Medicare all debate jump concerns about deductibles

With Republicans struggling to defend a controversial president and signs pointing to a big opportunity in next month’s elections, Democrats are finding that health care reform is a blue-hot issue. And it’s hottest when they speak of building on a 53-year-old program that, all told, has a pretty good rep for delivering health care to the nation’s seniors. As Paige Winfield Cunningham wrote in the Washington Post’s “Health 202” blog in April, “If you want to sell Americans a bill expanding the government’s role in health care, be sure to include ‘Medicare’ in the title.”

Smart packaging, yes, but some experts think it’s smart substance, too. Writes Princeton economist Paul Starr in this August’s Journal o f Health Politics, Policy, and Law: “From a political and economic standpoint, the fundamentals favor Medicare as a platform for both expanding coverage and containing costs.”

Indeed, building on Medicare is one thing current coverage-expansion proposals have in common— with one Medicaid-based exception. Aside from that, they’re a dizzying array, but they come in two basic “flavors,” explains Matthew Fiedler, a fellow at the Brookings Institution’s Center for Health Policy. “One is a true single-payer approach, in which all services would be provided through one public insurer. Private insurance would no longer exist, and all the costs of financing that public coverage would be borne, typically, by the federal government. The other flavor would give individuals the option to buy into a public plan that would compete alongside private insurers. Many plans of this kind would provide additional subsidies to make purchasing coverage more affordable, and some would restore an individual mandate.”

Nine years ago, when the Affordable Care Act passed, even a public option—a light-touch choice for increased government participation—proved politically unpalatable. So why are Democratic candidates excited today? Polls are one reason. In a recent Kaiser Family Foundation survey, a “Medicare for All” proposal to expand coverage won the approval of 59% of Americans, including 58% of political independents, while an even heftier 75% gave the nod to a public option plan. Another reason is the “in-your-face” political era we live in, when there seems to be no payoff for playing nice with the GOP. Democrats remember the Obamacare struggle, when they took pains to craft a health care reform proposal built on market principles dear to Republican hearts and the Republican idea of an individual mandate. The tally of Republican votes it got them? Zero.

Meet M4A

As proposed by Sen. Bernie Sanders, Medicare for All would extend coverage beyond seniors to all Americans by establishing the U.S. government as the single payer. It would eliminate private insurance with its concoction of premiums, deductibles, coinsurance, and copays. Sanders also wants to include coverage for dental and vision care. As Starr points out, it’s a bit of a misnomer because Medicare is not really a single-payer program, but one in which a third of beneficiaries now buy private coverage through Medicare Advantage plans. The proposal might be more accurately named “Medicare’s public plan for all.”

Whatever it’s called, it’s riding higher than ever. When Sanders introduced his bill in the Senate in 2013 he found no cosponsors. The version introduced in September 2017—S. 1804, the Medicare for All Act of 2017—had 16. “There’s never been as much support for single-payer as there is now” says Sally Pipes of the conservative Pacific Research Institute—and she’s no booster but a foe who believes that “M4A”—as some insiders call it—is a terrible idea.

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