Medicare for All Costs Too Much, Pelosi Adviser Assures Health Insurance Executives

A top aide to Democratic leader and Speaker of the House Nancy Pelosi rebuffed a single-payer, Medicare for All approach to health care reform to insurance company executives, a slide presentation leaked to The Intercept revealed.

Wendell Primus, Pelosi's senior health policy and budget adviser, wrote the presentation—titled "Moving Forward on Health: A Difficult Terrain"—which was presented to Blue Cross Blue Shield executives less than a month after Democrats took back control of the House of Representatives, flipping 40 seats in the 2018 midterm elections. The presentation outlines proposed steps for lowering spending growth for private insurers, particularly targeting high drug prices, while arguing for a restoration and expansion of the Affordable Care Act, or Obamacare.

Top health care aide to @SpeakerPelosi tells insurance execs privately that Democrats have major problems with “Medicare for All”

— Stephanie Kelton (@StephanieKelton) February 5, 2019

On one slide, titled "Universal Coverage," the presentation specifically rebuffed a single-payer approach to universal coverage, under which the government, rather than private insurance companies, would cover medical services, eliminating employer-based health care.

The presentation raised five objections to a single-payer approach:

  1. "Cost"
  2. "Creates winners and losers"
  3. "Stakeholders are against"
  4. "Monies are needed for other priorities"
  5. "Implementation challenges"

Two of the five objections to a single-payer program focus on costs. But while a single-payer Medicare for All plan would shift the burden from employers and individuals to the government, a study by the libertarian Mercatus Center found that the Medicare for All plan proposed by Bernie Sanders could insure 30 million more Americans and still save $2 trillion in aggregate health care spending over the next 10 years.

"We don't discuss private meetings, if there was such a meeting," a spokesperson for Blue Cross Blue Shield told The Intercept.

"We're not going to barter lower prescription drug costs for inaction in the rest of the health care industry," Pelosi spokesperson Henry Connelly told The Intercept. "The presentation was a broad look at the health care environment and some of House Democrats' legislative priorities over the next two years in a period of GOP control of the Senate and White House."

Newsweek reached out to Pelosi's office with additional questions and will update this article accordingly.

Medicare for All has become a litmus test for potential Democratic presidential candidates, with such proponents as Senator Bernie Sanders arguing for a universal expansion of the Medicare program to cover all Americans and largely eliminate the private insurance industry, while Senators Cory Booker, Elizabeth Warren and Kamala Harris have all endorsed more incremental measures under the "Medicare for All" label, such as a Medicare buy-in or the "public option."

But Pelosi's office has instead put the focus on proposals with the possibility of bipartisan support. "The biggest obstacles facing Medicare for All right now are Mitch McConnell and Donald Trump," Connelly told The Intercept. "But in the near term, there is a window for Democrats to press Trump to help pass aggressive legislation to negotiate down the skyrocketing price of prescription drugs."