Bernie Sanders unveiled the 2019 version of his Medicare for All bill and like iterations in recent years it was met with much support from the bulk of the Democratic Party and a significant number of national political organizations.
In fact, on roll out, the 2019 version featured co-sponsorships from Senators Cory Booker, Elizabeth Warren, Kamala Harris, and Kirsten Gillibrand, among others. In the house the effort is spearheaded by Washington Rep. Primila Jayapal, additionally the bill has over 100+ co-sponsors, including the likes of Alexandria Ocascio-Cortez, Ilhan Omar, Rashida Tlaib, and many, many others.
Outside congress the American Federation of Teachers, Service Employees International Union (SEIU), and National Nurses United all support the bill as well. So labor is well represented as well. As are other progressive/leftist political organizations such as MoveOn and the Democratic Socialists of America. As far as institutional buy in goes, movers and shakers in congress and massive unions with a lot of clout all support the bill.
To top it off, Medicare for All is supported by the majority of Americans (70%+ in recent polling, even when specifics are hashed out.) So there is a good chance Bernie’s bill could actually become law, at which point the question becomes, what does Medicare for All mean and what does Medicare for All do?
The Bill Itself: No More Private Insurance, No More Premiums, And A Four Year Roll Out
The first thing to get straight with Bernie’s bill, is what stays and what goes. First, there would be no more private insurance in the form it exists today. Bernie has left open the door for supplemental insurance for special procedures like cosmetic surgeries or other retail care. But what that looks like remains to be seen. The Veterans Health Administration (VA) and Indian Health Services remain as is. Those on private plans have four years to transition to Medicare as it exists today with a buy-in option, after four years those plans will be transitioned into the new Medicare for All plan. At which point people’s healthcare will be totally government run and their payment will come in the form of taxes.
The new Medicare for All plan itself is far more generous than anything else in the developed world. All care would be free of charge at point of service. This is a departure from international programs which force patients to contribute some percentage to their care, even Medicare as it stands today requires a 20% contribution for most doctors visits. So the plan is more generous in that respect, additionally prescription drugs would be free as well. Medicare for All would also cover dental and vision, something even Canadian and Dutch counterpart programs don’t cover.
That’s the basics of the plan, which leaves the question, how exactly does Bernie Sanders plan to provide a more generous healthcare system, abolish private insurance, and then offer more than Canadian and European models, all while saving Americans money?
Glad you asked, the answer? Americans are grossly overcharged (emphasis on grossly and overcharged) for healthcare. We also pay record low taxes, both are things Bernie’s Medicare for All plans would change.
The Biggest Benefit: Everybody Gets Care, AND We Save Money
As highlighted by Vox, a 2003 study by the New England Journal of Health declared the American healthcare system as a whole spends over twice as much on administrative costs as the Canadian system. A 2011 study in the journal of Health Affairs estimated Americans spend nearly 4 times as much money dealing with insurance companies as their Canadian counterparts.
On top of that, a recent analysis from the U.S. government showed Americans spent $3.65 trillion dollars on health care in 2018. Which was up 4.4% from 2017 and by far the most in the world. And if the price of healthcare continues to grow at the rate it has over the last decade, it will outpace inflation, wage growth, and leave healthcare even more inaccessible for millions of Americans.
Medicare for All solves this problem, in fact it would almost cover the costs of 2018 just to switch and would allow an effective price control mechanism that currently does not exist in the American system. According to the Mercatus Institute, a libertarian leaning group of economists, a move to Medicare for All would save the United States $2 trillion dollars in healthcare expenditures over 10 years. Most of this cost savings comes from the sheer collective bargaining power the United States government has under a national healthcare system.
This alone is one of the sheer cost differences between the United States and most other developed countries. In those countries the government has the clout necessary to force concessions from pharmaceutical companies and hospitals. They also have the infrastructure and funding in place to subsidize research and development and care itself.
So a switch to Medicare for All may very well pay for itself, but there are still dozens and dozens of programs and funding mechanisms which could be used to shore up the program. And while the bill itself doesn’t settle on just one or a particular set, it does offer quite a few options.
The Rich Can Cover It, Plus Money Not Spent on Private Insurance Covers the Rest
Just to name a few of the potential funding options. One option, a 7.5% income-based premium placed on employers, with an exemption on the first $2 million in payroll. Eliminating current healthcare related tax expenditures and putting those funds towards Medicare for All (dissolving Medicaid would be a big boost in funding in this way.) Restructuring American income tax in a far more progressive way, for example something akin to Alexandria Ocasio Cortez’s 70% top marginal rate on all income over $10 million. The “Wall Street speculation tax” Bernie Sanders has campaigned on for years, Bernie’s proposed estate tax, or even Elizabeth Warren’s wealth tax, these are all distinct funding mechanisms that can and should be used to support a Medicare for All healthcare scheme.
What all those various funding mechanisms do is essentially restructure American healthcare from a market based, every person on their own, sort of status quo, to a progressively funded national system where the wealthy keep the system afloat and everyone benefits. Each of those funding mechanisms is progressive, meaning it disproportionately impacts the rich, and universal programs are inherently progressive as well. Meaning it’s a win-win, especially when you consider it would totally eliminate out of pocket insurance costs, meaning, as Bernie Sanders likes to point out, thousands of dollars in insurance bills would vanish for millions of Americans.
Bernie Sanders has laid out a very ambitious and compelling vision for American health care. His vision is supported by dozens of influential people in congress and has significant institutional buy in from unions and other groups. More importantly, it’s incredibly popular with the people. It looks like Medicare for All has a real chance at becoming reality and if it does, don’t let anybody say we can’t pay for it. We can, we should, and we must if we’re going to have a country that puts people over profit and provides a basic standard of living for all of its citizens.