Adding Principle To Pragmatism: The Transformative Potential of 'Medicare-for-All'
46 Pages Posted: 29 May 2019 Last revised: 10 Feb 2020
Date Written: May 13, 2019
“Medicare-for-All” should be more than a badge of political identity or opposition. This Article examines the concept’s potential to catalyze policy innovation in the U.S. health care system. After suggesting that the half century of existing Medicare has been as much “Gilded Age” as “Golden Age,” the Article arrays the operational possibilities for a Medicare-for-All initiative. It revisits America’s recent history of pragmatic rather than principled health policy, and identifies professional and political barriers to more sweeping reform. It focuses on four aspects of health policy that have become apparent: simultaneous inefficiency and injustice in medical care, neglect of the social determinants of health, inertia resulting from the legal architecture of health care, and the latent power of generational change. It concludes by explaining how a Medicare-for-All frame might prompt ethical re-engagement by the medical profession and help the health care system take specific steps on a path to improvement.
Keywords: Medicare-for-All, Obamacare, ACA, health reform, social determinants, disparities, health law, generational change
JEL Classification: I11, I13, I18, K32
Suggested Citation: Suggested Citation