It’s possible you’ve tuned out when the Democrats running for president have tussled over “Medicare for all.” But now that Bernie Sanders, the author of the Medicare for All Act, is ascending in the nominating contest, it’s a good time to take a closer look at what it would mean for the health system, your health insurance and finances, and the federal budget.
Here’s our quick primer, with some suggestions for further reading.
Would it be a big change?
Yes. When you think about Medicare for all, it is more helpful to focus on the “all” part than the “Medicare” part. Mr. Sanders’s proposal would set up a brand-new government health insurance system, with many more benefits than Medicare. Everyone in the United States would get health insurance from this new, generous government system. Existing private health insurance plans would be eliminated. So would insurance premiums, deductibles and co-payments.
Medicare for all insurance would cover many services that most health plans omit now, including dental care, eyeglasses, hearing aids and home-based long-term care for people with disabilities.
It would also make major changes to how health care is financed in the United States. Now, we pay for health care through federal taxes and state taxes, as well as premiums and cash when we go to the doctor or the pharmacy counter. Under Medicare for all, federal taxes would pay for the entire system.
How much would it cost?
A lot, but be wary of any politician brandishing a precise number. Medicare for all would be a very big change to many parts of the health system and the government, and it would involve a lot of tough policy decisions. That makes calculating a price tricky.
Economists have produced various estimates. It’s probably most helpful to think about the range. Give or take, they said the Medicare for all system would cost around the same as the current system — government, employer and individual spending combined. But even the most conservative spending estimate would involve a huge shift of health care dollars from individuals and businesses to the federal government. Medicare for all would be an enormous expansion of government spending, and would almost certainly require large tax increases.
Mr. Sanders recently released a fact sheet with some ideas about how he might finance the system. His proposal is centered on a large payroll tax that would be paid by medium and large companies and by families earning more than $29,000 a year. But it also would include higher taxes on corporations and people with high incomes. Altogether, his proposed taxes would raise far less money than most estimates of what the program would cost.
Would you have to change your current health insurance?
Yes. People who get their coverage from Medicare would see the smallest change. They would keep getting insurance called Medicare from the government, only with new benefits and fewer fees. People with nearly any other type of insurance would have to switch to the government plan.
But, as Mr. Sanders often points out, people who lose their private insurance would, in almost all cases, get more generous government insurance instead. Nearly every doctor and hospital in the country would probably accept the new Medicare insurance, so changing your insurance would probably not mean changing doctors, as it often means now when you change your private insurer.
What would this mean for doctors, hospitals and drug companies?
Under Medicare for all, doctors and hospitals would remain in private hands. But because the government insurance would effectively be their only source of income, the government would have much more control over the medical system. Nearly every estimate of the cost of Medicare for all assumes that the public system would pay doctors and hospitals less than they currently earn from private insurers. That could mean substantial pay cuts for certain health care providers who see a lot of privately insured patients.
Drug companies would probably take the biggest cut. Estimates tend to assume that the government would pay them substantially lower prices for their products than they currently receive.
Would this system make the United States like other Western countries?
Not exactly. Nearly every peer country has universal health insurance coverage. But Mr. Sanders proposes a plan in which the government provides insurance to everyone directly, and where people are responsible for almost no out-of-pocket costs. It comes the closest to the Canadian system, also called Medicare. But in Canada, Medicare does not cover prescription drugs or dental care, for example. In most European countries, there is a mix of private and public sources of insurance.
Would cosmetic surgery be covered?
Probably not. Mr. Sanders says a market might spring up for cosmetic surgery insurance in a Medicare-for-all world. But many experts say you’d still have to pay out of pocket for a face-lift.
Is this plan popular?
It’s pretty popular — with a big caveat. In recent surveys, just over half of Americans consistently say they approve of the idea. Medicare for all polls even better among Democratic voters, the people who are participating in presidential primaries and caucuses.
But support has proved malleable. Public opinion surveys also show that many voters who say they like Medicare for all don’t know much about the details, and some change their minds after learning about certain features, like the loss of private insurance or possible tax increases. In a general election, voters are likely to hear far more about these counterarguments than they are now.
Democratic health proposals that would allow people to choose a government plan or keep their current insurance arrangements are also quite popular.
What are the other Democratic candidates proposing?
With the exception of Elizabeth Warren, who also endorses a Medicare for all plan, the other top remaining Democratic presidential candidates have all backed flavors of a “public option” health plan, in which people can choose between buying a government plan or buying private health insurance. These various public-option plans would expand the reach of government insurance and improve the generosity of government subsidies to help middle-income people pay for insurance. They would also probably affect insurance markets, causing some people to lose their current coverage even if they did not choose the public plan.
But “public option” approaches would preserve more of the current structure of our health system, with its varying plans, premiums, deductibles and co-payments. These approaches would also require increases in federal spending, but the increases would be smaller because people, businesses and state governments would largely continue paying for health care in the manner they do now.
How can I understand these differences using home construction metaphors?
I’m so glad you asked.