Itshould be noted that M4A is not socialized medicine or a nationalhealth service as in some other countries. The private health careprovider market would remain private, but the US government wouldpay the bills. (Photo: Shutterstock)

The discussion and debate regarding Medicare for All (M4A) as a solution for theUnited States health care delivery system has re-emerged and islikely to become more intense in the coming months.

Most recently introduced in bills sponsored in the U.S. House ofRepresentatives and by Sen. Bernie Sanders (I-VT) in 2017, debate over the costs and benefits of M4A havebeen recently amplified in the political arena.

Ultimately, the fate of M4A will be determined in the politicaland legal arena, and importantly, in the court of public opinion.Below are some of the key flashpoints for the M4A discussion:

Cost: A recently publicized working paper by Charles Blahous of GeorgeMason University estimates that a M4A single payer health systemwould increase federal budget commitments by $32.6 trillion over 10years, or an average of $3.26 trillion per year.

This would increase federal health care commitments to nearly 13per cent of Gross Domestic Product (GDP) by 2031. In Blahous'spaper, the first year of implementation (2022) assumes a startingpoint of $3.85 trillion in spending under M4A. The analysis thenprojects an increase in health care utilization, offset by lowerMedicare reimbursement rates, lower prescription drug prices andreduced administrative costs.

A further projected reduction in federal Affordable Care Act(ACA) subsidies would bring the 2022 estimated net addition tofederal cost for M4A to $2.35 trillion.

Potential benefits: In addition to costsavings, advocates for M4A have cited universal health carecoverage as a primary benefit. Also noted have been enhanced workerproductivity and potential health care employment gains generatedby higher utilization.

Other: It should be noted that M4A is notsocialized medicine or a national health service as in some othercountries. The private health care provider market would remainprivate, but the US government would pay the bills.

As with all analyses of policy alternatives (particularlycomplex ones such as health care), one should be careful not to“cherry pick” data points either supporting and opposing M4A.Further studies and discussion will be necessary, as well asnavigating politics and the clout of industry groups such asinsurance companies and hospitals. However, it is generally agreedthat our health care system needs reform, and M4A will continue tobe part of this discussion.

NOTE: Information presented herein is for discussion andillustrative purposes only and is not a recommendation or an offeror solicitation to buy or sell any securities. Past performance isnot a guarantee of future results.

Fred Slade has over 25 years of experience inthe investment management and retirement services industries. He isSenior Director, Investments for Pentegra RetirementServices, a leading provider of retirement services tofinancial institutions and organizations nationwide, founded by theFederal Home Loan Bank System in 1943. Slade manages over $1billion in internal bond portfolios and provides analytics andstrategy for Pentegra's Defined Benefit and Defined ContributionPlans. He holds a Ph.D. in Economics from University ofPennsylvania and a CFA, and has presented at a number of seminarsand conferences.

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