Even as the movement to promote a single-payer or Medicare for all system grows, there are a lot of details that haven’t been worked out yet. Here’s what we know and don’t know.
What do we know about these proposals?
There are two main pieces of legislation: The Sen. Bernie Sanders bill and the Rep. Keith Ellison bill. There are some differences, but in general both bills would dramatically expand the scope of Medicare, both in terms of services and who it covers. Under the proposals, everyone in the United States would be able to receive free health care.
What needs to be decided?
Both bills leave a lot to be implemented by the administration. The plans detail what kind of coverage would be free, but the Department of Health and Human Services would be in charge of the details. And, of course, a major question is how to pay for it.
How big would this change be?
It’s hard to overstate how much of a change this would be to the structure of the U.S. health care system. So many choices, including sometimes what jobs people take, now are determined by insurance coverage; under the new system, that would all go away and be replaced in some form by a government entity.
What is the argument for Medicare for all?
The premise of this proposal is that health care is a right and that everyone is entitled to high-quality health care, regardless of income. Proponents say a new system would mean that people don’t have to make health decisions based on money. And they argue that a single payer — the government — would have more negotiating power with providers and pharmaceutical companies, lowering the overall cost of health care.
What is the argument against it?
Opponents worry that the government, not doctors, would make decisions about patients’ care. They worry that those with the most money would pay for private care while the middle and lower class are forced to participate in a government system that might fail to meet the promises of the bill sponsors.
How would this affect Nebraska specifically?
Opponents point out that Omaha’s economy is dependent on insurance as an industry. In the metro area, the private finance and insurance industry accounted for 13.1 percent of the private industry GDP in 2016, as opposed to 7.6 percent for the U.S., according to the U.S. Bureau of Economic Analysis. So if private health insurance becomes illegal, the shift — and loss of jobs — could hit Omaha harder than the rest of the country.
Both supporters and detractors point out that rural hospitals in Nebraska and elsewhere are struggling under the current system. Opponents of single-payer also say that the federal government would prioritize areas with more people, leaving rural hospitals to reduce services or even close. Supporters argue that the government would prioritize making sure people get care over hospital profits, and they say this would benefit rural areas.
What about the cost?
Cost estimates for these proposals vary. Sanders puts the cost of his plan at $1.38 trillion annually. Others estimate it to be up to $2.8 trillion. (The initial proposal for a fiscal 2019 federal budget totaled $4.4 trillion.)
Sanders’ proposal to pay for the plan includes major tax hikes on individuals and employers in exchange for no private insurance premiums, deductibles or copays.
Sanders also banks on savings from efficiencies. He says, for example, that private insurance companies spend 12 to 18 percent on administrative costs compared with Medicare’s 2 percent, and they also have marketing expenses. Experts from the Politifact fact check, however, have challenged how much money that translates into for two reasons: expanding Medicare to those below age 65 would require more administrative expenses not covered by the Social Security Administration, and sometimes administrative costs make delivery more cost-effective.
How would this compare with other countries’ health care systems?
As Vox noted in a 2017 explainer about Sanders’ proposal: “The plan is significantly more generous than the single-payer plans run by America’s peer countries.”
Not only would it cover dental and vision services, unlike many other countries with a single-payer system, but there also would be no copay for doctor or hospital visits.
Does this idea have public support?
The Kaiser Family Foundation in March found about six in 10 respondents favored “a national health plan, or Medicare for all,” including a majority of both Democrats and independents and about one-third of Republicans. If respondents were given the option of having the Medicare coverage or keeping the coverage they already have, support increased dramatically. Another Kaiser poll found just 51 percent support when respondents were asked if they supported a “national health plan, also known as a single-payer plan.” And pollsters cautioned that public opinion could be expected to change with more public debate.
How quickly could this happen?
A change this big could take awhile to phase in, though Democratic Congressional candidate Kara Eastman said she’d like to see it implemented as soon as 2020.
Perhaps an even bigger hurdle is the political side. Democratic Party leadership in Congress has viewed the idea as too radical to pursue. And the proposal has virtually no chance of passing with a Republican-controlled House and Senate.