What Is "Medicare for All"?

(Image is from pro.fm.)

There is no doubt that our current heal care system is broken. Millions of citizens have no health insurance (and therefore cannot adequately access the system, especially for vitally important preventative care). Also medical costs are already outrageous (and the leading cause of bankruptcies in the U.S.), and rising faster than the rate of inflation each year.

Other countries provide health care for all of their citizens, and control the costs of that health care. The United States does neither. Until it finds a way to do both, we will continue to have the worst health care system in the developed world -- spending twice as much per capita as any other country, and getting less for that spending.

One solution that has been offered is a single-payer, government-run health insurance system. It is commonly called "Medicare for All".  I believe this will finally be the answer to our health care problem, but it will only come once the public understands what it is and demands it.

The most talked about version is the plan submitted in Congress by Senator Bernie Sanders (I-Vermont). But it's not the only idea. Here is part of a discussion of "Medicare for All" by Jon Greenberg at PolitiFact.com.

What is Medicare for All?

Sanders’ idea of Medicare for All would be a single, national health insurance program that would cover everyone who lives in the United States. In the bill he introduced in 2017, it would pay for every medically necessary service, from routine doctor visits to surgery to mental health to prescription drugs. Dental and vision care are part of the package, too. The details on long-term care might vary between the Senate and House versions, but broadly speaking, nursing home and related care grow under both proposals.

The government would set payment rates for services, drugs and medical equipment. Each year, the secretary of Health and Human Services would determine a national budget for all covered services and spending would be limited by that cap. For individuals, there would be no costs — no deductibles, no copays or coinsurance. The two exceptions would be for some prescription drugs — though that would be limited to $200 a year — and possibly for long-term care.

It would replace all other insurance, with limited exceptions, such as cosmetic surgery. Employer-provided insurance, Medicaid and ultimately Medicare would all disappear.

Medicare for all?

No. Medicare for All is much more generous than the current Medicare program. Right now, the Medicare program is for Americans 65 and over; they receive care, but they’re also responsible for part of the costs. Unlike traditional Medicare, Sanders’ Medicare for All would cover medical bills completely, with no burden on the patient. There would be no Medigap insurance or Medicare Advantage.

If Medicare for All sounds a lot like a single-payer health care system — where the government foots the bill for people’s health care — that’s because the two are largely the same. The new name seems intended to make the concept more popular. When the Kaiser Family Foundation asked people in 2017 how they felt about the term single-payer health, 48 percent gave it a thumbs up. When Kaiser asked them how they felt about Medicare for All, support rose to 62 percent. . . .

How would the country switch to a primarily single-payer system?

Sanders’ 2017 bill included a four-year phase-in during which increasingly younger people could buy into Medicare. So 55-year-olds could choose that option in the first year, 45-year-olds in the second, and 35-year-olds in the third. There would be out-of-pocket cost reductions across the entire Medicare program.

Outside of Medicare, Washington would offer a public option insurance plan for people of any age through the Obamacare marketplaces.

To help people who work in the insurance industry, the government would set aside up to 1 percent of the total health spending budget for job dislocation assistance.

What other plans build on Medicare or Medicaid?

Lawmakers have floated several versions of extending Medicare to people younger than 65, offering it as a more practical expansion of the current system.

Sens. Debbie Stabenow, D-Mich.; Sherrod Brown, D-Ohio,; and Tammy Baldwin, D-Wisc., introduced the Medicare at 50 Act in mid February. Under it, people between 50 and 64 could pay to get Medicare coverage. The main difference from current Medicare, where hospital care is automatic and other parts are optional, is that coverage would be a package deal of Parts A (hospital), B (physician) and D (prescription drug) coverage. Or someone could choose Medicare Advantage, which is Medicare offered through private insurers.

If someone qualified for a premium subsidy under the Affordable Care Act, they could could apply that to extended Medicare. So basically, the government would offer a new insurance option for people 50 and up.

A second approach, called Medicare-X Choice, introduced last session by Sen. Michael Bennet, D-Colo., and Rep. Brian Higgins, D-N.Y., would offer Medicare to people of any age through the Affordable Care Act marketplaces. Initially, this would not be nationwide. The bill would focus on adding the Medicare option in places that had only one insurer offering coverage, or in areas with few hospitals and doctors.

A variant of this approach would simply offer a public insurance option through the marketplaces across the country.

Lastly, another idea would be to let people buy into Medicaid, rather than Medicare. Under a bill from Sen. Brian Schatz, D-Hawaii, and Rep. Ray Lujan, D-N.M., a plan would be available on the marketplaces, but because it is Medicaid, not Medicare, the details of covered services could vary from state to state. Still, no plan could offer less than the essential health benefits under the Affordable Care Act. Some states have explored this option on their own.