Isaac Buck

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University of Tennessee Legal Studies Research Paper


Medicare-for-All proposals are heralded for the guarantee of additional coverage they provide, moving health insurance in the United States from nearly universal to completely universal. Indeed, if Medicare is known for something, it is the guarantee of access to health insurance it provides. Since its inception, the Medicare program has provided universal coverage to Americans aged 65 and older—a population that is both expensive to cover and often most in need of high-quality health care. But Medicare is more than that. While Medicare has become the program that guarantees coverage to an entire subset of American citizens, it has also served as a platform for innovative policy designs intended to address the health care cost crisis. From Accountable Care Organizations (ACOs), to the Merit-Based Incentive Payment System (MIPS) within its Part B, to its formidable fraud and abuse tools like the False Claims Act, Medicare has been important not only because of the example it has provided in achieving insurance universality, but also because it has provided a space for law, policy, and medicine to innovate. Specifically, it has served an important role in making American health care delivery more standardized, efficient, and equitable. An expansion of the program could extend its efficiencies on a universal or near-universal basis, with positive impacts for millions of American patients. This piece makes the argument that the real upside of the implementation of such “Medicare-for-All” proposals, however unlikely politically, may not be the coverage gains they promise, particularly because the Affordable Care Act’s exchanges have secured such extensive growth in coverage for millions of Americans. Instead, the value of “Medicare-for-All” proposals may be their ability to universally extend Medicare’s cost-containment policies, many of which are unknown to the general public or at least not fully understood. It is this impact—the expansion of Medicare’s regulatory regime to cover millions more Americans—that may be the most important consequence of the push for “Medicare-for-All.”

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