The likelihood of expanding Medicare to cover all Americans in the near future is close to zero, but the proposal will be prominent.
The likelihood of expanding Medicare to cover all Americans in the near future is close to zero, but the proposal will be prominent.

“Medicare for All” is the banner under which a variety of Democrats present their plans for reforming the health care system.

Sen. Bernie Sanders (I-Vt.) was among the earliest and most prominent advocates of universal health care. In the 2017–18 Congress, he introduced the Medicare for All Act. Earlier this year in the House of Representatives, Rep. Pramila Jayapal (D-Wa.) and more than 100 cosponsors introduced another bill for Medicare for All.

Four-year phase-in

Sanders’ plan for expanded Medicare would be phased in over a four-year period. The program would cover all residents of the United States. The U.S. Secretary of Health and Human Services would issue regulations regarding who is eligible as a “resident.”

Medicare for All would cover all treatment that is “medically necessary or appropriate.” Unlike the current traditional Medicare program, Sanders’ proposal also would cover oral, audiology and vision services, as well as prescription drugs.

To help make sure that the government health plan is truly universal, insurance companies and employers would be prohibited from offering coverage that duplicated coverage under the act.

The act provides there shall be “no cost-sharing, including deductibles, coinsurance, copayments, or similar charges” for benefits under the act.

Some exceptions are allowed, including for prescription drugs and biological products, provided the purpose of the exception is to encourage use of generic products and the cost-sharing does not exceed $200 per person per year (adjusted for inflation).

Effect on physicians’ pay

Physicians and other providers who enter into a “Participation Agreement” with the government would be prohibited from making any charges to patients for covered services other than for payments authorized by the act.

Compensation for physicians and other providers would be likely to drop under Medicare for All. The government would set the payment rates, and Medicare rates are usually less than payments currently paid by insurance companies.

On the other hand, compensation for treating patients who had been covered under Medicaid probably will increase since Medicare rates generally are higher than Medicaid rates.

Funding for the program

Under Sanders’ proposal, funding for the program will come from existing health care dollars, plus an undetermined amount of new taxes.

Payments that would have been made to the existing programs for Medicare, Medicaid, Federal Employees Health Benefits, and other federal health programs will be deposited into a new Medicare Trust Fund.

Since the new program covers all U.S.residents and not just the current Medicare population, additional revenue will be necessary. Sources of that revenue could include an increase in the Medicare tax or higher income taxes.

Advocates of Medicare for All project substantial savings in some categories of expenditures compared to the current system. Estimates of savings have ranged from $1.5 to $5 trillion over 10 years.

Since there will be a single payer rather than hundreds of payers, administrative costs will be much less. In addition, under the Sanders proposal, the government will negotiate (or dictate) the amount it is willing to pay for pharmaceutical and medical supplies, thus dropping the cost for drugs.

On the other hand, the shift of more than 155 million people who are currently covered by employer-based health plans to a government health plan could increase federal spending by at least $32 trillion over 10 years, according to the AMA.

Level of public support

A survey by the Kaiser Family Foundation found public support for the broad concept of Medicare for All. The labels used in the surveys affected the level of support. “Medicare for All” drew the most positive response (62%); “national health plan” received a 57% rating. When the term “single payer” was used, support dropped to 48 percent.

If respondents to the survey were given more information about tradeoffs for the added coverage—such as higher taxes and increased government control—support dropped further.

Multiple industry groups oppose Medicare for All. Those groups include insurance companies, pharmaceutical companies, some hospital groups, and the AMA.A statement from the AMA said basing payments on Medicare rates and global budgets “raise significant questions as to whether physicians and other health care providers would be able to sustain their practices under Medicare for All.”

As long as Republicans have control of the Senate, the House, or the White House, passage of Medicare for All is very unlikely. The issue, along with alternative proposals, will be prominent in the coming campaigns.