There’s a lot of rhetoric out there right now about how providing “Medicare for All” (M4A) could destroy the economy or lead to ruinous tax increases. But one bright spot was HBO host John Oliver’s monologue on the plan that went viral last month.
Oliver took a characteristically in-depth look at the issues and was largely positive about how M4A could help a “badly broken” health care system given the millions of people who are uninsured and underinsured. Crucially, he noted that we’re going to pay for healthcare one way or the other, and M4A largely doesn’t add to the costs we pay (indeed, it could well reduce them significantly in the long run), instead it just changes how we pay these costs—substituting taxes for premiums.
Oliver provided a comprehensive accounting of the benefits of the healthcare proposal, but he also raised some possible pitfalls, including the jobs that could be lost given the elimination of the private health insurance industry. The problem is he quoted a 1.8 million job-loss figure that’s been widely circulated but is widely misleading when presented without context, as I explain in my new analysis of M4A’s impact on the labor market.
These potential 1.8 million lost jobs are frequently presented as if they constitute the net employment effect of M4A, but the figure is a deeply flawed misrepresentation of the data. It is true that one source of cost savings from M4A is the reduced demand for insurance and billing administration. In turn, this reduced demand would shift employment out of these sectors. This could certainly cause challenges and economic distress for the workers within these sectors who are directly affected.
However, there are many aspects of M4A that would boost the demand for workers and create jobs. For example, many studies project that providing health insurance to currently uninsured and underinsured people will substantially boost demand for health care services, which in turn will boost demand for health care workers. Further, depending on how it is financed, M4A could certainly boost disposable incomes for typical U.S. families, which would boost spending overall and increase demand for workers across a wide range of economic sectors. In short, the net effect of M4A on jobs is likely to be positive, not negative.
It is worth noting that 21.5 million workers were laid off in 2018, and yet I’ve heard little from critics of M4A about how we should think about the challenges this presented these workers—challenges, by the way, that would be greatly ameliorated if we had universal health coverage not linked to specific jobs, like M4A. A policy as sweeping as M4A would clearly require some reallocation of jobs in the U.S. economy, and this won’t be completely painless for everybody. But our current broken health system is far from painless for everybody, and quoting job numbers that are misleading without further context only muddies the waters in the debate surrounding M4A.