Abdul el Sayed’s Medicare for All needs a black box warning

The federal government reserves its most serious health warning — the “black box” warning — for medications that carry potentially life-threatening risks. If the same honesty were required for political prescriptions, Medicare for All would get a black-box warning.Its marketing is irresistible: no premiums, no deductibles, no copays. Its fine print is terrifying. Many Democrats are touting a proposal that would do untold harm to American patients. Most notably, Michigan Democratic Senate nominee Abdul el Sayed has made this prescription the centerpiece of his campaign, without honestly explaining what it means for Michigan residents or anyone else in America.I say this as someone who’s been on the front lines of healthcare for 45 years. I’ve practiced dentistry, served on California’s Dental Regulatory Board, and overseen dental ethics education at the University of Southern California. I believe government has a legitimate role in protecting patients and improving healthcare. But having seen how over-intrusive government interacts with medicine, I can safely say that Medicare for All would be disastrous for patients. Start with the price tag — one so high it won’t be affordable. The government will quickly be forced to ration care and limit patients’ options at the same time. The nonpartisan Committee for a Responsible Federal Budget estimated that sweeping Medicare-for-All proposals could increase federal spending by $25 trillion to $35 trillion over a decade.There’s no possible way to pay for that. The tax hikes would be so crippling that the economy would crash. Vermont and Oregon have tried to build government-run healthcare programs, but Vermont abandoned the plan after realizing it would nearly double the state’s tax burden, while Oregon stalled in a swamp of administrative hurdles. Nationwide, the price tag for Medicare for All would be so high that the government would cut costs by cutting medical services, especially for the most vulnerable. Americans’ health will be seriously at risk.What’s more, el Sayed isn’t admitting that millions of people would lose the better insurance they have now. Michigan’s auto workers and other union members fought for their health benefits at the bargaining table. Yet under the single-payer framework that el Sayed advocates, employer-sponsored plans would be completely replaced by one-size-fits-all federal plans.That’s not expanding choice. It’s eliminating an option that millions of Americans earned through years of work and negotiation. The trade-off matters. A recent KFF poll found broad support for Medicare for All, but support dropped dramatically when Americans were told it would eliminate private insurance companies. People want affordable healthcare. They also want to keep coverage and the doctor they trust — the coverage that works for their specific health needs.My experience in California offers another warning. More than a third of Californians depend on Medi-Cal, the state’s Medicaid program. Medi-Cal is not exactly Medicare for All, but it points to a serious problem with government-financed healthcare: coverage does not equal care.When the government pays the bills, it inevitably turns to reimbursement rates, burdensome paperwork, endless authorization requirements, and post-treatment denials. All of this makes it financially impossible for providers to treat patients. An insurance card means little when doctors and dentists cannot afford to accept it. In my own practice, we treated DentiCal-covered children with autism at no charge, because public-program paperwork and denials made reimbursement an obstacle course. I was so happy to help those children. But charity is not a sustainable healthcare system.And el Sayed’s wife knows this perfectly well. She refuses to accept Medicare — or any insurance at all — at her psychiatry practice. That’s surely because she recognizes it would destroy her ability to treat patients at the highest level. She also surely knows Medicare pays too little to ensure good care. Right now, she has the choice to avoid a worse healthcare system. Why should anyone support her husband’s plan to take that same choice away from every American?Naturally, Medicare for All proponents such as el Sayed promise savings through reduced administrative costs and lower payments to healthcare providers. But those savings are not consequence-free. Push reimbursement rates too low, and practices may limit services or stop accepting patients. Pay providers more, and the program becomes more expensive. Patients deserve an honest accounting of the trade-offs.None of this means America’s healthcare system is working well. Patients are rightfully furious about surprise bills, insurance denials, opaque prices, and crushing medical debt. We need greater price transparency, less bureaucracy, more competition, and better access for those who cannot afford care.Fixing a broken system has proven elusive. However, shifting control from insurers to Washington would limit choices for patients and their doctors while increasing Medicare fraud — a problem painfully exposed in Minnesota over the past two years.OPINION: DEMOCRATS JUST HANDED REPUBLICANS A LOADED WEAPON FOR THE MIDTERMS — THEY WON’T PULL THE TRIGGERA black box warning doesn’t mean a medication can never be used. Rather, it means serious risks cannot be buried beneath attractive promises. El Sayed’s Medicare for All prescription deserves the same standard. Show us the tax bill. Explain what happens to hard-won union and employer coverage. And demonstrate how patients will find doctors willing and able to treat them.Until then, Medicare for All is a sweeping promise that urgently needs an honest warning label.Dr. Joel Strom is the former president of the California State Dental Board, chairman of Ethics in Dentistry at the University of Southern California, National Advisory Dental and Craniofacial Research Council advisory panelist at the National Institutes of Health, and a 47-year practicing dentist.