Obamacare is old news for the political left. Now, the big item is “Medicare for All”—a single-payer, government-run health care system. But what kind of impact would that have on Americans’ lives? In this interview produced by The Daily Signal, we discuss that and more with the administrator of the Centers for Medicare and Medicaid Services, Seema Verma, who joins us for an exclusive interview.

Daniel Davis: I’m joined now in the studio by Verma. She is the administrator of the Centers for Medicare and Medicaid Services. Administrator, thanks for your time today.

Seema Verma: My pleasure. Thanks for having me.

Davis: Health care remains such a concern for Americans, a top issue for voters, according to the most recent polls. Some on the left are now addressing that by proposing what they call “Medicare for All,” which would fundamentally shift who’s in charge of health care decisions.

You actually administer Medicare and Medicaid as they exist today. From your perspective, is this Medicare for All proposal the right way to go? What kinds of changes would people feel under that approach?

Verma: Well, as the head of the program, I am very deeply concerned about these types of proposals. First of all, Medicare is a program that our seniors have paid into their entire lives, and now we’re talking about putting 180 million people into this program. So stripping away private coverage for 180 million people and putting it into the program that was designed for them.

So I’m concerned about the impact on seniors directly. But it’s also taking away this private coverage, which most Americans are happy with their private coverage, and they shouldn’t be forced to be in a Washington, D.C.-run program.

The other main concern with this is that when the cost of this is going to be very expensive for the country, some of the estimates coming out is that this could be a $32 trillion program. The more expensive the program becomes, everybody is paying higher taxes.

When you’re paying higher taxes, it puts the government or Washington bureaucrats in a decision-making role where they have to figure out, “Well, what kind of coverage should people have? What kind of benefits should they be covering?” And those decisions then are made in Washington, D.C.

That concerns me in terms of the decision-making. We want to see patients and families in control of their health care, not the government, not D.C. bureaucrats.

When they’re in that type of decision, what we’ve seen in other countries that have tried these types of programs is that, that leads to rationing of care and it leads to long wait times.

What we see in other countries … that’s why a lot of people will come from other countries to get care in America, because they know they can get ready access to it.

But in other countries, whether it’s Canada or the United Kingdom, in those countries they could wait for months to get routine services that Americans can get very readily. So that’s one of the main concerns that I have.

Davis: Yeah, you mentioned access to care, and that is something that here at The Heritage Foundation we’ve found in talking to people about their concerns when it comes to health care is being able to access the doctor when they need it, and their fear being that they’ll lose that access when they need it the most.

How would Medicare for All affect people’s access? You mentioned countries like the United Kingdom where there’s over 4 million people on waiting lists and long wait [times], sometimes a year and a half for necessary treatments.

Is that something that people should expect under a Medicare for All proposal?

Verma: I think it actually could exacerbate access issues that we already have today in some of our public programs.

So if we look at the Medicaid program today, because providers are paid under government rule, so government price setting … prices set in Washington, D.C., a lot of providers today won’t even see patients on Medicaid, won’t see patients on Medicare, and they’re kind of moving to more of a direct pay situation.

Now, if the entire market is being paid by government rates, providers don’t even have the ability to have some income that’s more appropriate for them under commercial reimbursement. You could see providers sort of turn away from the government programs, which is going to exacerbate access problems. That’s actually what gives me the most concern for our beneficiaries.

These are people that have paid into the program their entire life and now we’re asking them to get in line and wait for care. I just think that’s immoral.

Davis: Well, [there’s] a lot of talk, obviously, about Medicare for All, but less focus has been given to the people that are actually part of that program now—American seniors.

What’s in it for them in the Medicare for All program? What happens to their care?

Verma: Well, my main concern is that they’re going to face access problems. They’re going to face long wait times and they’re going to be subject to potential government, Washington, D.C. rationing of their health care services.

This is a program that was designed uniquely for them.

What we’re hearing from the Medicare trustees is that the program is already on shaky financial ground. The trustees are indicating that in six, seven years we’re going to run out of money and part of the program.

Our administration has been focused on protecting the program, strengthening the program, making it work better for seniors. I think these proposals threaten all of that and could expose them to longer wait times and rationing of care.

We want to make sure that we’re creating a program that’s sustainable over the long term, and putting 180 million people into it [is] not going to solve that problem.

Davis: Another proposal being discussed is the public option, basically letting people under the age of 65 buy into traditional Medicare. You recently wrote an op-ed about this in The Washington Post, and you referred to the public option as “a Trojan horse with single-payer hiding inside.” I want to ask you about that.

Why is this proposal just as concerning to you as the full-fledged Medicare for All?

Verma: I think these are all versions of more and more government.

That’s what we’re talking about. More and more Washington-controlled health care, one-size-fits-all, where the government is making decisions about your care, not you, not your family. That’s what the discussion is today and in all of these types of proposals.

I think the public option in particular is problematic for a few reasons.

No. 1 is people are saying, “Hey, if you want to be able to get a public program, you should be able to get one and look how well these public programs are doing or they’re going to be cheaper and less expensive.”

Well, the reason why public programs are less expensive is because we pay doctors less. In the Medicaid program, 30% of doctors won’t even see a Medicaid patient and those numbers are rising every year.

And so that’s a concern, that a public option would not have the type of access that people are used to. They wouldn’t be able to have that choice of doctor. They wouldn’t be able to go see who they want to see because that provider may not be in the network.

The other concern is that when that happens, where there’s lower reimbursement, providers are going to react by increasing their charges to those folks that are still commercially insured or through their private insurer. So that could actually mean raising premiums for everybody else in the market.

We’ve tried these types of what I’d say [are] D.C.-based solutions. If you look at Obamacare, for example, that’s a great example of where the government stepped in and took over the individual market.

Let’s look at the results of that. I mean, the results have been, whether you like Obamacare or not, the simple fact is rates went up by over 100% across the nation on average. And some parts of the country, they went up by 200%.

For people that are not subsidized today, they can’t afford health insurance and people are leaving the individual market. Millions of people are leaving because they can’t afford coverage anymore.

And then choices went down. Obamacare created monopolies across the nation where there’s only one insurance company, and they’re just increasing rates every year.

I think there’s broad acknowledgement that Obamacare didn’t work, doesn’t work, and won’t work, and that’s why people are looking for different solutions. But it seems surprising to me that we’re doubling down on big government, big D.C. government solutions, which have not worked in the past.

We need to move to a system where we have a competitive free-market environment and people say, “Well, it’s not working and so let’s do more government.” But the reality is we haven’t had a free market.