A recent note from Rep. Pramila Jayapal boasts that she “co-sponsored H.R.676, the Expanded & Improved Medicare for All Act, which would provide all residents of United States and U.S. territories with free health care that includes all medically necessary care.” I know what she means – no premiums, no deductibles, no copays, etc. But it just riles me when politicians morph these features into “free health care.”

“Free health care” is a lie, and I hate it when our side lies just like I hate it when the other side lies. I especially dislike this lie because it’s a disservice to voters. Voters need to know how major programs such as Medicare for All will be paid for. And even though there is research that shows that deductibles may be bad for your health, the same is not true for copays and premiums. We might just need some cost-sharing provisions to keep us invested in controlling costs. If you’ve ever eaten too much at a buffet because “it’s paid for,” you’ll understand my point.

Scan the text of HR 676. Check Subtitle B: Funding. Several sources of funding are listed, concluding with “Additional annual appropriations as needed.” So, no. Definitely Not Free! For starters, it would create a Medicare For All Trust Fund to be filled in part by payroll taxes, i.e. additional taxes on people who get paychecks. During my activist past, I pounded the pavement asking for signatures to support a single-payer health plan. I got signatures from people who were enthused about such an option, but also a lot of flack from people who felt that paying taxes instead of premiums was not a trade they wanted to make. A person has options regarding premiums: opt out; pay a lot for good coverage; pay a little for lousy coverage. But ordinary folks can’t opt out of taxes.

As ugly as Obamacare is, it succeeded because it got buy-in from a wide variety of  stakeholders who realized that it required sacrifices from many participants: patients, providers, hospitals, insurance companies. I wonder how the buy-in will be for Medicare for All. There would great uncertainty for providers and hospitals, death for health insurance companies, but also uncertainty for patients. Most national universal health care schemes involve trade-offs, some more than others. Could this one really provide easy access to all necessary care, including dental, mental, prescriptions and long-term care?

I, myself, have long wondered what value insurance companies add to our health care system. I’ve been mystified by people who gripe about government intervention in our health care while clinging to their insurance companies. What’s with that? If you (or your doctor, most likely) have ever had to appeal a denial of coverage for a medication or procedure you need, the denial is the same no matter who it comes from. Maybe an appeal to the government is more tedious than one to an insurance company. I’ve found them both tedious.

Actually, I’m not opposed to a single-payer health plan. I just think there is too much opposition to government in general and taxes in particular to move forward with it. It’s OK to prove me wrong on this, though. Plus, I’ve read enough about the challenge of controlling health care costs in Canada and other countries that I’m fairly clear-headed about the fact that no system solves all problems.

For what it’s worth, there is an alternative that Democrats might be able to offer as an improvement on Obamacare. Read a proposal by Paul Starr in The American Prospect’s current issue, namely “Mid-Life Medicare.” I think it offers a viable alternative for the near term. Let me know what you think of it. It’s designed to address some of the challenges specific to Obamacare by creating a special Medicare extension for the 50-65 age group, while preserving a role for private health plans for large companies and the individual market for younger people not covered by an employer.

I’d like to know if you think Democrats should put all their eggs in the Medicare for All basket, or if you think other options should be put forward, too.