Paul Starr Reality Checks Medicare for All

February 21, 2020

Princeton healthcare historian sees lowering age of Medicare eligibility as doable.

Paul Starr, the Princeton heathcare reform expert and historian who was a senior healthcare policy adviser during the formulation of the failed Clinton administration healthcare plan, poured cold water on the financial and political prospects of Medicare for all today at a symposium at the University of Pennsylvania law school.

Starr, the keynote speaker at the “Medicare for All and Beyond” symposium quipped that Bernie Sanders’s plan, which calls for coverage of dental, hearing, vision, and long-term care “is not Medicare for all. It is Medicare for everything.”  

The cost would be so high, Starr said, the federal government would become a “health insurance company with armed forces,” and he predicted that once the tax implications were become clear, Sanders’ plan would not even receive 10 votes in the Senate.

Starr called for far more modest reforms, such as lowering the age at which Americans would be eligible for Medicare to 62 and using Medicare rates as the basis for settling out-of-network “surprise” billing disputes.

“If we get real, we can get moving,” Starr told the audience of several hundred, which included Mark Cuban, the owner of the Dallas Mavericks and a member of the “Shark Tank’ cast.

Starr invoked the “devils is in the details” cliché when he discussed the public option favored by moderate Democrats and considered by many to be relatively easy path to healthcare reform. A lot would depend on whether the public option would pay hospital and other providers at Medicare rates, which are much lower than what private insurers pay. If it did, the public option would result in major revenue losses for hospitals. 

Starr’s book The Social Transformation of American Medicine is the definitive history of the American healthcare, and he covered healthcare reform politics in Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. In his talk, Starr divided 20th century healthcare reform into three eras, each characterized by ambitious reform efforts and ideas, opposition, and manifestation into smaller achievements.

He described the ACA as “minimally invasive healthcare reform.”