“Medicare for All” proposals may vary greatly, but a common feature is their call for the regulation of prices for hospital care. This element has widespread support among establishment Democrats, and it lacks the enormous cost and controversy associated with other aspects of single-payer health care.

Comprehensive hospital-payment regulation is not a new idea: it’s been widely tried at the state level for half a century, including in Maryland—the only state where it remains. Maryland therefore provides a useful case study.

“Specifically, we are concerned about proposals for open-ended arbitration, which have been floated as a solution to the problem. If arbitration appears innocuous, it is to a large extent because it is not transparent. Experience suggests that arbitration would be cumbersome to deploy, and highly favorable to those health care providers who charge high prices today. If Congress were to endorse arbitration, it could potentially open the door to a system quite unintended – establishing an inflationary dynamic that accommodates and encourages the rapid growth of costs.”

Short-Term Limited-Duration Insurance (STLDI), which is exempt from ACA rules, survived as a viable competitive market, offering health coverage priced in proportion to individuals’ risks. But it has been disparaged as “junk insurance” that fails to cover adequate provider networks, offers only catastrophic coverage, makes essential benefits unavailable, helps only young and healthy individuals, undermines protections for those with preexisting conditions, and causes premiums for plans on the ACA’s exchange to soar. This study of the STLDI market finds that each of these claims is false. For equivalent insurance protection, the premiums for STLDI plans are lower than—in some cases, almost half the cost of—premiums on the exchange. The savings to be gained from switching to STLDI are even greater for more comprehensive insurance coverage.

Medicare funds health-care services for 60 million elderly and disabled Americans. Of these, 39 million receive coverage through a plan known as “Traditional Medicare” or “Medicare Fee-for-Service” (MFFS) that the federal government administers directly. Increasing numbers of seniors—21 million in 2019—enroll in Medicare Advantage (MA), choosing from competing plans managed by private insurers. MA provides an incentive for plans to develop innovative care arrangements, but the rules under which MA plans operate can be restructured so that more of the efficiency gains can be passed on to beneficiaries.