AuthorTopic: Medicare for All: What Is It and How Will It Work?  (Read 31 times)

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Medicare for All: What Is It and How Will It Work?
« on: June 02, 2020, 12:26:58 PM »
Experts answer your most pressing questions and explain how "Medicare for All" could change healthcare in America.

Ask someone what they think about the idea of “Medicare for All” — that is, one national health insurance plan for all Americans — and you’ll likely hear one of two opinions: One, that it sounds great and could potentially fix the country’s broken healthcare system. Or two, that it would be the downfall of our country’s (broken) healthcare system.

What you likely won’t hear? A succinct, fact-based explanation of what Medicare for All would actually entail and how it could affect you.

It’s a topic that is especially relevant right now. In the midst of the 2020 U.S. presidential election, Medicare for All has become a key point of contention in the Democratic Party primary. From Senators Bernie Sanders and Elizabeth Warren’s embrace of single-payer healthcare to former Vice President Joe Biden and Sen. Amy Klobuchar’s embrace of reforms to the Affordable Care Act (ACA), how to best improve healthcare in America is a divisive issue for voters.

It also can become confusing and difficult to parse out differences between different policies in order to assess how they might impact your day-to-day life if enacted. The other question in this divisive political climate: Will any of these plans be enacted in a Washington D.C. that has been defined more by its partisan divides and policy inaction?

To try to make sense of Medicare for All and how the politics of the day are impacting America’s approach to health coverage, we asked healthcare experts to answer your most pressing questions.

What is the overall plan?

One of the biggest misconceptions about Medicare for All is that there’s just one proposal on the table.

“In fact, there are a number of different proposals out there,” explained Katie Keith, JD, MPH, a research faculty member for Georgetown University’s Center on Health Insurance Reforms.

“Most people tend to think of the most far-reaching Medicare for All proposals, which are outlined in bills sponsored by Sen. Bernie Sanders and Rep. Pramila Jayapal. But there are a number of proposals out there that would expand the role of public programs in healthcare,” she said.

Although all of these plans tend to get grouped together, “there are key differences among the various options,” Keith added, “and, as we know in healthcare, the differences and details really matter.”

According to the Kaiser Family Foundation, Sanders’ and Jayapal's bills (S. 1129 and H.R. 1384, respectively) share many similarities, such as:

    comprehensive benefits
    tax financed
    a replacement for all private health insurance, as well as the current Medicare program
    lifetime enrollment
    no premiums
    all state-licensed, certified providers who meet eligible standards can apply

Other bills put a slightly different spin on single-payer health insurance. For instance, they may give you the right to opt out of the plan, offer this healthcare only to people who don’t qualify for Medicaid, or make it eligible to people who are only between the ages of 50 and 64.

When it comes to the current Democratic presidential primary, out of a field that initially numbered nearly 30 candidates, support for Medicare for All offered something of a litmus test for who would be considered a “progressive” along the lines of Sanders and who would fall more on the side of building upon the existing system put forward by the Obama administration.

Out of the remaining candidates in the Democratic field, Warren is the only top-tier contender who embraces a full-on implementation of a Medicare for All Plan over the course of a hypothetical first term. Outside of that top tier, Rep. Tulsi Gabbard, Congresswoman from Hawaii, also embraces a Medicare for All approach.

Warren’s plan essentially has the same objectives of Sanders’ bill. She’s advocated for phasing in this system. In the first 100 days of her presidency, she would use executive powers to reign in high insurance and prescription drug costs while also introducing a pathway for people to opt in for a government Medicare system if they choose. She says that by the end of her third year in office, she would advocate to pass legislation for a full national transition to a Medicare for All system, according to the Warren campaign website.

So far this election cycle, there has been contention over how these plans would be implemented. For instance, other top candidates might not advocate for a stringent Medicare for All policy like that promoted by Warren and Sanders. Instead, the focus of this other group of candidates is building upon and expanding coverage provided by the ACA.

Former South Bend, Indiana, Mayor Pete Buttigieg has advocated for what his campaign calls “Medicare for All who want it,” adding a public option to the ACA. This means a government-supported public Medicare option would exist alongside the choice of keeping one’s private health plan, according to the candidate’s website.

The other top candidates support possibly working toward this goal. Biden is campaigning on improving upon the ACA with the potential goal of a public option down the line. This incrementalist approach is also shared by Minnesota Sen. Amy Klobuchar and former New York City mayor Michael Bloomberg.

John McDonough, DrPH, MPA, a professor of public health practice in the department of health policy and management at the Harvard T.H. Chan School of Public Health and director of executive and continuing professional education, said since Medicare for All discussions have been framed as a “for or against debate” by media analysts and political handicappers this cycle, the atmosphere has become particularly contentious.

It’s something McDonough is certainly familiar with, given he previously worked on the development and passage of the ACA as a senior advisor on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions.

“The other issues on the table in the Democratic debates do not parse so easily, and that helps to explain the prominence of this issue tied to the overall interest in health system reform,” he told Healthline.

How, exactly, would Medicare for All work?

As far as the current legislation on the table like the Sanders and Jayapal bills, "the simplest explanation is that these bills would move the United States from our current multi-payer healthcare system to what is known as a single-payer system,” explained Keith.

Right now, multiple groups pay for healthcare. That includes private health insurance companies, employers, and the government, through programs like Medicare and Medicaid.

Single-payer is an umbrella term for multiple approaches. In essence, single-payer means your taxes would cover health expenses for the whole population, according to a definition of the term from the Journal of General Internal MedicineTrusted Source. The objective is for a single publicly funded health system, like that in Canada, the United Kingdom, and Australia.

Right now in the United States, multiple groups pay for healthcare. That includes private health insurance companies, employers, and the government, through programs like Medicare and Medicaid.

The system we have right now places America’s health system on an island on its own, away from its peers on the global stage.

For instance, the Commonwealth Fund reports the United States ranks last “on measures of quality, efficiency, access to care, equity, and the ability to lead long, healthy, and productive lives.” This is compared to six other major industrialized countries — Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. Another dubious honor for the United States? The system here is by far the most expensive.

“Under Medicare for All, we would have only a single entity — in this case, the federal government — paying for healthcare,” said Keith. “This would largely eliminate the role of private health insurance companies and employers in providing health insurance and paying for healthcare.”

The current Medicare program wouldn’t exactly vanish.

“It would be also expanded to cover everyone and would include much more robust benefits (such as long-term care) that [are] not currently covered by Medicare right now,” said Keith.
What might out-of-pocket costs look like for different income brackets?

Despite what some online conspiracy theories warn, “under the Sanders and Jayapal bills, there would be virtually no out-of-pocket costs for healthcare-related expenses,” Keith said. “The bills would prohibit deductibles, coinsurance, co-pays, and surprise medical bills for healthcare services and items covered under Medicare for All.”

You may have to pay some out-of-pocket costs for services that aren’t covered by the program, “but the benefits are expansive, so it’s not clear that this would happen often,” said Keith.

The Jayapal bill fully prohibits all cost-sharing. The Sanders bill allows for very limited out-of-pocket costs of up to $200 per year for prescription drugs, but that doesn’t apply to individuals or families with an income under 200 percent of the federal poverty level.

Other proposals, such as the Medicare for America Act from Reps. Rosa DeLauro (D-Conn.) and Jan Schakowsky (D-Ill.), would nix out-of-pocket costs for lower-income individuals, but people in higher income brackets would pay more: up to $3,500 in annual out-of-pocket costs for individuals or $5,000 for a family.

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Mark Twain — 'There are many humorous things in the world; among them, the white man's notion that he is less savage than the other savages.'


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