University of Massachusetts economist Gerald Friedman talks about his recent debate at the Soho Forum with Sally Pipes, a leading figure in the conservative anti-single payer movement. He breaks down the major lines of attack used by the right against Medicare for All, including wait times, horror stories, and free market ideology.

Show Notes

This week we welcome Professor Gerald (Jerry) Friedman, economist at the University of Massachusetts Amherst, and author of many Medicare for All economic analyses. Last week, Jerry debated Sally Pipes, well-known conservative opponent of single-payer healthcare, on whether the COVID-19 pandemic makes the need for Medicare for All more urgent. Jerry joins the podcast today to talk about free market arguments against Medicare for All. And how they're wrong!

Market-based attacks on Medicare for All are based on, Jerry says, a fantasy theory in which free market competition in healthcare would promote efficient delivery of services, but only the services that people want. In addition to being wrong, these theories make no allowance for:

people who can't afford healthcare;the lack of information or inability for people to make "consumer choices" in healthcare; or even the benefits we all receive when other people are kept healthy with good access to care (for example... during a pandemic!).

Jerry says that playing with free market theories of healthcare can be fun, but they have as much bearing on the real world as playing chess has to modern warfare.

Although Pipes is making economic arguments against Medicare for All, do real economists believe that a free market can work in healthcare? No, Jerry says, she is really on the fringes. There are debates among economists around Medicare for All, such as around eliminating all cost sharing, but not about substituting a free market principle.

Stephanie notes that most conservatives who attack Medicare for All, do so by characterizing countries with single-payer healthcare systems, as Pipes did in their debate, as "being in a constant state of crisis." This is an umbrella for wait-times, rationing, etc. Jerry says this comes out of the assumption that if we make healthcare free at the point of service, there would be a huge surge in demand for healthcare. Even if that did happen, we could accommodate large increases in demand by moving to Medicare for All because of all the administrative hours and burden it would remove for providers, who could then treat more patients.

If you look at the data, the United States has more wait times than other countries even for those have access to healthcare (i.e. for those who have insurance): only 43% of Americans can see a doctor that day or the next day - in the OECD (the coalition of wealthy countries), the average is 57%. You can find areas where the American healthcare system works well, but that's only for the people who get into the system.

When you look at basic things like life expectancy, the United States is way below most countries - as much as 6 years below how long we should live for what we spend. We are comparable in life expectancy to Chile, which although a wonderful country, does not spend near the resources on healthcare that the U.S. does.

While we can have a debate on the facts, data, and merits of Medicare for All, that is not how the political debate will play out when M4A is attacked by free market conservatives, or the healthcare industry. Jerry took one for the team and read Sally Pipes's book opposing Medicare for All. The attacks will certainly use cherry-picked data, but more importantly powerful "horror" stories claiming to show Medicare for All doesn't work...