EDITORIAL: With Medicare already on shaky ground, Medicare for all makes little sense

April 26-- Apr. 26--The federal government released an annual report this week on the financial health of Medicare and Social Security. It says the programs are projected to run out of cash, eventually requiring higher taxes, reductions in benefits, or both.

The Social Security program's costs will exceed its income in 2020, with its reserve fund emptied out in just 16 years. The news for Medicare is even more dire. The program's hospital insurance fund is projected to be broke in 2026.

That doesn't mean the programs will cease to exist, but it could mean they pay out less than is owed to retirees and health care providers, while payroll taxes and patient costs could go up.

"Lawmakers should address these financial challenges as soon as possible," the report from the programs' trustees warned. "Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes."

However, the only change lawmakers in Washington are contemplating is expanding Medicare. Instead of covering Americans age 65 and older, the senior health insurance program would be changed into "Medicare for all."

Proponents of this idea insist that it would provide more people with better health care while saving the nation money through greater efficiency. It's admirably optimistic to believe that the government can run the health care system for the entire population efficiently, but this optimism is only possible because the proposals that have been offered are long on promises and light on details.

Currently, individuals and employers pay almost half the cost of medical care in the United States. Where would the government get the money to make those payments under Medicare for all?

Higher taxes would seem to be involved. Who would pay, and how much, is rarely if ever discussed.

Another place the government is expected to find the money is in the bank accounts of doctors, hospitals and other health care providers. If everybody takes a pay cut and accepts the Medicare reimbursement rates for services provided to all patients, the nation's spending on health care spending might be lower, assuming health care utilization stayed the same.

Of course, if payments for health care services were sharply cut, there's no guarantee that hospitals could stay in business or that health care professionals would continue to work in the field. It's possible that the waiting times for doctors' appointments and medical procedures will lengthen to the point that the delays have a severe impact on the quality of health care in the nation.

That might happen even if the reimbursements are set higher than Medicare's current rates. Expanding access to care, while reducing or eliminating co-payments and deductibles, will likely increase demands on the system as more people seek medical care more often.

Are there cost-savings efficiencies to be found in eliminating private insurance? Some experts are skeptical, pointing out that Medicare's administrative cost share appears lower only because it's relative to higher total health care spending for older patients.

There are many uncertainties about the cost and the potential savings of a full government takeover of health insurance. However, with Medicare already spending more than it takes in, and insolvency projected within a decade, proponents of Medicare for all should be required to explain how the program can be expanded without putting current Medicare recipients at an unacceptable risk of deadly side effects.

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