During Tuesday’s Democratic debate, Senator Bernie Sanders declared that his Medicare for All (M4A) Act could solve America’s healthcare crisis. Co-authored by other Democratic presidential candidates, including Senators Kamala Harris, Elizabeth Warren, and Cory Booker, the bill demonstrates that the idea of universal healthcare is a popular one. But if enacted, it would do a great deal of harm, possibly depriving one in seven patients of the healthcare they currently receive.
Healthcare and health insurance are sometimes used as synonyms, yet they’re vastly different concepts. Healthcare means the goods and services provided to a patient by medical professionals. Health insurance is a means of payment for those goods and services. M4A would take care of the latter. But it’s the former that presents a big problem for M4A supporters.
If they get their way, the government would be in charge of paying for healthcare and get to decide what services it covers. Sanders’ M4A Act, for instance, would cover “comprehensive reproductive…care,” which includes contraceptives and abortions, as confirmed by the authors. For a good number of religious patients, that’s unacceptable.
Furthermore, the bill states that “[a]ny other provision of law in effect on the date of enactment of this Act restricting the use of Federal funds for any reproductive health service shall not apply to monies in the [Universal Medicare] Trust Fund.” That’s right: Senator Sanders’ M4A bill would quietly do away with the Hyde Amendment, which prevents federal funds from being used to pay for abortions except in cases of rape, incest, and danger to a woman’s life.
You don’t need to be a woman seeking those particular services to be affected by those clauses. Currently, one out of every seven American patients is treated at a Catholic hospital, which neither render services that go against Catholic moral teachings (like abortion and contraception) nor refer patients to clinics that perform such procedures.
The coverage of those services by M4A wouldn’t be a problem if hospitals were able to choose what services they offer. However, existing rules already abrogate Catholic providers’ consciences. Right now, a mandate from the Department of Health and Human Services (HHS) forces employer-sponsored health plans to cover contraceptive services. Faced with the threat of tens of millions of dollars in fines, the Little Sisters of the Poor, a religious institute for women that takes care of the elderly, brought the mandate before the Supreme Court in 2018. They pleaded for an exemption from which thousands of non-religious employers already benefited because HHS determined that it would be too costly or inconvenient for those employers to comply with the new rules. They won their case.
But as the name of the bill makes clear, M4A would do away with employer-sponsored insurance and cover all patients. All hospitals would have to comply with its requirements—including Catholic facilities. That would leave them one lawsuit away from having to close up shop.
Right now, Catholic hospitals are crucial presences in rural states, where other medical facilities can be hard to find. One report even found that 46 Catholic hospitals were the sole providers of acute care services in their communities. Under M4A, those rural patients would risk having to go without life-saving care.
As it stands, one in nine jobs in the United States are linked to hospitals, and for every Catholic hospital that closes, a local economy would risk collapsing. M4A, too, might exacerbate an already-worrisome pattern of nonprofit hospital consolidation, with devastating effects on the economic welfare of the areas concerned.
A good many doctors whose convictions are violated by the bill’s requirements would be barred from entering the medical field, too. In the face of a terrifying primary care provider shortage, can America really afford to drive physicians away from the profession?
In short, Senator Sanders’ healthcare ambitions would provide coverage at the expense of care. In going against the consciences of thousands of medical professionals and crushing the ambitions of many Christian medical hopefuls, his legislation horribly misses the mark. If the goal of the proposal is to give all Americans access to healthcare service, then it would be foolish to ignore the authoritarian impact it would have on those who do the providing.
Elise Amez-Droz is a Young Voices contributor and a healthcare policy associate in the Washington, D.C. metro area.