A proposal to provide free health care for everyone in America is catching fire among left-leaning candidates who want to see sweeping changes to the health system.
The bills that would move the United States to a single-payer health system — dubbed “Medicare for all” by supporters — are short on details, but it’s clear that they would create a radical shift for patients, doctors and employers.
Medicare for all is a long way from being law, but it is an idea voters can expect to hear more about.
Kara Eastman, the Democratic House candidate in the Omaha-based 2nd District, is at the forefront of this movement. Eastman made the proposal into a central theme of her primary campaign and says she plans to keep pushing it in her general election campaign against Republican Rep. Don Bacon.
Eastman sees Medicare for all as a winning idea that will appeal to voters concerned about losing health care benefits, or never having them at all. But Bacon says it’s a proposal that will cast Eastman as too liberal for a district with many people working in the insurance industry.
The most prominent of the proposals would mean the U.S. adopts a single-payer system in which Americans would not rely on private insurance — an industry that employs about 33,000 in Nebraska. Instead, the government would reimburse doctors for providing health care, in most cases at no costs to the patient.
[Read more: What we know and don't know about Medicare for all]
“It would be monumental,” said Chuck Olson, an Omaha health insurance broker who opposes the change to what also is called a single-payer system.
As of 2016, about 56 percent of people got private health insurance through an employer. All of those people — along with the more than 16 percent who buy private individual plans — would be transitioned to the new government system. Health insurance would no longer be a factor in choosing, or staying with, a job or career based on benefits packages.
The estimated 37 percent of people who are already on government-run plans — Medicare, Medicaid or military insurance — also would see their coverage change under the current Medicare-for-all proposals.
Olson and other critics argue that patients would see the government making decisions about what treatments are acceptable. “I think anytime government steps in, the unfortunate thing is they don’t seem to do a very good job of sticking with their promises,” Olson said.
But those who favor the policy say insurance companies already make decisions about patient care. They say that under a single-payer system, patients wouldn’t have to worry about the cost but instead could focus on the quality of care.
Sen. Bernie Sanders, a longtime proponent of a single-payer system, has offered a bill that would require every American to get care through a government-run system that would be based on Medicare. The idea is that everyone is entitled to free health care with no premiums, deductibles or other costs.
The new system, as envisioned by Sanders, would go far beyond the existing Medicare program for people who are 65 and older or disabled; the goal would be to cover nearly every medical problem. In fact, both bills in Congress would make private insurance illegal, though they would allow the purchase of supplemental insurance.
Opponents paint a bleak picture of health care shortages and government interference with doctors’ decisions.
“It would change the health system detrimentally across the board,” said Rob Rhodes, a family physician in Lincoln who’s the head of the Nebraska Medical Association.
Rhodes argues that patients need to have a financial stake in their health care so they take ownership of their well-being.
The Medicare for all concept is not any more popular among Republicans than the Affordable Care Act.
Republicans argue that the ACA has driven up premium costs and that the answers lie in the free market and pushing control to the state level.
Bacon voted to repeal the ACA. He, like Eastman, sees rising health care costs as a major problem.
But to him, the solutions lie in more piecemeal changes to health care, such as allowing small businesses or others to create pools to purchase insurance with better rates, allowing insurers to sell policies across state lines, or limiting the financial impact of medical malpractice lawsuits.
Bacon says he wants to preserve the ACA’s protections for pre-existing conditions coverage, from coverage caps and for coverage of young adults to age 26.
For proponents of Medicare for all, like Eastman, the whole point is to make a massive change. And they say that free government-supplied health care would lead to healthier Americans and a cheaper overall system.
“The system does need an overhaul,” Eastman said. “I think most people agree with that. The system is broken.”
Eastman often tells the story of her mother, who before her death was spending $800 per month on pills as part of her cancer treatment, which were not covered by Medicare or even a supplemental policy. Eastman’s argument is that even Medicare is not sufficient, and that people should not have to pay out of pocket for health care in the United States.
“In the wealthiest country in the world, I think this is something we can afford, and the cost-benefit of it would be tremendous,” Eastman said.
She’s also in favor of taking steps toward this system, such as allowing people to buy into the existing Medicare system. (This was the approach favored by her primary opponent, Brad Ashford, who Eastman cast as not progressive enough on health care issues.)
Politically, support of a single-payer system is growing among Democrats nationally.
“Democrats are becoming more comfortable and confident in talking about Medicare for all or sometimes a single-payer system without using that language specifically,” said Nathan Gonzalez, editor and publisher of Inside Elections, which provides nonpartisan analysis of campaigns.
“Democrats are emboldened by what Republicans have done to health care in the last year and a half. Democrats believe they have the upper hand on the issue.”
Medicare-for-all candidates have won primaries not just in Nebraska but also in California and New York.
The Nebraska Democratic Party just last month adopted Medicare for all as part of its official 2018 platform.