What does "Medicare for All" mean, both politically and practically?

Many of those who advocate for Medicare for All believe that health care is a human right and many believe that bringing more people into the Medicare system can help limit the rising costs of the US health care system.

Where did this idea come from and why does it gain ground?

The concept of a government-funded health care system is not new. In the United States, efforts to establish a kind of universal health coverage date back to 1904, when the Socialist Party approved this idea.

In September 2017, Sanders and 16 Democratic co-sponsors introduced a Medicare for All extension bill, designed to cover all Americans. The co-sponsors included California Senator Kamala Harris and New Jersey Senator Cory Booker who run in the 2020 presidential elections. Announcing her run, Harris said, "I'm announcing once for all that health care is a fundamental right and we will guarantee it with Medicare for All! "

Their bill was not the only bill to expand health insurance. At the last session of the Congress, at least eight other proposals were presented to the House and Senate to expand the program. Some would have expanded the program by reducing eligibility for Medicare at age 55; Other bills have added a Medicare option while maintaining private insurance choices.

Last summer, Democratic Representative Pramila Jayapal of Washington helped create the Medicare for All caucus, which now has 78 Democratic representatives.

And throughout the last few sessions, "Medicare for All" was a rallying cry for Democrats. Representatives like Alexandria Ocasio-Cortez, Republican of New York and now Republican, and the Republican Harley Rouda of California, who defeated Dana Rohrabacher, holder of 15 Republican mandates.

What would the program do?

Our health system could be described as a hybrid system. About half of the money comes from the private sector: people who have private insurance with their employer or who are self-insured. The other half comes from the public sector: federal, provincial and local governments contribute to Medicare and Medicaid.

If the country adopts Sanders' proposal, people who currently buy insurance from their employers would switch to the government system. Sanders' plan would cover basic health services, as Medicare currently does, and would include copayless dental and visual coverage. The only potential costs associated with certain prescription drugs and optional procedures would be additional costs.

If states wanted to fund additional benefits for their residents, they could do so under the Sanders proposal, but they should do so without federal support.

According to Sanders' plan, would I be able to keep my doctor?

As long as your doctor is licensed by the state and that he is a certified Medicare provider, your visit will be covered. But if your doctor chooses not to participate in Medicare, you will have to pay out of pocket or consult a participating physician.

What would the program not cover?

As part of the full Sanders program, the only things you would likely have to pay would be some elective and aesthetic procedures. But the devil is in the details, and many of these details have yet to be clarified.

For example, Medicare has entered into contracts with certain private insurers and has approved their agreement to provide additional coverage. Would a Medicare for All system be a tiered system with complementary insurance, similar to what we have now, or would the private insurance sector completely disappear? It depends on the proposal that needed to be approved.

In the first year, Medicare will increase with age of eligibility increasing to 55 and all children 18 and under added to the rolls. Over the next two years, this age would drop to 45, then 35. By the fourth year, it would truly become "health insurance for all".

How would that be paid?

That's where things go wrong and one of the reasons it's such a controversial issue.

The chart below illustrates the forecasts for the federal Medicare and Medicaid centers for health care expenditures from 2017 to 2026.

There are several numbers to consider when thinking about the costs of health care.

1. National health expenditure: That's the yellow line in the graph. This represents how much we spend as a country in areas such as drugs, doctor visits and hospital care; including all sources of funding, public and private. In 2017, the cost of health care was $ 3.5 trillion. Over the 2017-2026 period), the cost is expected to be $ 45 trillion.

2 Federal health expenditures: This purple line represents the federal government's share of national health care spending, which includes Medicare and Medicaid. This comes largely from taxes. In 2017, federal spending on health care was $ 974 billion. Between 2017 and 2026, federal spending on health care is expected to reach $ 13 trillion.

3 Total government expenditures: That's the green line, federal spending on health care, plus what states and local municipalities pay. This represents about half of total national health expenditure. the other half comes from the private sector. In 2017, total government spending was $ 1.56 trillion. Between 2017 and 2026, total government spending is expected to reach $ 21 trillion.

Analysis of the health insurance plan for all of Sanders:

Sanders 'analysis was based on the Centers for Medicare & Medicaid Services 2016 health expenditure forecast. CNN used Sanders' assumptions and applied the same savings ratios to the most recent projections in this analysis of Sanders data.

Keep in mind that Centers for Medicare & Medicaid Services predicted that national health care expenditures would rise to about $ 45 trillion between 2017 and 2026. If Sanders' assumptions are correct, Medicare for All would reduce national spending on health care by about $ 6 trillion a decade.

Sanders estimates that these savings would result largely from the reduction in administrative costs, payments to physicians and lower prescription drug prices resulting from a single payer system.

2 Government expenditures: Sanders does not distinguish between federal and state spending in his analysis. All of its expenses are considered federal or public since, in the health insurance plan for all, the federal government is largely the sole payer.

Sanders' analysis assumes that if Medicare for All had been implemented in 2017, federal spending would have been about $ 2 trillion and total public or federal spending would have been about $ 27 trillion for the 2017-2026 decade. But again, Sanders estimates that total national spending on Medicare for All would have reached $ 3.2 trillion in 2017 and about $ 39 trillion over the decade. decade.

To pay for his plan, Sanders called for a new 2.2% income tax on all Americans and a 6.2% levy on employers. It would also increase taxes on the rich. But, he argues, people would save money because they would no longer have to pay copays, monthly premiums, or deductibles. A family of four earning $ 50,000 would save more than $ 5,800 a year, he said. Sanders says that even though everyone will pay more taxes, he will make up for that by paying fewer premiums in health care overhead.

Some experts believe that Sanders' chart is too rosy, overestimating the amount of savings realized through the single payer system.

Other experts, including Kenneth Thorpe, president of health policy and management at Rollins School of Public Health at Emory University, are also contesting Sanders' estimates. No matter the cost reduction, everyone will be affected, said Thorpe, and the tax increases proposed by Sanders could not cover the $ 32 trillion increase.

Thorpe believes that sales taxes should increase, in addition to other tax increases advocated by Sanders, to reach the $ 32 trillion needed. And that would affect everyone. The sales tax is a regressive tax, which means that it will affect the poor more than the rich.

"There will be winners and losers," he said. And who could pay more might surprise you.

According to Thorpe, a person already affiliated with Medicare or Medicaid and paying very little, if any, premiums would likely start paying more taxes and potentially no relief or compensation on premiums. The reason is that what they pay in taxes is potentially higher than their current premiums.

Small business owners could be in a similar boat. If they have less than 50 employees, they currently do not pay any bonuses for their employees. But they would pay more taxes on wages and would see no relief, nor any compensation on premiums.

Are there other places that do this?

Canada and Taiwan are often cited as examples in other countries with a single payer health system under which all residents are insured. These governments pay for health care by imposing taxes on their citizens. In Canada, the federal government provides only health care, and dental, vision care and prescription drugs may be covered by the province or by private insurers.

The UK National Health Service is also often used as an example of a single payer system. But in the English system, not only does the government pay for the services, but it contracts and directly employs doctors and hospitals. This is considered a socialized or nationalized health.

In Canada and Taiwan, and under Medicare in the United States, the government does not own or contract suppliers. The British system appears more like the administration of American veterans.

France, which combines both public and private insurance, is another country often cited as an example in the health care debate. Although most of France is covered by one of the three non-profit health insurance funds funded by the government and covers between 70% and 80% of the costs, there are also private insurers .

All of these countries provide almost universal health care, through which insurance is provided or mandated by the federal government.

Why are health care so expensive in the first place?

In the United States, there are about 16 staff members for a physician, but only six of them have clinical roles, such as nurse aides or medical assistants.

We also spend a lot more on technology and drugs. Pharmaceutical drugs are particularly expensive in the United States, in part because the biggest user of prescription drugs – Medicare – can not lower prices with drug manufacturers. According to Sanders' plan, the government would come to the table to negotiate prices.

What do most people think of Medicare for all?

Public support also depends on your qualification of the program. Remind people that this will eliminate health insurance premiums and lower health care costs for more Americans, and that the program will benefit from a 67% increase. If you tell people that Medicare for All guarantees health care a right for all Americans, the program's approval climbs to 71%.

But remind them that this could eliminate private insurance and support reversals. According to the survey, 58% of Americans would oppose Medicare for All if it got rid of private insurance. Sixty percent of respondents said they oppose the single payer system when it was announced to them that it would increase taxes for most Americans.

In the meantime, what can I do to reduce my own health care costs?

Take charge of your health. Eat better. Exercise.