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In the race for the Democratic presidency, "Medicare for All" (Medicare for All) is one of the most discussed policy proposals for reforming and reorganizing the country's health system. This phrase is encouraged during the election campaign – even by some Republicans – and promoted by a host of presidential candidates.
Senator Bernie Sanders, a hopeful at the White House, shifted the health care debate to the center of the 2020 Democratic presidential primary in April, after presenting a new proposal for "Medicare for All". Several leading Democrats vying for President Donald Trump in 2020 have adopted this measure since Sanders first popularized it during his first run for president in 2016, while other contenders have presented more moderate proposals that would more gradually support the public-private model. coverage currently in place.
Sanders' Medicare for All plan is essentially an expanded version of Medicare, the federal insurance program currently serving approximately 44 million people aged 65 and over and some people with disabilities. It proposes to achieve universal health coverage by moving the country from a fragmented network of public and private funding – in which patients receive care from multiple providers related to patient preferences 39, a physician and provider-specific factors – towards a government-managed plan. almost every person is covered by Medicare. This would prohibit employers from offering private plans that would compete with its government-sponsored option, while maintaining the administration of veterans and Indian health services.
The measure, which aims to eliminate premiums, quotas and deductibles, proposes covering virtually all health expenditures, including: outpatient and ambulatory hospital care, emergency services, primary and preventive care, prescription drugs, mental health and addiction treatment, maternity and newborn care , pediatric care and long-term home and community care. Dental, hearing and visual care would also be included.
Sanders said that Medicare for All would allow Americans to keep their insurance plans even if they changed jobs. Some experts have argued that the program proposed by the senator, managed by the government, would facilitate navigation in the country's health system, because consumers would no longer have to determine whether services or providers are "integrated into the system". network "or" off the network ". and have their choice of doctors and hospitals across the country.
Amelia Haviland, a statistician and public policy professor at Carnegie Mellon University, said consumers would likely live a "pleasantly different" experience by switching to a Medicare for All system.
"There is no precaution at the point of care," Haviland told Salon. "There is no restriction on what you can keep at the doctor.There is no restriction on what you can see doctors.There is no need to worry about to know if this doctor is "networked."
She indicated that Sanders' plan dealt with "the patient's experience" and that she asked questions such as, "Can I pay for this? How should I arrange my care to be able to pay for this? Which supplier can I consult and when can I see them? "
From the patient's point of view, the coverage offered by Medicare for All "may not look very different from what it is currently in. It may just be that someone else is paying the bill at the same time. Ultimately, that's before, "Allison Hoffman, a health law professor and policy professor at the University of Pennsylvania's Faculty of Law, told Salon. "There is nothing in Sanders' plan that changes the way health care is provided."
Lindsey Wiley, professor of health law at American University and president of the American Society of Law, Medicine and Ethics, explained: "According to traditional Medicare, worry about restrictive networks does not exist. Is not the same.It may happen that a doctor refuses to accept new patients, but you would not have to find the list of doctors who have entered into a contract with your private insurance plan . "
Hoffman also pointed out that Medicare for All would produce a system with reduced administrative costs, as doctors and nurses no longer have to spend time transferring medical records between providers, sorting out insurance bills. , fill out forms and negotiate with providers.
"The process from the doctor's point of view would be much simpler," she said. "They would not need to have an entire office filled with people charging all that care, which would significantly reduce administrative costs and complexity – and the same goes for people trying to choose their plan. of health care or even use their health plan. "
Hoffman said that Sanders' proposal would be "much simpler than the type of health insurance we have now".
The projected cost of Sanders' plan remains uncertain – the Congressional Budget Office (CBO) did not note it – but it would likely cost tens of billions of dollars. Sanders said he would fund this through a host of taxes and letting the government set health care prices.
In the United States, health insurance remains one of the most expensive in the world and millions of Americans are less and less covered. Sanders pointed out that his Medicare for All plan had "nothing to do with health care, it was about greed and profit, and we wanted to maintain a dysfunctional system that allowed the five largest health insurance companies to realize more than $ 20 billion in year profits. "
Sanders has proposed extending Medicare rates throughout the health system to reduce healthcare costs – an idea known as centralized pricing. Most countries with universal coverage also set their prices by relying on a single government entity to negotiate prices with hospitals and manufacturers. The United States does it too – Medicare, Medicaid and the Veterans Health Administration all negotiate much lower prices than private insurance companies for the same services – but they do not have a central body to negotiate the prices of all consumers and each private plan is negotiated individually. Medicare, for example, tends to pay health care providers significantly less than private insurers for the same services.
This principle of the Sanders Bill raised questions from consumers, experts, doctors, economists and hospitals about the role of government in centralizing prices. Some Americans have clearly expressed their suspicion of increasing centralized authority, while others have expressed concern that pricing will massively reduce hospital revenues.
Haviland explained the impact of Medicare rates on service providers: "For a provider who sees primarily Medicaid patients, [Medicare for All] would lead to a big increase. For a provider who sees mainly Medicare patients, it would be the same, but with less hassle than in the past. For providers who primarily see patients with private insurance, it's a big pay cut. "
"Payment rates for private insurance are about 40% higher than those for Medicare, and those for Medicare are about 20% higher than those for Medicaid, so if rates are all going to Medicare levels there are serious questions about what would happen to the provider's offer, "she added.
Some critics of Sanders' plan went so far as to claim that extending Medicare payment rates into the health system would cause a massive shortage of doctors and would force hospitals to close, especially those in rural communities. who already have financial difficulties. They argued that some providers might try to offset any reduction in their reimbursement rates by laying off millions of workers and limiting the care provided.
It was feared that the United States would suffer from a growing shortage of doctors before the adoption of the signing law of former President Barack Obama, the Affordable Care Act, or "Obamacare." ", in 2010 and before the expansion of the Medicaid plan in 2014 and 2016. Research shows Obamacare, which provided about 20 million Americans, has not experienced a shortage of doctors.
Democratic presidential nominee John Delaney, a former congressman from Maryland, predicted that Medicare for All would force all hospitals to close.
"If you go to every hospital in the country and ask them a question," How would it have been for you last year if each of your bills had been paid at the Medicare rate? "Every hospital administrator said it would close," said Delaney at the first debate of the 2020 primary race. "And the Medicare for All bill requires payments to remain at current Medicare rates. So we support to a certain extent a bill that will close all hospitals. "
At present, there is insufficient evidence to support Delaney's claim, and experts interviewed by Salon have indicated that the possible effects of Medicare for All on hospitals would likely be varied. They said that while some hospitals could be heavily impacted by a single payer system, others could earn more money.
In fact, some experts have argued that hospitals should earn less money. They stated that US health expenditures were considerably higher than those of other developed countries and that it was necessary to tackle the exorbitant prices of health services in the country. Research suggests that hospitals, especially those with high market power, are among the major drivers of rising health care costs for private insurance because they are able to negotiate much higher health care costs. higher. Rising health care costs and the high administrative costs associated with the enormous complexity of the country's health system also contribute to the huge US health care spending.
In addition to questions about repayment rates, Sanders' plan was subjected to scrutiny by Republicans and conservative policy experts who were concerned that the large influx of patients into the health care system could lengthen wait times and reduce the quality of care. Others have argued that price control of pharmaceutical products would curb innovation.
Salon experts said critics that patients face long waiting times to get a doctor's appointment tell them the truth, but noted that there was little evidence that Medicare for All would decrease the quality of care.
"If you cover 30 million people who did not have access to health care and were starting to use it, there would obviously be increased demand," Hoffman said.
At the same time, Haviland has argued that Medicare for All could actually improve the quality of care because "the provider will not spend a lot of time trying to charge 15 or 100 different payers and it will not negotiate prices with 100 payers different, will probably be able to devote more time to providing care. "
For the moment, many aspects of Sanders' bill remain unknown, including its total cost, design and political feasibility.
"Bernie's proposal is extremely generous at the present time – it's really an ambitious bill – and it's not a bad place to start a discussion," Hoffman said.
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