Medicare for All?

“Medicare for All” is a bill pending in Congress. It’s never had a hearing. The “Consumer Health Insurance Protection Act,” introduced last year, also has never had a hearing. Nor have ” Medicare-X Choice Act of 2019,” ” Choose Medicare Act,” “Medicare buy-in for 50+.” Other plans with fancy names haven’t even been introduced as formal legislation.

“Making Sausage” in the Congress

Let’s get away from labels and get to work to solve problems for the public good! A good piece of healthcare legislation will take some time and serious attention from Congress — something the Republicans have had no interest in during their 8 years of control. (Though they have voted 54 times on whether to repeal Obamacare without a replacement — and failed each time.) With Democrats in the majority in the Senate and House and a Democrat in the White House, we can move forward on healthcare as on so many other issues.

Remember that Obamacare had 9-10 months of hearings and, based on actual expert testimony, was substantially rewritten from its original form. It was phased in over four years, with some provisions like coverage for pre-existing conditions and insurance for children and young adults going into place early and the exchanges going into full effect in 2014. Obamacare – formally the “Patient Protection and Affordable Care Act” — was never intended as an endpoint for the healthcare system, but rather as a practical way to increase insurance coverage for many who did not have it. In that, it succeeded, expanding coverage to over 20 million previously uninsured Americans, saving rural hospitals from bankruptcy, and improving coverage for those with pre-existing conditions.

Presidential candidates are now pressed for healthcare plans and almost all 20-plus Democratic candidates support some pathway to universal health coverage. Some have proposed “Medicare for All,” (with a variety of meanings), others have proposed a “Single Payer System” (with a variety of meanings), others something called “Medicare for America,” “Medicare Extra,” “Choose Medicare,” Medicare -X” and then there are a variety of “Public Options,” and other combinations of the dozens of possible elements of policy design. Some of these keep some of Obamacare, others do not. Most lead to universal coverage. Some have plans for how to pay for it; some do not.

Nonetheless, it does not make sense to choose among the various Democratic candidates on the basis of minute details of their health care plans. “The devil is in the details,” and no one will know what can actually be done until after the 2020 election and the results of the U.S. Senate races are known. Still, we as opinion leaders need to know a few details.

Hat-tip to Anne Schneider and the Arizona Legislative Alert of July 28 for some of the material that appears here!

First, Some Definitions

Universal Coverage: Coverage is universal, according to the World Health Organization, when

“all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be 2 effective while also ensuring that the use of these services does not expose the user to financial hardship.”

https://www.who.int/healthsystems/universal_health_coverage/en/

In other words, everyone is covered for everything at a cost they can afford.

Single-Payer System – Strictly, “single payor” means the health care provider sends a bill for your treatment to a single-payer (usually the government), and that payer pays all the bills for everything, and everything is covered. That means you pay nothing – no premiums, no co-pays, no deductibles for anything including drugs, hospital, physician, dentist, vision, mental health and so on. There is no side insurance; no private insurance. There are no benefit or access issues that make it worthwhile for private insurance to have a role.

What does “Medicare for All” Mean? It appears that the most common interpretation is that this is Universal Coverage with Single Payer, no private insurance, no co-pays or premiums or deductibles. On the other hand, it could just mean expanding the current Medicare system to everyone. If so, as all of us over 65 know, this system would still have private insurance, co-pays, premiums, and deductibles. And, some think a person could keep their employer insurance (others think not), and so on.

So, where are we?

With these definitions of Universal Coverage and Single Payer, and the common notion that “Medicare for All” embraces both, there is not a single country in the world that has done this. None has true universal coverage and none has a true “single-payer” system and none has done away with private insurance (although it plays a bigger role in some countries than others).

There is not a single proposal on the table in the U.S. that provides universal coverage and a single-payer system. Suffice it to say, there are many moving parts on any health care proposal, but none meets these standards. Schneider offers details on each of the bills in Congress, several of which have been sponsored by more than one or two of the Presidential candidates. She also provides a table of comparisons from other countries. Read more here.

Bottom line: Don’t fall for labels and don’t get boxed into a corner over the details of improving our healthcare system. Each candidate deserves the opportunity to explain how — with or without a Democratic Senate — they would bring us closer to universal coverage (a shared goal) and how they would pay for it. But don’t expect it can be done overnight and without some “sausage-making” in Congress.

It means you’re probably not informed yet.

Further reading: How Medicare for All Went Mainstream

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