(bias disclaimer: i don't work for a commercial health insurance company, but i work for an EHR (electronic health record) company—Epic Systems—on a team that makes software for some of them. if m4a was passed i would probably just be transferred to a different division, but all the code i've written in the last 3 years would be set on fire, which would make me kind of sad.)
I don't want to come out swinging here, but I don't see how anyone who's intimately familiar with the US health care / insurance industry can enthusiastically support Medicare for All. I'm not particularly interested in the "other countries have done it" argument because frankly a culturally homogenous nation the size of the southern half of California does not face the same challenges in implemention as the United States.
Point one: our government is evil.
I'm really not sure how much this kind of news penetrates my bubble, but you may have seen headlines like
"Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info." My view in this matter is that the government is being evil, and the stooge who wrote this headline is either a useful idiot or an accomplice. To break it down simply, the government has proposed new rules that EHRs have to send their data to any random iPhone app that asks for it. That has obvious consumer privacy implementations because hospitals and EHRs are governed by HIPAA, but random iPhone apps aren't, so my company asked that we extend HIPAA to health care apps, which I think is pretty reasonable. Of course, iPhone apps all make a profit off of selling data so if they were actually governed by HIPAA random health startups would have a hard time attracting venture capital so the government's response was to cry BUHHH OLIGARCH ROBBER BARON. (There are other, more morally gray fights over the proposed regulation but I think this one is pretty black and white).
If you're giving control of your health care to the government, you have to accept that at some point you are giving control of your health care to whoever you hate, to people like Seema Verma and Donald Trump or maybe even worse, to evil immoral people.
Point two: our government is incompetent.
There is talk about how M4A will save money. Bernie has some numbers he likes to bring up in every debate. I absolutely don't believe it. The Centers for Medicare and Medicaid Services (CMS) is already the biggest payer in the US by leaps and bounds. Because they pay reliably (even if usually less than private payers), they are courted by providers around the nation. CMS has incredible influence on health prices currently—many private insurers don't even bother setting their own rates for many services, just saying they will reimburse at x% of CMS—yet they have consistently failed to keep costs down. And it's not like they haven't tried; they've come up with a dozen schemes in as many years. They just don't work.
Medicare Advantage failed to save money. So did
Next Gen ACOs. Ironically, something that has saved a little money is
managed Medicaid, which is the practice of capitating out Medicaid populations to private insurers, i.e. the exact opposite of M4A. Food for thought.
I don't think M4A will cause a ton of deaths or anything, but I don't think our government is capable of making anything more efficient. Expect prices to rise even further and lots of very perplexed op-eds from kool aid drinkers.
Point three: our government is political.
Politics has a ton of unfortunate implications on how things are run. For just two examples: NASA gets fucked by politics; every time a new president is elected, or a new party takes control of congress, or someone breaks wind in DC their priorities completely shift, which hamstrings them from actually making long-term strides toward their goals (I could point to similar examples in healthcare here, but this is an example I expect more people to identify with). healthcare.gov got fucked by politics; various aspects of the technical design which should have just been a black-box were codified in law, which turned the implementation into a disaster. Every large scale project our government tackles gets to pick one of two modes: get ruined by 535 cooks trying to salt the pot at once, or get ruined by delegating power to the executive branch and watching it get whiplash every four to eight years.
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In the end, do I support m4a? It's a tough call but very trepidatiously, I think I do. Despite what I've said above, private industry is equally evil (though at least in a more predictable way), less incompetent and less political. I'm rich, so if M4A is passed I expect that my health care will become worse. But if we're all gonna get fucked by the big dick of fate I think it's morally right that we all get fucked equally, rather than by how much wealth we were born into.
