It looks to me like one of the biggest issues that will be aired in the upcoming Democratic presidential debates will be “Medicare For All.” Candidates from the liberal wing of the party all want to be the one left standing to fight it out with Joe Biden, who seems to be staking his bid as the moderate. Medicare For All really appeals to the Democratic base, so count on several embracing it.
The concept sounds good, but the devil is in the details. A new Kaiser Family Foundation poll released Tuesday found that majorities of those polled have mistaken views about the government-run program backed by Vermont Sen. Bernie Sanders.
The poll shows that nearly seven in 10 Americans think they would continue to pay deductibles and co-pays under Medicare For All, Kaiser found, when, in fact, they would not. Some 54 percent wrongly believe that individuals and employers would continue to pay premiums.
The poll also found that the majority think that those who currently get health insurance through their jobs or buy it on their own would be able to keep their plans. This is very unlikely. In fact, the current proposals would essentially do away with private insurance altogether.
Let’s discuss some basic facts.
Although I tend to be conservative on most issues, this is not one not them. I have written many times that I think our health care system is broken and needs fixed. I have castigated Republicans for not taking this giant problem seriously enough and pretending that all is fine. Like I said, the devil is in the details. Let’s consider the rough framework of what a plan would look like.
Rep. Pramila Jayapal (D-WA), a co-chair of the Medicare For All Caucus, released a bill this year that would adopt a “single-payer system,” which Medicare For All would be. As such, the federal government would replace private health insurance companies as the sole provider of most health care financing. Estimates of the costs vary wildly, but most similar proposals have been estimated to cost the federal government roughly $28-32 trillion over a decade, or several trillion a year. That’s trillion not billion.
Rep. Jayapal’s Medicare For All Act would replace nearly all current insurance with a government-run, single-payer plan and extend that plan to those who currently lack health coverage. The plan itself would be far more generous than either Medicare or most private coverage, as it would include no deductibles or copayments, would not restrict beneficiaries to networks of care and would offer a broad suite of benefits including dental care, vision care, transportation for disabled and low-income patients, dietary and nutritional care, long-term care, etc.
The proposal also establishes a global health budget and moves away from fee-for-service towards lump-sum payments for many providers. It includes a number of measures to hold down drug prices and makes a variety of other changes to the health care system.
This proposal is fairly similar to Sen. Sanders’ proposed single-payer plan. During the 2016 presidential campaign, his campaign estimated that plan would cost the federal government about $14 trillion over a decade. Take that with a grain of salt. Most other estimates are at least twice that high.
That being said, our current Frankenstein private system is crazily expensive and unfair to many, including the self-employed or those working for small business. As a small businessman that has to pay for my employees’ group coverage, I can personally attest to how ridiculously overpriced and unfair our current system is. Our country needs a serious debate on the subject.
Enacting Medicare For All would mean increasing federal spending by about 60 percent or more. Financing a $30 trillion program would require the equivalent of tripling payroll taxes or more than doubling all other taxes.
Keep in mind when candidates are throwing numbers out there that these totals represent the increased cost to the federal government, not the total of national health expenditures. My guess is that overall national health expenditures would likely change by no more than a few trillion dollars over a decade. That is where the details of the plan become very important. To be successful, it would need to be able to force down costs with lower provider payments, drug payments and administrative spending.
Can that be done without ruining our health care quality and freedom of choice? Don’t let anybody fool you. That is the rub. But in my opinion, we at least need to seriously consider something.
That’s my take; let me know yours. Vote in our weekly Post online poll. “Is Medicare For All a realistic possibility for America?”