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Glancing through the “Medicare for All” Bills one quickly sees “The Secretary” making critically important decisions, including negotiation of drug prices. That Secretary is apparently the US Secretary of Health and Human Services, who is a constantly changing political appointee-hack appointed by the US President.

Thus, if we had “Medicare for All” at the present, as designed by Bernie Sanders and Pramila Jayapal, that all important Secretary would be Alex Azar, former CEO of Eli Lilly & Company and former member of Biotechnology Innovation Organization, a pharmaceutical lobby.

So, apart from shifting the cost of a large part of health care cost burden from employers to tax payers, which is a huge and unsustainable corporate subsidy, there is the problem of centrality of control and decisions made by an ever-changing political appointee. The funding, of course, will be up to the whims of the US Congress, and we know how that goes.

Most health care systems, such as in Canada and Denmark, are decentralized. The Canadian system is provincial and the Danish one regional, and previously at the county level. Even the UK has separate systems for the component countries. Sanders-Jayapal are proposing a highly centralized nation-wide behemoth, which even covers illegal immigrants, because it fails to require a social security number.

Even real Medicare doesn’t pay 100% of charges. And, Canada doesn’t provide drug coverage, either. Bernie is from Burlington, just across the border from Canada, and Jayapal lives in Seattle, so both should know that.

The United States Secretary of Health and Human Services is the head of the United States Department of Health and Human Services, concerned with health matters. The Secretary is a member of the President’s Cabinet. The office was formerly Secretary of Health, Education, and Welfare… https://en.wikipedia.org/wiki/United_States_Secretary_of_Health_and_Human_Services
Alex Michael Azar II (/ˈeɪzər/ born June 17, 1967) is an American attorney, politician, pharmaceutical lobbyist, and former drug company executive who serves as the United States Secretary of Health and Human Services, having been Deputy Secretary from 2005 to 2007. He was nominated by President Donald Trump on November 13, 2017, and confirmed by the Senate on January 24, 2018. From 2012 to 2017, Azar was President of the U.S. division of Eli Lilly and Company, a major pharmaceutical drug company, and was a member of the board of directors of the Biotechnology Innovation Organization, a pharmaceutical lobby.” https://en.wikipedia.org/wiki/Alex_Azar

Excerpt from Sanders’ Senate bill “Medicare for All” bill, which may or may not be a typo. It says “no cost-sharing”, only to describe cost-sharing, and that’s no typo:
S. 1129 To establish a Medicare-for-all national health insurance program.
EXCEPTIONS.—The Secretary may set a cost-sharing schedule for prescription drugs and biological products—
(2) under which the Secretary may exempt brand-name drugs from consideration in determining whether an individual has reached any out-of-pocket limit if a generic version of such drug is available
. ” Is this a typo? Available or unavailable?


S. 1129 To establish a Medicare-for-all national health insurance program.
https://www.congress.gov/bill/116th-congress/senate-bill/1129/text
H. R. 1384
To establish an improved Medicare for All national health insurance program
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https://www.congress.gov/bill/116th-congress/house-bill/1384