Medicare for All – What is it, Exactly?

Kate Dixon, Class of 2023
Kate has worked in Washington D.C. for the past two years in policy.

We’ve all seen the political tweets. Typically, something incoherent with poor grammar from one extreme of the political spectrum or the other (see my personal favorite about “HealtCare”). And as of late those tweets have had a lot to do with Medicare for All. But what exactly is Medicare for All (M4A)?

Skeleton Outline of Medicare For All

The health reform proposal was first introduced as a skeleton of a plan in the 2016 presidential election by Senator Bernie Sanders and has since evolved into (somewhat) legitimate bills introduced in both the House (by Representative Jayapal of Washington) and Senate (by Senator Sanders of Vermont). I say somewhat because neither bill includes any language as to how the program will be paid for, which, as you’ll see in a moment, is a pretty important piece. As the name suggests, it would expand the Medicare system (what now provides coverage for those over 65) to cover all Americans. Both bills result in the complete elimination of health insurance as we know it: there would be no private insurers; prices for provider services and drugs would be set at a national level; and patients would no longer pay a thing for care – no premiums, no deductibles, no cost-sharing, no nothing.

 Now that you have spent your very precious time reading all of that you should know that these bills will literally never be a thing in the current Administration.

Extraordinary Cost of M4A

First of all, free health care? That’s the dream. But unfortunately, “free” comes at a cost. According to a recent study, that cost is $32 trillion over 10 years (and that’s the low estimate which assumes providers will take pay cuts of more than 40%).[1] Someone will have to pay for it. However, that same study suggests that even doubling both individual and corporate tax rates wouldn’t come close to covering the cost of the program.

Political Intransigency’s of M4A

 Even if the money were to magically appear, the politics – as they often do – would keep these bills from moving forward any time soon (listen to this banger for a reminder of how a bill becomes a law). Our current Congress has a Democrat-majority House and a Republican-majority Senate. As Schoolhouse Rock so mentions, in order for a bill to become a law you need it to pass BOTH the House and the Senate before it will be considered by the President. Because both M4A bills are about as far to the left of the political spectrum as can be, there is no political chance that either will pass in the Senate.

Current Health Reform Options

 So, let me zoom out just a bit and catch you up to speed as to where things stand more generally on health reform. Currently, the Democratic Party is working hard to gain foothold of health care as they head into the 2020 elections. This is happening in the form of three major approaches to health reform: single-payer, a public plan option, and Medicare/Medicaid buy-in (see my cheat sheet). However, similar to the reasons listed above, none of these plans are likely to gain any real traction in Congress. As for the Republican Party, they’re still licking their wounds from failing to “Repeal and Replace” Obamacare – the ’UGE (cue Trump hand gesture), Republican health care overhaul that was supposed to take place in 2017. As of now, there are no legitimate plans in the works for what a right-winged reform might look like.

CHEAT SHEET

Medicare cheat sheet

Here’s the deal, folks. Big, grand health reform isn’t looking likely this year. It’s probably not even going to happen before the majority of us are practicing physicians. But it will absolutely, 100 percent be happening in our lifetime. And I truly believe it’s going to be our generation that makes it happen – we need to make it happen.

We live in a country that currently spends three times more on health care than any other nation in the world; yet our health outcomes fall well below our fellow developed nations. When looking at maternal mortality rates, for example, the US ranks as the worst developed country to have a baby.[2] That’s terrifying. We’re spending far more to perform way worse. How does that make any sense?

Universal Coverage Can Be Accomplished In Different Ways

 Numerous countries across the globe have accomplished universal coverage for their people. Mind you, no health system looks the same and very few are in the form of single-payer. For example, coverage in Germany and Switzerland’s systems are provided entirely by private insurance companies with the government covering the majority of the costs.[3] Universal health care is absolutely possible – it’s just how we get there that’s the big question.

It’s going to take lots of patience, lots of strategy, (probably) lots of trade-offs, and lots of big brains to make the United States another country that provides access to affordable, quality health care for all of its citizens. But if I’m not mistaken, we have a few of those big brains here at KUMC.

As the youths say: stay woke. Health care change is coming, and it just might be on us to see it through.

[1] https://www.mercatus.org/bridge/commentary/medicare-all-plan-would-cost-federal-government-32-trillion

[2] https://www.newsweek.com/us-most-dangerous-developed-country-give-birth-report-1044898

[3] https://www.thebalance.com/universal-health-care-4156211

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