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Understanding "Medicare for All"

Health Care Reform and Policy
by David Dillon
Understanding 'Medicare for All'
Understanding 'Medicare for All'

At this point, just about every American - and certainly everyone in the health care and insurance sectors - has heard the talk about "Medicare for All." The idea, first advanced with a relatively clear definition by Sen. Bernie Sanders of Vermont during his 2016 Democratic primary campaign, has since come to mean a great number of things, depending upon which lawmakers are talking about it. It can therefore be difficult to parse just what Medicare for All actually entails, how viable it may be as federal policy and thus what it might mean for the national health care sector as a whole.

The basic idea behind M4A, as it is also known, is that Medicare does a fairly good job of keeping enrollees' health care costs down because it grants broad bargaining power to the payor - in this case, the federal government - when dealing with care providers, drug companies, device makers and so on. In general, polling suggests that the nation's tens of millions of Medicare enrollees love the coverage they receive through the program. Expanding that program to all Americans, not just those who qualify under current rules, would theoretically give the federal government even greater bargaining power, simultaneously reducing costs and expanding access to care for hundreds of millions of people.

A deeper understanding
Of course, that would mean doing away with some, and potentially all, of the private health insurance industry, at least under Sanders' plan. While current enrollees often supplement their Medicare coverage with private insurance, if there is a single-payer health insurance system administered at the federal level, there would be far less reason for people to keep private coverage. Indeed, under Sanders' version of M4A, the only costs people faced at the point of care would likely be for prescription drugs, personal costs for which would be capped at $200 per year, according to Politifact.

In this way, M4A is actually a much broader version of Medicare than currently exists, but the idea would be to get everyone onto the system initially and then expand it to the point that it effectively serves as the only sizable provider of coverage in the U.S.

What all this would actually cost is open for significant debate. But the general consensus is that it would carry a price tag in the trillions of dollars over a 10-year period, and certainly raise taxes while also reducing or eliminating out-of-pocket expenditures for care or coverage, potentially by a comparable amount. Sanders argues that, currently, the U.S. spends about $5 trillion on health care every year, and his plan would roughly reduce that number by more than a third.

Different ideas
As mentioned, a number of different ideas for how to implement and administer something even resembling an M4A plan have come to the fore since Sanders first announced it in the run-up to 2016's elections. Just in the current Congressional session, 10 different plans that would broadly fall into the scope of M4A have been introduced in either the House or Senate, including the one initially advanced by Sanders a few years ago. The Kaiser Family Foundation notes that some would basically create a state or federal public option for health insurance, or allow people to buy into Medicare, while another would give people access to Medicare coverage at 50.

All, of course, would carry their own costs and considerations, as well as various levels of eligibility to account for. In addition, these plans do not include the sometimes competing visions for how to improve the national health care system held by Sanders' competition for the Democratic nomination ahead of the 2020 election.

What's the support?
It's worth noting that there is broad acknowledgement that the American health care system is, at best, inefficient and costly. But the reason the term Medicare for All seems to have captured the public imagination is that it's concise, relatively easy to understand and involves an already-popular program. It's little wonder, then, that the idea has broad support among the voting public; recent polling from RealClear Opinion Research found that 82% of Democrats support the notion, as do about 2 in every 3 people who identify as independents and almost half of Republicans. It may not be the most important issue to consumers right now, but it's certainly popular.

Interestingly, that's not quite so true among people who work in the health care sector. Medscape recently found that close to half of all doctors support some version of M4A, as do almost as many nurses. Pharmacists and those in health business or administration were less likely to back the idea, at a ratio of only 2 in 5. Meanwhile, all four groups broadly shared opinions that cost is the industry's biggest issue, just ahead of bureaucracy.

Obviously, there is still much to be decided and dealt with when it comes to actually implementing a M4A-type overhaul of the American health care system. In the meantime, those within the insurance industry would be wise to keep close tabs on what seems most likely to take place, and craft contingencies for how their companies will deal with these issues as they continue to develop.



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