You say that MFA on its own may not be enough. What would be enough? What do you think we're missing that other countries have?
Personally, I'm more excited about the potential of MFA than Mark; however, I'm equally frustrated by the national conversation around it. It's a political battleground and the public debate lacks nuance or depth. MFA, in my opinion, solves a set of problems and introduces a set of unknown problems while doing nothing for certain root issues (clinical variation, potentially avoidable events, etc.). The focus on who pays and taxes is a very small part of a much larger conversation and many of the voices talking about it lack industry knowledge or experience. But the same can be said about a bunch of different controversial issues right now and I'm off topic.
To actually get to your question - it's MFA+Medicare reform+a whole bunch of other reforms related to the delivery of care. MFA is not enough because it's just one piece of the puzzle. If we're missing anything as a country, is a political environment that would make this sort of widespread societal reform possible because it truly isn't as simple as switching to single payer.
Medicare for All (MFA) is a proposal to provide the Medicare-based basic basket of medical services as a baseline for health coverage. The common assumption is the reference here is the scope of services covered by Medicare Part A and B (hospital and physician related services, respectively). This is a limited basket of services. For example, there are restrictions on how many nursing days or physical therapy sessions, and it does not cover drugs. There is no oversight in the form of quality in its current form. There are thousands of search results for the search terms “OIG” and “Medicare fraud”.
And cost - rolls eyes Funding is a political nightmare because of the need to increase taxes and likely a need to adjust physician fee schedules upwards (I.e. the inherent cost to CMS becomes higher). Most physicians look to charge commercial based business as much as 4 times what Medicare pays in order to offset what they believe to be as inadequate rates set by MedPac. That dynamic would not be sustainable in a system where Medicare was being used for everyone’s basic care needs.
We said MFA by itself may not be enough because it does not address clinical variation in care delivery or just quality of care in general, it does not address prevalence of fraud, and it does nothing to address the cost issue. We all would end up spending an extra $10,000 a year on taxes for what would likely be inadequate health benefits and still end up buying private insurance just like current seniors do with Medicare Supplemental Plans. BTW – the most popular MedSupp plans are Plan F, G and N, all of which cover the deductible of Part B and add pharmacy coverage.
Comparisons to other countries is tricky because most other countries work from an appropriations model, I.e. in United Kingdom the government sets the budget for the National Health System, and the NHS in turn sets the budget for each region, which in turn sets the budget for each hospital in that region. If you need a knee replacement inside the NHS, the hospital you live near may not have the budget to buy one or you do not meet the priority based guidelines, you will be put in queue to wait. Its not an approach we have patience for, but hopping (!?) on a plane to get one in another country is not covered. As you can see, comparing countries health systems is difficult at best, and even misleading.
Personally, I’d love to have what we had as kids in DoD. As a kid in a US-military household, I had the benefit of full healthcare and dental care and vision care. Our great healthcare was paid for by taxpayers who funded the DoD’s budget. Each child, irrespective of their parent’s income/rank/station/race, received great care. Personally, as a society, I wish we could all agree that every child and young adult should receive healthcare without obstacles or payment fears.