The Likelihood of Medicare for All
After passing the Affordable Care Act in 2010 and watching Republicans begin to dismantle it in 2017, many Democrats now are proposing Medicare for All.
Whether Medicare for All becomes law depends a great deal on who controls the House and Senate. For now, it has little chance of passing because Republicans control the Senate and President Donald Trump argued that Medicare for All would be disastrous. Democrats control the House, but Speaker Nancy Pelosi and a number of party moderates also are resisting the proposal.
Currently, half of U.S. health care costs are covered by private insurance through employers or individuals who are self-insured. The other half is from federal, state and local governments paying into Medicare and Medicaid.
Medicare is a federal government-run health insurance program for Americans who are 65 or older; for younger people with disabilities; and for people with End Stage Renal Disease. All Americans pay for the program from taxes withheld from their paychecks. Medicare Part A is available for no cost and covers hospital stays only. Individuals on Medicare can pay for additional coverage – Part B – from Medicare-approved private insurers to cover other services such as dental, vision care and prescription drugs.
According to a recent Gallup poll, about 79 percent of those who use Medicare or Medicaid (the government's health program that covers those with limited income), are happy with the quality of their health care and believe that they have good to excellent health coverage.
Many of those who want Medicare to cover all Americans believe that health care is a human right and the Medicare for All proposal will help rein in growing health care costs. Those opposed, such as The Heritage Foundation, stress that "The British and Canadian experiences with single-payer demonstrate that universal government coverage is not the same thing as universal access to quality care," … and that "social inequalities in accessing care, based on wealth or political influence, are often exacerbated." Plus, the cost would drastically increase taxes.
Medicare for All — The Jayapal Plan
In February, Democratic Rep. Pramila Jayapal of Washington and 100 co-sponsors proposed legislation to require all Americans to be covered by Medicare in two years. If approved, Medicare would cover comprehensive health care services and limit private insurance to supplemental benefits not provided by the government-run program.
Participants would not be charged copays, premiums or deductibles. The plan would cover prescription drugs, vision, dental, mental health, substance abuse and maternal care. It also would provide universal long-term care coverage for people with disabilities.
Jayapal gave no details on the cost to cover all Americans. Her staff said that ideas for financing the plan include a wealth tax; higher marginal tax rates; and repealing portions of the 2017 Republican tax cuts. Proponents believe health care costs will be lower because the government would reduce administrative costs and Medicare would set doctors' fees and hospital budgets and negotiate drug prices.
Medicare for All — The Sanders Plan
Independent Sen. Bernie Sanders of Vermont, a Democratic contender for the 2020 presidential nomination, introduced a bill in 2017. Four others declared 2020 presidential candidates — Sen. Cory Booker of New Jersey, Sen. Kirsten Gillibrand of New York, Sen. Kamala Harris of California and Sen. Elizabeth Warren of Massachusetts — co-sponsored it along with 11 other Democrats.
Sanders' plan would take four years to roll out and would cover basic health services, as Medicare does now, plus dental and vision coverage with no copays. However, Americans might have to pay for some prescription drugs and some elective procedures — although probably not cosmetic procedures. States could provide additional benefits for their residents, but without federal assistance.
Americans would be required to move to the government system, including those who currently get insurance from employers.
It's unknown whether Sanders' Medicare for All system would be a tiered system with supplemental insurance, similar to what we have now, and whether private insurance would go away.
The Case Against Medicare for All
Although a January 2019 poll by the nonpartisan Kaiser Family Foundation found that Americans favor the idea of Medicare-for-All by a margin of 56 percent, only 37 percent supported it when they learned it would eliminate private insurers, and require most Americans to pay more taxes.
Many observers are concerned that Medicare for All could cost $30 trillion to $41 trillion over a 10-year period. The Urban Institute estimates that under the Sanders plan, national health care spending would be closer to $51 trillion, instead of Sanders' projection of $41 trillion. Ultimately, that would mean an additional $32 trillion in new federal spending, according to the Urban Institute.
Kenneth Thorpe, chair of health policy and management at Emory University's Rollins School of Public Health, believes that if states provide additional benefits, sales taxes, which are regressive and affect the poor more than the rich, would also have to increase. Plus, he said there is a good chance that the taxes Americans have to pay would be more than the premiums they currently pay.
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The Likelihood of Medicare for All
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