Pros and Cons of Medicare for All

In this article...
  • A single payer universal health care system like Medicare for All would affect costs, coverage and delivery of health care for all Americans. The pros and cons of a universal health insurance program in America are still very much under debate.

Health care, and how to pay for it, continues to be a source of debate for the federal government and state governments across the country. One policy idea that gained increased attention during the 2020 presidential election was “Medicare for All.”

In essence, Medicare for All would expand the federal Medicare program, which currently covers only those 65 and older and some younger people with certain health conditions. Under a program like Medicare for All, the federal health insurance program would cover all Americans, regardless of age.

In this guide, we explain the definition of Medicare for All, and we outline some of the pros and cons of implementing a program like Medicare for All.

What Is Medicare for All?

Medicare for All usually means that all Americans would be covered by a “single-payer” health care program that would replace all other existing public and private plans. The single payer would be the federal government agency that administers the insurance program.

Single-payer universal coverage would drastically change the current U.S. health care system, in which most people get health insurance from a private insurance company plan that’s partially paid for by their employer.

According to the U.S. Census Bureau, 28 million people in the United States did not have any health insurance in 2020. That’s about 8.6% of the population.

Among the 91.4% of Americans who had health insurance that year, about two thirds had private insurance, and one third had government-provided coverage, such as Medicare or Medicaid. Employers provide health insurance for most Americans, covering 54.4% of the population.

There are other versions of single-payer universal health insurance. Medicare for All has become one of the versions that many political progressives are pushing for.

The name a politician uses to describe Medicare for All or a similar universal health insurance program seems to make a big difference. A poll taken in 2017 by the Kaiser Family Foundation found that, while only 48% of people approved of single-payer health care, 62% approved of Medicare for All.

Pros and Cons of Medicare for All

The political, moral and economic arguments for and against universal health care are wide and deep.

Those who are generally for it believe health care should be a right, not a privilege; that no one should be deprived health care because of financial need; and that universal coverage would actually save money for both individuals and businesses and improve the nation’s overall health.

Those who are generally against it believe that paying for health care should be the individual’s responsibility, not the government’s; that the free market is best suited to ensure quality health care; and that the costs of universal health insurance coverage would be prohibitive and cause large government deficits and debt.

Here are some of the arguments from both sides.

Pros

  • Everyone has health insurance
    The primary purpose of a single-payer system like Medicare for All is for every American to have insurance coverage, including the most economically vulnerable people.

  • Overall health care costs would decline
    Some economists believe that a single-payer plan would actually reduce the nation’s overall health care spending, because the government could negotiate or mandate lower fees for providers and drug companies and cut out the overhead charged by private insurance companies.

  • Health insurance would not be tied to jobs
    Universal health insurance would eliminate the need for employer-sponsored insurance. This would allow Americans to change jobs without risking the loss of coverage of their preferred health care network.

  • The nation’s health would improve
    Some health care industry experts believe universal health insurance could help improve overall health in the country, as more people would likely take advantage of health care visits and preventive care.

Cons

  • The cost would be high
    A 2018 study by the RAND Corporation found that a single-payer system similar to Medicare for All would increase federal spending on health care more than three-fold, from $1.09 trillion to $3.5 trillion per year. Many politicians who support single-payer health care bills have been reluctant to give highly detailed plans for how they would pay for such a plan. Without those details, it’s difficult to assess which Americans would be saddled with paying the higher costs, and how they would have to pay.

  • It would massively disrupt the health care system
    Opponents of universal health care argue that lower payments could affect the quality of health care and cause providers to leave the field or not enter it in the first place.

  • Many people like the health insurance they have
    A 2016 survey from the Kaiser Family Foundation found that 71% of insured adults younger than 65 rated their health care as either “excellent” or “good,” and 61% said their insurance plan was either excellent or good, given its cost.

  • Government inefficiency
    Some critics claim that universal care would cause longer wait times, reduced access to certain services and more overall inefficiencies than private-sector coverage.

  • Forced participation despite religious or political differences
    Issues such as abortion coverage and coverage for undocumented residents are divisive and not easily settled. Adding new taxes to help pay for the program – including broad and likely large tax increases on the middle class –is a contentious issue, to say the least.  

Is Medicare for All Like Obamacare?

The Affordable Care Act (ACA), also known as Obamacare, is not a single-payer universal health care program like Medicare for All.

The ACA provides ways for people who are unable to get insurance through an employer or from federal programs like Medicare or Medicaid to afford private health insurance. The government provides financial subsidies for individuals and families to buy private plans with more affordable premiums through a government exchange. It also expands Medicaid to cover more Americans, though some states have chosen not to expand their Medicaid programs.

This approach has allowed many more people to purchase health insurance than before Obamacare was signed into law.

About the Author

David Levine is an award-winning writer and editor whose work has been featured in the New York Times, New York Daily News, Sports Illustrated, American Heritage, U.S. News & World Report and others.

David has covered health, health insurance and health policy topics – among many others – since 2017. He earned a Bachelor's Degree in English from the University of Rochester and currently lives in Albany, New York.

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