Bernie Sanders’ Medicare for All Act
Politics and Policy
This week, Senator Bernie Sanders released the latest iteration of his vision of a single-payer American health system, titled the “Medicare for All Act.” Even as the battle over repeal-and-replace continues, the plan is an indication of the trajectory many Democrats will take going forward on health care. It shows that Democrats are becoming more comfortable with bold plans for universal health care that many would have shied away from just years ago, but also indicates that there’s still a ways to go in refining the nuts-and-bolts of the progressive single-payer approach.
The first thing to acknowledge is that the plan is dead on arrival in Congress. With Republican control of both chambers and the presidency, there’s no path forward for a bill that opponents would criticize as a far-left solution to healthcare. They’d be justified — the plan firmly states its aspirations as a radical shift to providing no-cost health services to every American. While the legislation may be in a holding pattern for a few years, it gives us a chance to examine what the policy actually entails.
Despite opposition, Sanders’ plan comes at a time when the idea of single-payer is at a historically high level of popularity.
The share of Americans who think the government should be responsible for providing health care to citizens is near all-time highs. Voters entrust Democrats more than Republicans when it comes to issues regarding health care. Support for single-payer, particularly the idea of “Medicare for all,” continues to grow and is at a record high. Evidence of this was on display when Sanders announced his plan surrounded by 16 other Senators, just under half the Democratic caucus in the Senate. Among others, he was joined by Senators Elizabeth Warren, Cory Booker, Al Franken, Kirsten Gillibrand, Kamala Harris, and Brian Schatz, who are considered flag bearers of the progressive cause and several have been suggested as 2020 presidential candidates.
Sanders is taking advantage of this increased popularity. His proposal stakes out the furthest-left that popular Democrats have been willing to go on health care. The first goal is to ensure universal coverage, finally realizing what Obama had hoped to achieve with the Affordable Care Act. The second goal is to provide virtually all health services (including vision and dental) with no direct costs to patients — no copays, coinsurance, or deductibles. Some drugs would have a small amount of copay not to exceed $200 annually.
This is a departure from Medicare simply broadened to provide for all citizens, as well as Canadian or British examples. All these programs place some restriction on services offered or have varying degrees of cost-sharing to discourage overuse of the medical system. The Sanders plan also reverts to what is referred to as an open network where patients would be able to utilize any provider across the country. As a result, the Medicare for All Act would almost certainly be an improvement over all current government and employer-sponsored health plans (as measured by actuarial value).
As Bernie well knows, the devil is in the details. As a placeholder, the bill is a significant step forward for Democrats looking coalesce around a specific vision to secure universal health care in the United States. However, the legislation is vague on many of the policy specifics, including where the money for all of America’s health services will come from and how it will be provided.
Covering more people, and without cost-sharing, means demand for services will increase. One predictable need is a plan for increasing the amount of clinicians — particularly primary care physicians. We also need a reimbursement structure for those physicians, as well as the hospitals where they deliver care. These and many other issues are left to the discretion of the HHS Secretary. It’s legislation by delegation and means that many aspects of the policy are could change from administration to administration without acts of Congress.
Politically, the plan faces tremendous hurdles. As options for single-payer go, Sanders’ plan would be a relatively expensive one. Where that money comes from is an important question. Even though the senator intends to gather much of the money from higher taxes on the wealthiest individuals, it still requires a tax increase, which has historically been the death-knell for previous single-payer attempts. By ending insurance companies, and taking direct control of how every physician, hospital, pharmacy and drug or device company is paid, almost every vested interest in medicine will be fighting against the bill or for control over reimbursement. Additionally, the only constituents whose insurance plan would not change are those who get their care from the Veterans Administration or Indian Health Service. Many are skeptical of such a change even as most Americans would stand to get improved coverage.
Democrats still have years to fill in the details, and any final proposal will likely negotiate the suite of benefits down to something resembling current employer-sponsored insurance to control costs. For advocates of single-payer health care, this represents a major step forward as Democrats begin to accept it as part of their platform. For policy makers, it begins the discussion of how we can make a realistic transition from the current health care system to an all-new environment.
