con: Single-Payer Health Care Why It's Not the Best Answer," American Thoracic Society , 11/15/09)

In 2015, A Kaiser Family Foundation Study Found That 21 Percent Of Non-Pediatric Primary Care Physicians Were Not Accepting New Medicare Beneficiaries. (Christina Boccuti et. al, "Primary Care Physicians Accepting Medicare: A Snapshot," Kaiser Family Foundation , 10/20/15)

As Of September 10, 2018, The Centers For Medicare And Medicaid Reported 22,132 Doctors Who Have Opted Out Of The Medicare Program. ("Opt Out Affidavits," Centers For Medicare And Medicaid , Accessed 9/10/18)

The Expansion Of Medicare Could Invite Millions Of More Patients To "Compete For The Same Doctor Appointments And Surgery Slots." "Expanding Medicare will suddenly invite some 10 million more patients to compete for the same doctor appointments and surgery slots - a sudden 20 percent increase in demand." (Betsy McCaughey, Op-Ed, "Why 'Medicare For All' Means Deadly Trouble For Seniors," New York Post , 8/8/17)

A Single-Payer System Could Also Result In Longer Wait Times And A Lower Quality Of Care For All

The Atlantic : "Medicare Alone Has Proved Inadequate For The Needs Of Many Elderly People, Especially In The Ranks Of The 'Oldest Old,' Or Those Over 85 Years Of Age." (Vann R. Newkirk II, "Medicare Is Leaving Elderly Women Behind, The Atlantic , 3/4/16)

Blahous Found That The Implementation Of Medicare For All Would "Undoubtedly" Reduce The "Supply Of Healthcare Services At The Same Time M4A [Medicare For All] Sharply Increases Healthcare Demand." "The same study found that by 2019, over 80 percent of hospitals will lose money treating Medicare patients-a situation M4A would extend, to a first approximation, to all US patients. Perhaps some facilities and physicians would be able to generate heretofore unachieved cost savings that would enable their continued functioning without significant disruptions. However, at least some undoubtedly would not, thereby reducing the supply of healthcare services at the same time M4A sharply increases healthcare demand." (Charles Blahous, "The Costs Of A National Single-Payer Healthcare System," Mercatus Center , 9/11/18, p. 10 - 11)

Additionally A Single-Payer System Could Lead To "Rationing And Long Waiting Times For Medical Services" As Documented By Other Countries That Participate In Single-Payer Health Care Systems. "Single-payer health insurance would also lead to rationing and long waiting times for medical services. The adverse consequences of waiting for health services in countries with single-payer insurance are well documented (12, 13). Access to a waiting list for health care does not equate with access to health care, which is one reason why patients from abroad often prefer to come to the U.S. for treatment." (Michael A Diamond, "Con: Single-Payer Health Care Why It's Not the Best Answer," American Thoracic Society , 11/15/09)

For Example, In 1948, The National Health Service (NHS) Was Developed To Help Provide "Free And Universal" Health Care To All Residents Of England. "Despite their differences, the patients at this clinic -- and anywhere else in the UK -- have one thing in common: Not one of them will pay or receive a bill for the care they receive here. Their health care is free and universal and has been since the formation of the country's National Health Service in 1948." (Meera Senthilingam, "How Health Care Works Around The World," CNN , 3/17/17)

In 2018, The National Health Service (NHS) Hit A 10 Year High Of At Least 4.3 Million Patients Waiting For "Non-Urgent" Surgeries Such As Cataract Removal Or Hip Or Knee Replacement. "The number of patients waiting for an operation on the NHS has reached 4.3 million, the highest total for 10 years, official figures show. Growing numbers are having to wait more than the supposed maximum of 18 weeks for planned non-urgent surgery such as a cataract removal or hip or knee replacement." (Denis Campbell, "NHS Operation Waiting Lists Reach 10-Year High At 4.3m Patients," The Guardian , 7/13/18)

Under A Single-Payer System, Medicare Beneficiaries Would Face Fewer Choices In Care As Their "Lower-Cost Alternative" Medicare Advantage Program Would Be Eliminated

In 2017, It Was Estimated That 19 Million People Were Enrolled In Medicare Advantage. "In 2017, one in three (33%) Medicare beneficiaries - 19.0 million people - is enrolled in a Medicare Advantage plan (Figure 1)." (Anthony Damico et. al, "Medicare Advantage 2017 Spotlight: Enrollment Market Update," Kaiser Family Foundation , 6/6/17)

  • Medicare Advantage Plans Are A "Lower-Cost Alternative" To Retiree Healthcare. "Retiree health care costs are taking an ever-growing bites out of seniors' income. So it's no surprise that Medicare Advantage plans are booming in popularity as a lower-cost alternative." (Phillip Moeller, Op-Ed, "The Hidden Risks Of Those Popular Medicare Advantage Plans," Time , 5/26/16)
  • Medicare Advantage Plans Are Offered By Private Companies Approved By Medicare, And Under These Plans Beneficiaries Receive Hospital Insurance (Medicare Part A) And Medical Insurance (Medicare Part B Coverage.) "Medicare Advantage Plans, sometimes called 'Part C' or 'MA Plans,' are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare." ("How Do Medicare Advantage Plans Work?," , Accessed 9/10/18)
  • Medicare Advantage Plans May Also Offer "Additional Benefits" Not Covered By Part A Or Part B Such As Vision Or Dental Coverage. "Beyond the benefits that Original Medicare offers, your Medicare Advantage plan may cover additional benefits that are not covered by Part A and Part B, such as vision or dental coverage." (Tamera Jackson, "The Pros And Cons Of Switching To A Medicare Advantage Plan," , Accessed 9/10/18)

The "Overhaul" Of A Single-Payer System Would "Eliminate" Private Medicare Advantage Health Plans. "But the overhaul would also eliminate private Medicare Advantage health plans, which enroll just under a third of beneficiaries, bringing all beneficiaries into the government program." (Margot Sanger-Katz and Haeyoun Park, "How Medicare For All Would Affect You," The New York Times , 9/14/17)

Medicare Advantage Plans Come With A "Maximum Out-Of-Pocket Limit" For How Much A Beneficiary Can Spend On Health Costs Each Year, After The Limit Is Reached The Beneficiary Will Pay "Nothing For Covered Services." "Each plan comes with a maximum out-of-pocket limit on how much you will spend on health costs each year. Once that limited is reached, you will pay nothing for covered services. Each Medicare Advantage plan could have a different limit, and that amount may change each year." (Tamera Jackson, "The Pros And Cons Of Switching To A Medicare Advantage Plan," , Accessed 9/10/18)

Some Medicare Advantage Plans Also Offer Beneficiaries $0 Premiums For Their Plans. "Some insurance companies could offer a $0 premium for the Medicare Advantage plan. Medicare Advantage plan availability will depend on the county and state in which you live." (Tamera Jackson, "The Pros And Cons Of Switching To A Medicare Advantage Plan," , Accessed 9/10/18)

Under A Single-Payer Program, Seniors May Lose The Benefits Of Low Cost And Choice Associated With The Medicare Advantage Program

Medicare Advantage, Often Referred To As Medicare Part C Includes Both Hospital Insurance (Part A) And Medical Insurance (Part B.) "What's Medicare Advantage? Sometimes called 'Part C' - includes both Part A (Hospital Insurance) and Part B (Medical Insurance)." ("Your Medicare Coverage Choices," , Accessed 9/10/18)

However, Nearly 89 Percent Of Medicare Advantage Enrollees Seek Medicare Advantage Plans That Offer Prescription Drug Benefits (MA-PDs). "This brief analyzes premiums for Medicare Advantage plans that offer prescription drug benefits (MA-PDs) because the vast majority (89%) of Medicare Advantage enrollees is in MA-PDs and Medicare Advantage enrollees who seek prescription drug benefits are required to get them through their plan if the plan offers prescription drugs." (Anthony Damico et. al, "Medicare Advantage 2017 Spotlight: Enrollment Market Update," Kaiser Family Foundation , 6/6/17)

In 2017, The Average MA-PD Enrollee Paid A Monthly Premium Of $36. "The average MA-PD enrollee pays a monthly premium of about $36 in 2017, about $1 per month less than in 2016 (Figure 8)." (Anthony Damico et. al, "Medicare Advantage 2017 Spotlight: Enrollment Market Update," Kaiser Family Foundation , 6/6/17)

In 2017, At Least 81 Percent Of Medicare Beneficiaries Had A Choice Of At Least One "Zero Premium" MA-PD Plan. "In 2017, as in prior years, most Medicare beneficiaries (81%) had a choice of at least one 'zero premium' MA-PD,4 plans that charge no additional premium for coverage of Medicare Part A, B, and D benefits , other than the monthly Part B premium." (Anthony Damico et. al, "Medicare Advantage 2017 Spotlight: Enrollment Market Update," Kaiser Family Foundation , 6/6/17)

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