Joe Biden likes to promote himself as the moderate candidate. He has resisted pressure from progressives like Senator Bernie Sanders to endorse his Medicare for All plan, which is complete takeover of healthcare by the government and elimination of private health insurance.

But the old saying is, “the devil is in the details.” Biden is inching closer and closer to Sanders’ socialized medicine plan the longer he campaigns. The distinction between the two is getting slimmer and slimmer.

Biden began his campaign stressing he wanted to “protect and preserve ObamaCare.” Back then he wanted nothing to do with Medicare for All. Then he said he wanted to offer a “Public Option”, which would lead to socialized medicine eventually as the government-supported “Public Option” eliminated competition from the private insurance market gradually over time. I explained this in detail in Bernie v. Biden: Medicare for All Sooner or Later. 

Now Biden is taking his move to the left one step farther. Now he’s calling for “Medicare for More.” In this new proposal, Biden wants to reduce eligibility for Medicare from age 65 to age 60. There are multiple problems to this new approach.

Benedic Ippolito and Chris Pope, writing in The Wall Street Journal, say Biden’s plan relies on large cuts to hospital revenues that won’t fly in Congress, especially among Democrats. Moreover, his expansion is poorly designed if the goal is to help the uninsured. Lowering the age of Medicare to 60 would require heavy subsidies from taxpayers. Employers would be prohibited from dropping the newly eligible from their plans.

Currently, hospitals are effectively required to treat Medicare enrollees at rates averaging 59% less than what hospitals receive from employer-sponsored insurance plans. In 2015, adults 60 to 65 accounted for 6% of the U.S. population but 17% of costs paid by private insurers, according to the Department of Health and Human Services. This loss of revenue would seriously impact hospitals and probably lead to many of them closing. Of course, this same impact would be even greater with Medicare for All.

This push to reduce funding of hospitals goes counter to the prevailing Democratic Party leadership which is pushing efforts to expand hospital funding substantially after the Covid-19 pandemic. Republican efforts to end “surprise medical billing” were derailed by the prospect of payment reductions to hospitals.

Another issue is the impact on the uninsured. Currently only 8% of the 60 to 64 age population is uninsured. With this new Biden proposal, Americans would be asked to pick up the tab for those in this age group who are already covered – at a cost of roughly $250 billion a year currently paid by private insurance. Medicare outlays are already expected to double in the next decade and the program’s trust fund is projected to be insolvent in 2026.

This Biden proposal would be subsidizing the income of workers whose median household income was more than $92,000 in 2017. It would help the relatively affluent instead of devoting resources to the most needy. Of the 28.5 million Americans without insurance, only 1.6 million of those are in the 60 to 64 age group according to the Census Bureau.

Joe Biden may think this idea will get him more votes in November, but it won’t fix the flaws in Medicare or assist the families that need help the most. But it will be one step closer to Medicare for All.