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Through Medicare, the U.S. health-insurance program created in 1965 to help older Americans afford their medical bills, the government helps one in five citizens pay for doctor visits, blood tests, prescription drugs, stays in hospitals or nursing facilities, and hospice care. Why not offer those benefits to everybody? “Medicare for All” has emerged as a rallying cry among so-called progressive Democrats and has split the field of prospective challengers to President Donald Trump’s re-election, some of whom prefer what’s called a “public option” instead.
1. Who can get Medicare now?
About 86% of Medicare’s 61 million members are eligible because of their age — 65 or older. The rest participate because they have permanent disabilities. Beneficiaries are responsible for paying part of their health-care costs out of pocket, and most have some type of additional coverage to help with those costs and services that aren’t covered, such as long-term care, dental and vision treatment, and hearing aids.
2. What would Medicare for All mean?
That depends on who’s talking. Broadly speaking, it suggests an end to the dominance of private health insurance in the U.S., a system under which 30.4 million Americans lacked coverage in 2018. (The U.S. is an outlier among rich countries by not having universal health coverage.) Unlike Obamacare, which helps millions of Americans obtain health insurance but maintains the central role of private insurers, Medicare for All generally means a government-run “single-payer” system, such as Canada’s, that does away with private insurance. A less drastic offshoot of the idea would allow older Americans to buy into Medicare at age 50 — what might be called Medicare for More. Another proposal that some Democrats have touted as more realistic is creation of a government-provided alternative to private insurance plans that Americans could buy into, what’s known as the public option.
3. Who supports which proposals?
Senator Bernie Sanders, the Vermont independent who is seeking the Democratic Party’s presidential nomination for a second time, has for decades advocated a Canadian-style single-payer system. Self-described progressives in the House of Representatives, including Alexandria Ocasio-Cortez and Pramila Jayapal, also favor a government-run single-payer system. Other Democratic presidential hopefuls, including former Vice President Joe Biden, favor a public option. Trump derides Medicare for All as socialist, and his fellow Republicans in Congress are uniformly opposed as well.
4. Would Medicare for All change health care for all Americans?
It would depend on the plan. The most expansive visions of Medicare for All, like those of Sanders and Jayapal, would establish universal benefits and outlaw most forms of private insurance, including employer-provided coverage. That might mean little if any out-of-pocket cost to patients, but also less choice for people who like to pick their insurer and for employers who use health benefits to attract workers. Under a public-option plan, people satisfied with their insurance and medical care would have more flexibility to keep it.
5. Would Medicare for All cut health-care costs?
That’s a matter of debate. Combining what the government, employers and households pay, the U.S. spent $3.6 trillion on health care in 2018, or $11,000 for each American. About 18% of gross domestic product goes to medical spending, compared with about 11% in peer countries. Proponents of a single-payer system say it would allow the government to limit costs by setting prices of medical procedures and drugs and eliminating the administrative burden of private health insurance. Critics argue that would remove the incentives private purchasers of health care have to steer their dollars toward more efficient, innovative suppliers.
6. Do Americans want Medicare for All?
That changes with how the question is phrased. In a January 2019 poll by the Henry J. Kaiser Family Foundation, 74% of those surveyed supported “creating a national government-administered health plan similar to Medicare open to anyone” if that meant people could choose to keep the coverage they already have. Support dropped to 56% if it meant “all Americans would get their insurance from a single government plan” and to 37% if it would “eliminate private health-insurance companies.”
The Reference Shelf
- A Bloomberg Opinion visualization of the health care debate among the original field of Democratic candidates.
- The Washington Post breaks down where the remaining field stands on the issue.
- More on the Medicare for All bill introduced by House progressives.
- Running for president in 2016, Sanders asked audience members to shout out their medical deductibles.
- Vox broke down the different Medicare for All proposals.
- The Henry J. Kaiser Family Foundation’s overview of Medicare for All and its poll showing that public support varies with how it’s described.
- The Commonwealth Fund on the many varieties of universal coverage.