Explain Like I’m 65: “Medicare for All”
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Some people act like they know it all. Our new series Explain Like I’m 65 is for the rest of us. It will provide clear, digestible summaries to help seniors sort through the noise and get the factual information they need. From political buzzwords to household how-tos, we’re here to provide accessible guides and informative answers.
Efforts to provide government-backed health coverage aren’t anything new. The idea of guaranteed healthcare for all Americans even predates Medicare itself. In 1935, President Franklin Roosevelt attempted to make health coverage a component of the Social Security Act. Unfortunately, the obstacles to universal coverage have also proven to be consistent over the past century. According to Time, “businesses and doctors attacked the idea of government healthcare,” and Roosevelt’s proposal quickly fell apart. Sound familiar?
His successor, Harry Truman, faced even stronger opposition. Organizations including the American Medical Association employed “Cold War scare tactics” to frame universal healthcare as an inherently Communist idea. From there, discussion around public health insurance turned toward guaranteed coverage for seniors citizens alone. President Lyndon Johnson established Medicare as we know it in 1965 and, in 1972, Richard Nixon introduced coverage for certain disabled Americans.
For many Americans, the conversation around universal healthcare began in earnest during the Obama presidency. Barack Obama came into office on a groundswell of support for a “single-payer” plan that would guarantee coverage to all Americans. Years of intense, partisan debate ultimately resulted in the Affordable Care Act (ACA). The ACA did not create a comprehensive public option, but it has effectively become the standard by which new plans and proposals are judged.
President Donald Trump has spent his entire first term attempting to “repeal and replace” the ACA and the Democrats hoping to challenge him are divided on the program’s efficacy. On the one hand, progressives like Senator Bernie Sanders want to replace the ACA with an all-encompassing Medicare-like program (Medicare for All). On the other, more moderate figures like Joe Biden want to make incremental changes to the ACA.
Medicare for All Act of 2019
One huge misconception about the term “Medicare for All” is that it refers to a single piece of legislation. In reality, there are several proposals for expanding health insurance coverage to reach the more than 27 million uninsured or underinsured Americans. By the time Democrats took control of the House in January, eight separate proposals for expanding public health coverage were on the table.
For our purposes, we’ll focus on the most well-known: The Medicare for All Act of 2019. When a progressive like Senator Bernie Sanders says, “Medicare for All,” they’re typically using it as shorthand for this bill.
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The term Medicare for All is somewhat misleading. Proponents like Sanders and Representative Primila Jayapal aren’t really talking about offering Medicare to every American. They are instead proposing an all-encompassing plan that would fill in the gaps in existing Medicare coverage and extend coverage to Americans who are otherwise ineligible for Medicare. Their use of the word “Medicare” has more to do with the existing program’s popularity than the structure of their proposals.
Traditional Medicare does not cover a variety of services including routine dental care, long-term care, and hearing aids. In addition to filling these gaps, Medicare for All would cover the full spectrum of medically necessary services, from routine check-ups to mental healthcare. The plan would also put new limits on prescription drug prices and effectively eliminate all other out-of-pocket expenses.
Crucially and controversially, Medicare for All would eliminate the private health insurance industry within a matter of years. The timeline for such a transition is still up for debate. Sanders has proposed a four-year transition, which would have Americans progressively enroll by age group.
What Will it Cost Me?
No facet of Medicare for All (or similar proposals) has inspired more discussion than the question of payment. Facing intense pressure, Sanders recently shared a number of potential options for funding this transformation. While some members of the middle class will see tax hikes, the onus of payment will fall mostly on corporations and the wealthiest Americans.
Most fixed-income seniors on Medicare will not face any additional taxation. With debt forgiveness, new limits on drug prices, and the elimination of nearly every out-of-pocket expense, it is more likely that they will save money each year. What’s more, by eliminating the concept of “out-of-network” doctors, Medicare for All could significantly increase quality of care for everyone.
Will it Actually Happen?
Alan Weil, editor-in-chief of Health Affairs, suggests Medicare for All (or something like it) will eventually become a reality, but he’s not confident that this will happen anytime soon. This shouldn’t surprise anyone who has taken part in the political discourse recently. It’s not just Republicans calling the plan’s viability into question, but more moderate Democrats as well. The race for the Democratic nomination has, at times, resembled a single-issue argument. With Sanders and Biden now head-to-head, the issue promises to remain central.
Even if Sanders beats Biden and Trump, the path toward Medicare for All would be both steep and winding. Democrats would need to retake the Senate and the bill itself would face scrutiny in a divided Congress. From there, the government would have to cooperate with the private sector to eliminate and replace private insurance. Weil predicts “elements of pressure” (such as public outrage) will eventually force the government to intervene and reform the health insurance industry. “Once you have a consolidated, regulated industry,” he remarks, “it’s not that different than single-payer.”
Whether you think Medicare for All is a moral necessity or pie in the sky, seniors can count on several more months of debates before they head to the polls.