Medicare for all would cost more than what we are paying now. We need to stop avoiding this fact.

[Igel]

21. This is something that most overlook.

They hear "free" and assume "no cost." Many already vaguely assume that Medicare is self-funding, unaware that for decades it's been subsidized by general revenues.

They hear "lower costs" and when they'd save money it means one thing. When it's a manager saying that a company has to lower costs, they immediately hear, "They want to cut wages and benefits."

Ultimately, all the cost-lowering schemes for Medicare/Medicaid involve cutting wages and benefits to providers and managers. That can mean firing insurance company employees, whether actuaries, case managers, or secretaries. That can mean lowering wages to doctors and specialists, nurses and such.

While that's great, most such schemes also rely on more tax revenues. When most people say "tax increases" they really mean "tax somebody else, not me." Especially whoever has money. When it's a politician saying this, they often hear, "They want to tax me."

Then again, health care providers tend to be well represented in that upper quintile, those who have money. Lower their wages and suddenly who's taxed has to change. Revenues have to be sought from those making less money.

As for what insurance companies provide, they provide two things. First, it's a voluntary way of spreading out risk. They're often resented because they don't spread out risk the way that many would have government spread out risk--it's not as flat, nor as all-encompassing (because it's voluntary risk assumption, not mandatory, coerced risk assumption, and if it were flat risk distribution far fewer people would afford or buy it). Second, it's a way of limiting procedures and negotiating for lower prices from providers. Nobody likes that the limitation on procedures is seen as imposed (when it's something we agreed to as a condition of the insurance), and the negotiating with providers is from a position of limited power. Labor has a right to negotiate on an equal basis for pay; but when their rights are involved, then the result of the negotiations are to be dictated.

In a sense the call for single-payer amounts to a call for removing the possibility for doctors to reject Medicaid and Medicare. If they have no other alternative source of income, they'd be compelled to accept whatever deal they had to leave the field. Some love the idea of compulsion, especially in a Democracy.