National Review Online
Tuesday, September 15, 2026
Democrats are partying like it’s 2019.
Coming off a successful midterm election year and
convinced that socialism was where the energy of the party would be, Democratic
presidential candidates lined up that year to embrace a government takeover of
the health-care system they branded as “Medicare for All.” But in relatively
short order, questions about the staggering cost and massive disruptions
associated with the idea helped sink the candidacies of Elizabeth Warren and
Kamala Harris, and ultimately helped catapult Joe Biden (who endorsed more incremental
expansion of government-subsidized health insurance) over Bernie Sanders.
This year, Medicare for All has reemerged. Democrats have
nominated a number of candidates who support the idea, including in two of the
most competitive Senate races — Abdul El-Sayed in Michigan and Troy Jackson in
Maine.
The pitch for Medicare for All starts off quite simply.
We’re the richest country in the world, we spend all sorts of money on weapons,
we should be able to afford to provide free health care to everybody. The
promise is of a paradise in which there is no more dealing with being denied
care by insurance companies or struggling to pay for prescription drugs.
Yet once anybody examines the details, the sales pitch
becomes much less appealing. To start, there is the incredible cost. Back in
2019, the progressive Urban Institute estimated that a Medicare for All system along the lines of
what Sanders proposed would cost about $34 trillion over ten years. To be
clear, that was not the total cost of the program, but how much it would be
expected to increase federal spending on top of the trillions a year we already
spend on health-care programs. After seven years of inflation, the number is
certainly higher today. An updated analysis from Stephen Parente of the right-leaning American
Action Forum estimated that the cost of such a system over the next decade
would be $47.4 trillion.
The immense cost of health care doesn’t disappear when
it’s absorbed by the government — it just is paid in the form of taxes and debt
rather than premiums. At the time, the Committee for a Responsible Federal
Budget estimated that a $30 trillion increase in health-care
spending could not be financed through simply taxing the rich, and would
actually require the equivalent of a 32 percent increase in payroll taxes or
doubling all income tax rates — actions that could shrink annual economic
output by over 7 percent.
Efforts to contain costs by denying care do not go away —
the only difference is that in socialist systems like the U.K. and Canada, it
is a government bureaucrat saying “no.”
Lately, Sanders has been pointing to an analysis done by Medicare for All–supporting authors from
the Yale School of Public Health last month claiming that implementing such a
system would save lives while reducing health-care spending by $1 trillion a
year. But the assumptions required to get that estimate are ridiculous. For
instance, under the current system, doctors and hospitals earn less money from
treating Medicare patients, which they are able to do by shifting costs onto
privately insured patients. But the Yale analysis assumes that the new program
would be paying Medicare rates for all Americans — which would be financially
unsustainable for medical providers and would reduce access for Americans,
especially at more cash-strapped rural hospitals. The analysis also assumes a
51 percent reduction in costs for prescription drugs, without any discussion of
how that would impact research and development.
In addition to the costs and disruption to health-care
access, a true Medicare for All system would necessitate the elimination of
private health insurance, meaning most Americans, including the 161 million Americans who obtain insurance through their
employers and the 36
million seniors who have chosen Medicare Advantage plans, wouldn’t be able
to keep their coverage, even if they liked it. There was a massive backlash
when Americans realized they wouldn’t be able to keep their plans under
Obamacare, and that was a comparatively small few million people.
Republicans, facing headwinds in the midterms, would be
wise to spend this fall making a sustained case against Medicare for All.
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