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There’s an emerging fight in the Democratic party between two competing ideas for healthcare policies: Medicare For All — strongly backed by Bernie Sanders — and Medicare for America.
In this video I’m going to go through both plans and explain why the Medicare For All plan is better.
But before we go further: what is Medicare For All?
This is the healthcare plan associated with Bernie Sanders’ healthcare bill which would replace the private for-profit health insurance system with a public, single payer system.
Rather than having a whole bunch of private insurance company, you’d have one public insurance provider that everyone would use.
People wouldn’t get insurance through their job anymore, they’d get it from the public insurance provider.
And this public provider would be better than private insurers for a whole bunch of reasons.
First, you would no longer have to pay to go the doctor, get surgery, or use the healthcare system in any way. It’s 100% funded by taxes, so there’s no copayments or deductibles or premiums.
Think of it more like public school rather — you get the service for free at the point of access because taxes have already funded it.
Bernie’s proposal covers doctors visits and all the usual treatments, along with dental and vision, so most of your healthcare needs will be taken care of throughout your life.
Second, having one public insurance provider makes everything cheaper and more efficient.
Right now a big part of healthcare costs are the overhead and marketing budgets for private insurers. A public insurer eliminates all this, so you pay less overall, and what you do pay goes directly to healthcare.
The best estimates around this show that Medicare For All would lower total spending on healthcare by around 5 trillion dollars over a decade.
Even a study by the Mercatus Centre, which is a right wing think tank funded by the Koch Brothers, showed Sanders plan reducing total healthcare spending by 2 trillion dollars over a decade.
Third, your healthcare would no longer be tied to your job. So if you lost your job, you and your family would still have the same healthcare. If you wanted to leave your job and go somewhere else, you wouldn’t have to worry about losing coverage.
Having Medicare For All makes everyone more free and less tied down to an employer.
Now I know something about this because I live in Canada, and here we have a healthcare system very similar to the Medicare For All plan Bernie is proposing.
Compared to the US system, it’s incredible. When I need to see a doctor, I walk into a clinic — there are about 5 within a 20 minute walk of me — and see a doctor the same day.
Some times you have to wait 45 minutes or so but it’s not a big deal.
I see the doctor, they look into whatever issue I’m having, and I leave. I never pay a thing. All I do is show the front desk my health card, and it’s taken care of.
And if you need to see a specialist, it’s the same deal. Your doctor will write you a referral, you call them and setup an appointment, and then go see them — all for free.
Most people have a dedicated family doctor which makes the whole process even more streamlined, though I don’t because I just don’t need to see a doctor that often.
Now the one thing you’ll often hear about in the Canadian system is wait times. People complain that they have to wait too long for surgeries and such.
There is some truth to this, but it’s not any worse than the US system, and urgent care is available immediately.
The key difference between the public and private system is that in the public system procedures are done based on need, so more urgent care is provided faster. Things that can wait a bit longer like knee replacement take a bit longer to schedule.
In the private system, procedures are done based on who can pay. So rich people get their care sooner (and better) even if their problem is less urgent than someone with less money.
To me this is another benefit of the public Medicare For All system: it allocates resources more fairly based on need and urgency rather than wealth.
So that’s the Medicare For All plan backed by Bernie.
The emerging alternative to this is Medicare For America.
The Medicare for America plan has come out of a think tank called the Center for American Progress, which typically supports more incrementalist or centrist policies.
Right now no candidate has endorsed Medicare for America, but Beto O’Rourke has said positive things about it, and I suspect most of them will end up supporting this plan.
So what is it?
The basic idea of Medicare for America is that you’d have a public insurance provider that existed alongside private insurers.
Medicare for America would still have co-payments, deductibles, premiums, and so on, but these would be limited for people on low incomes.
The big idea about this plan is that employers would have the ability to switch from their private insurance to the public plan, and because it would be so much cheaper the architects of the plan expect 85% of people would end up on Medicare for America.
Centrist Democrats appear to be drawn to this plan for a number of reasons that I don’t think they have really thought through.
The big argument they give is that Medicare for America would let people keep their current plans if they like them whereas Medicare For All would push everyone onto a public system.
This they argue would be more popular because people are happy with their current insurance and don’t want to switch.
But regardless of whether they want to switch, insurance switching happens all the time right now — everytime someone loses their job, or every time their employers changes insurance providers, they lose their current insurance.
Under the Medicare for America plan they’d also have to switch.
The whole rationale for Medicare for America is that most employers will switch to the public insurer, meaning their employees will lose their private insurance, and gain public insurance.
If you think it’s a political problem that Medicare for All puts everyone in the public system, then you must also think the same problem will exist for Medicare for America — after all, most people are going to have to switch anyway!
The virtue of Medicare for All is that it takes the decision of what insurance you’ll have out of the hands of your employer, so everyone will switch once to the public insurance system and then be covered by that forever.
There’s no gaps in coverage when you change jobs or your employer switches providers — you always have consistent, good health insurance when you need it.
So if you’re concerned about forced switching, you should support Medicare for All — it minimizes the process to just one switch.
As far as I can tell there’s no good reason to prefer Medicare for America to Medicare for All. It’s less comprehensive and leaves gaps open that many people will surely fall through.
You also end up with a two-tier healthcare system in which rich people can get care faster and at a higher quality even though they may need it less.
I think healthcare should be allocated based on need, not ability to pay, and having a two-tier system is incompatible with this view.
I suspect the real reason centrist Democrats prefer it is because they think it will generate less backlash from the big insurance companies.
To me this looks like a foolish bet — insurance companies were ready to go to war with Obama over a public option before he backed down, they will certainly do the same over this plan… especially when its creators say it will destroy most private insurance providers anyway.
Whether Democrats support Medicare for All or Medicare for America, they’re going to have to take on the private interests who stand to lose in these proposals.
Rather than hiding from the inevitable fight, I say better to prepare now to win it.
That’ll do it for this video. If you liked it remember to subscribe and leave a comment letting me know what you think. For The Cable, I’m Taylor Scollon — see you next time.