Obamacare may have survived the Republican attempts to repeal and replace it, but the battle over the future of the U.S. health care system is far from over.
On Wednesday, liberal and conservative senators proposed “radically different” plans for overhauling American health care. Sen. Bernie Sanders (I-VT) unveiled a bill to turn Medicare into a national health insurance program covering every U.S. resident. Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) offered up the GOP’s last hope of repealing Obamacare this year with a plan that would turn over control of health care markets to the states.
One key point the two plans have in common: Neither has much chance at actually becoming the law of the land, at least for now.
Nevertheless, the new proposals are valuable indicators of how the political landscape has shifted in just a few short years when it comes to fixing health care. Sanders has four of the Democratic Party’s leading 2020 presidential prospects — Sens. Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren — cosponsoring his bill, and Democrats like Max Baucus, who opposed a single-payer system, now say it’s inevitable. “Single-payer universal health care — once cast as a radical daydream — has moved with staggering swiftness from purported fantasy to palpable possibility,” Harvard Medical School instructor Adam Gaffney, who runs a site called The Progressive Physician, writes in The Washington Post.
Despite that momentum, there’s a huge obstacle that supporters of single-payer systems still have to address: how to pay for it.
Sanders’ Medicare for All Act is nothing if not ambitious. Dave Weigel of The Washington Post says it “would revolutionize America’s health care system.” Here are some of its key features:
1. What would the plan do?
- All Americans would be enrolled in universal Medicare within four years. The plan would proceed by dropping the age for Medicare eligibility – from 65 to 55 in the first year, then lower over the next three years.
- Medicaid would be phased out. However, two existing federal health care systems would continue to operate – Veterans Affairs and Indian Health Services.
- The roughly 150 million people with employer-based insurance would have to switch to the single-payer system.
2. How would it change Americans’ health care?
- The Sanders plan is comprehensive, covering dental and vision care, prescriptions drugs, hospitalization, medical devices, maternity and health care, and more. Sarah Kliff of Vox says that “The plan is significantly more generous than the single-payer plans run by America’s peer countries.” That also means it would be more expensive.
- Patients would face no out-of-pocket payments for services and prescription drugs.
- Patients would not be required to switch doctors, just insurance. Medical service providers would be reimbursed through the universal Medicare system.
3. What would it cost? And who would pay for it?
- The short answer: trillions. An estimate of a different Sanders plan from 2016 put the tab at $32 trillion over a decade. To pay for it, taxes would have to rise — but paying for the new system isn’t addressed in the bill in any detail.
- Sanders has put out a list of ideas for how to finance Medicare for All. They include a 7.5 percent income-based premium paid by employers, a 4 percent income-based premium paid by households, a "Wealth Tax" on the top 0.1 percent and a fee on financial transactions.
- Sanders says that middle class families would end up saving money, because their medical spending will go down by more than their taxes will go up.
- A single-payer system is intended to lower administrative expenses, thereby lowering overall cost of the system.