Proponents of socialized medicine who are pushing to extend Medicare to everybody have a real problem when it comes to figuring out a way to pay for its estimated $32 trillion cost without causing massive disruption. But one idea being floated, mandating that all employers pay for their workers to be enrolled in Medicare, is not a realistic solution.
Jonathan Cohn, one of the smartest liberal healthcare writers, noted the financing problem, and pointed to this post by Jon Walker, who grappled with the issue of how to pay for extending Medicare to everybody.
To his credit, Walker is honest about the political and policy challenges to implementing other ideas that have been considered as financing mechanisms, including severe cost-cutting, a national sales tax, taxing the rich, and payroll taxes. But I think he overlooks the challenges to “simply requiring every employer to purchase Medicare (or equivalent) coverage for their employees.”
Walker points to polls showing growing support for Obamacare’s employer mandate over time. But the Kaiser poll showing 69 percent support describes a law that “Requires employers with 50 or more employees to pay a fine if they don’t offer health insurance.” There is nothing in the poll asking about a law that would require employers to purchase Medicare. As it is, the employer mandate generated significant resistance, particularly among businesses that argued the rule was encouraging them to hire fewer workers to stay under the 50-person threshold and to keep others as part-time. This is a big reason why the Obama administration itself delayed enforcement of the mandate, and the IRS has only recently started trying to collect it.
Currently, 156 million Americans, or about half of the population, get their insurance through their employers. A Gallup survey, consistent with other polling on the issue, found that 75 percent of employed Americans believed the healthcare they received was “excellent” or “good.” One of the lowest points of Obama’s presidency came when a few million people stood to lose coverage that they liked as a result of his healthcare law. What happens when up to half of the country is dumped onto a new government plan?
In his post, Walker describes the employer mandate as “the least disruptive option.” But that says more about how disruptive “Medicare for all” would be than it does about the advisability of such a mandate.
