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Iowans aren’t buying Medicare for All

There’s a big problem with Sen Bernie Sanders’ Single Payer plan. [I think it is Sen Warren’s plan too, but she’s dithering these days.]

Nope, not the cost, not the “gubmint taking over my Medicare”, not the pharma or physician lobbies.

It’s a job killer.

The impact of Single Payer on Iowa’s economy would make the Dust Bowl look like a summer zephyr.

Polling is showing voters’ concerns with Single Payer; here’s the data on the impact on jobs… [Sanders’ version of Medicare for All is pretty much identical to Single Payer]

Somewhere between half a million and 800,000 Americans work for health insurance companies. Most would lose their jobs under Single Payer.

In Iowa, one out of eight workers are in healthcare; a lot of those are clinicians and direct support (med techs, nursing aides etc), most are doing administrative work.

A couple examples of the impact of Bernie Sanders’ Single Payer program on Iowa are helpful.

Wellmark Blue Cross employs 1878 people – adding up the admin costs plus commissions, about $290 million is spent on stuff besides direct healthcare costs – spend that would go away under Single Payer. Sure, some goes to IT, some goes to building maintenance, some goes to paperclips and travel. But much of that $290 million – and 1878 jobs – goes away under Bernie’s plan.

Another 800 folks work for other health insurers;  that’s about $130 million in wages…

Another metric – total healthcare employment. While it’s not possible to tease out the precise number of healthcare administrative jobs – billing clerks, coders, managers, IT support, claim handlers and the like – at least 30,000 Iowans are working in healthcare administration, earning a total of about $1.2 billion.

Some are likely medical billing clerks – the folks who figure out how to bill you and your insurance company for services you receive (these folks); total income for the 5000 Iowans doing billing is just under $200 million.

All this to say there are tens of thousands of Iowans who would lose good-paying, stable jobs if Bernie Sanders’ Single Payer becomes law.  And if they do, those billions in paychecks disappear.

What does this mean for you?

Single Payer is a great idea – if you are starting a healthcare system from scratch. Which we aren’t.

8 thoughts on “Iowans aren’t buying Medicare for All”

  1. Good point, Joe. I think the number of potential job losses (many of them well-paying) has been lost in most public discussions of a single-payer plan that would prohibit private insurance. Many are so focused on the perceived “greed” of insurers (usually in their minds some wealthy CEO or amorphous mega-corporation) that they have overlooked the many regular people (often friends and neighbors) who work and provide services in the industry.

    1. Adam, this is true. However with the savings of several thousand dollars a year in premiums and deductibles, I would be spending on other areas like tourism, home remodeling, and schooling. I feel that the argument that people will lose jobs, is an easy way out of a difficult discussion. Closing down coal power plants means losing jobs, but what about factory workers building new wind farms, or electricians installing new solar roofs? Jobs shouldn’t be used to define an issue especially if there are plenty of sectors new workers are desperately needed like, teachers, home health care, sustainable energy, programmers, data engineers and more. The bottom line is that if single payer was introduced, the redundancies would be eliminated and there would be much more money in the economy to generate jobs to replace those lost. The real problem is that the hesitation to let go of what you have.

  2. Here’s a different perspective: If single payer could deliver better health care to more people at a lower cost, we absolutely should adopt it and the fact that some folks in the health insurance industry are going to lose their jobs should not preclude us from doing so; those people will soon enough be gainfully employed doing some other productive work, all of which would make the world a better place. The problem is that there is zero reason to believe that single payer would accomplish any of those objectives and plenty of reason to believe that the bureaucracy that would instantly spring-up to replace the insurance industry would quickly assume all the undesirable characteristics of pretty much every government-run enterprise. So as frustrating as it is to deal with health insurers (and it often is), the industry provides a valuable service in spreading and pricing risk and in financing a pretty darn good healthcare system, imperfect as it is.

    1. Hey Mike – thanks for the comment as always.
      I’ll have to respectfully disagree with your characterization of pretty much every government enterprise as having undesirable characteristics.

      That statement relies on two inter-related assertions, the net being Medicare isn’t as “good” as private industry in delivering health benefits.

      Specific to the question at hand,
      member satisfaction
      Americans are significantly happier with plain old Medicare than they are with their employer- or individual- health insurance. Yes, they are happy with privately-administered Medicare Advantage programs too, but those MA plans get to use Medicare reimbursement rates and contract terms – so they are benefiting from those government controls

      Private insurers have failed miserably in their “efforts” to control costs and improve quality. For proof, look at your pay stub and compare it to last year’s – and your deductible’s growth over the last few years. Sure, Medicare benefits from price controls – but so does United and Aetna. United is a $270 billion dollar buyer of healthcare, yet it can’t keep your premiums under control. That’s pathetic.

      Quality and outcomes.
      Fact is, our healthcare “system’s” results are poor compared to other nations with government-run or much more highly regulated systems.
      Proof – we die earlier, have poorer health status, are more often killed by that very healthcare system, and about 18 million of us have no health insurance at all.

      Finally, by far the biggest obstacle to Single Payer success is the power of lobbyists and the corrupting influence of campaign donations. Get rid of that, and we’d fix healthcare in a nanosecond.

  3. What would the effect to the economy/stock market be with a switch to a single payer plan? Would there be a massive outflow of cash out of the stock market if insurance companies aren’t collecting premiums and investing a share in the market? I know they would have their other lines continue, but would there be enough of a downsize to impact the market as a whole?

    1. Hello again Marko – state and federal regulations prohibit any significant investment of health insurer reserves in equities. Therefore any impact would be minimal.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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