Bernie Sanders is surging in the polls. Here's how his 'Medicare for All' plan would affect every part of the 3.6 trillion US healthcare system.Get the Full StoryUnder "Medicare for All," everyone in the US would receive comprehensive health coverage from the government.
The idea has sparked many months of fierce debate between moderate and progressive candidates who agree on expanding insurance coverage, but disagree on the mechanism to do it.
Though specifics are missing on how Medicare for All would likely work, we can start gauging the effects some of the proposals could have on insurers, drug companies, employers, patients, providers and hospitals.
Read on for more of the possible effects of Medicare for All ahead of the NBC News Democratic Debate tonight in Las Vegas.
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The main idea behind "Medicare for All" is straightforward: Everyone in the US would receive comprehensive health coverage from the government.
But the reality of implementing it is far more complex, and it has sparked heated debate among Democratic presidential candidates with dueling ideological visions since it would represent the biggest reshaping of the 3.6 trillion US healthcare system in over half a century.
Democratic candidates all agree on expanding health insurance coverage, but they disagree on how to do it. Those on the progressive left like Sens. Bernie Sanders and Elizabeth Warren envision a government-run insurance system where Americans would get coverage including dental, vision, and long-term care, and private insurers are eliminated or sidelined.
Sanders is now a frontrunner in the race to be the Democratic president candidate, thanks to his lead in a series of polls. A recent Washington Post-ABC News poll for isntance, found his support climbed to 32 , from 23 in January.
Moderate candidates like former Vice President Joe Biden and former South Bend Mayor Pete Buttigieg would preserve the current system. And they would create an optional government insurance plan commonly known as the public option and inject more federal subsidies into the state exchanges set up under the Affordable Care Act.
Candidates have proposed incremental or sweeping healthcare reform plans, but Sanders' Medicare for All bill has been held up as the standard. The legislation would virtually eliminate private insurance and provide care to everyone without co-pays, deductibles, or out-of-pocket spending. Sanders would attempt to achieve it in four years.
The estimated price tag of a government-insurance system on the scale he seeks is around 34 trillion over a decade.
Warren unveiled her own plan last year that's projected to cost 20.5 trillion over ten years, and mirrors Sanders in many ways. But she has pledged to pursue a public option first and then pass Medicare for All through Congress in the third year of her presidency.
There is a lot of speculation on what would happen to all the key players in the healthcare system if a single-payer plan such as Medicare for All gets passed.
Though specifics are still missing on how Medicare for All would be fully implemented, we can start gauging the effects some of the proposals could have, based on analysis from groups including the nonpartisan Kaiser Family Foundation, conservative-leaning Mercatus Center, and Urban Institute among others.
Read on to see what Medicare for All would mean for every part of the US healthcare system: insurers, drug companies, employers, patients, providers and hospitals.
This article was published on August 13, 2019 and has been updated. People living in the US would probably pay higher taxes, but less for their healthcare.
AP Photo Jacquelyn Martin
In the Sanders plan, patients would face virtually no costs to get medical care, as the proposal does away with most charges like co-pays, co-insurance, and deductibles. And it would be financed by a blend of new taxes.
The Vermont senator has outlined nine possible ways to cover the plan, including a 4 premium for people earning more than 29,000 a year. So far, he maintains he doesn't need to roll out more details explaining how he'd fully pay for it, making it difficult to fully assess its impact.
By comparison, Warren said she would not raise middle class taxes by "one penny" in her proposal. She's relying instead on redirecting healthcare spending from employers, state government and households onto the federal budget.
Higher income individuals would likely pay more for healthcare while lower-income individuals would generally pay less, Kaiser Family Foundation Executive Vice President for Health Policy Larry Levitt told CNBC. But he pointed out it depends on which taxes are increased.
Sanders has argued that most Americans would be better off because their healthcare savings would offset any tax increase.
Big companies would no longer have to provide insurance for their workers. They could see taxes go up, too.
More than half of Americans get their health insurance through employers, according to the Kaiser Family Foundation.
In the Sanders plan, employer-sponsored insurance would be eliminated. Sanders has argued that Medicare for All is a cheaper alternative compared to what's already in place and that employers would spend less time and cut administrative costs providing decent health benefits to their workers.
Employers might face new taxes, though. Among the options Sanders has proposed to pay for his Medicare for All plan is a 7.5 income-based premium that's paid by employers, but exempting the first 2 million in payroll.
Under the Warren plan, employers would face a charge equal to 98 of their current health spending. According to the Tax Policy Center's Howard Gleckman, the fee could be "a flat tax" on all workers.
That means a company would spend the same amount for healthcare on a low-wage employee and an executive, possibly leading to lost wages that disproportionately affects those with smaller paychecks.
Sanders previously criticized this element of the Massachussetts senator's proposal.
Doctors might get paid less money.
One concern for doctors is how Medicare for All would affect their pay. If private insurance is eliminated, physicians could make less than they do currently.
Private insurers typically pay more for physician services than Medicare, the federal health insurance program for the elderly, according to the Congressional Budget Office. If Medicare for All was implemented, doctors would get paid government rates for all their patients.
"Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care," the CBO report said.
That'd be a hit to pay for doctors treating mostly privately insured patients now, but it could boost compensation for those with many patients covered by the Medicaid program for low income people, particularly in rural communities.
Still, there are concerns that cutting payments to doctors could lead to shortages and longer wait times for medical care under Medicare for All.
"That means there is going to be a substantial increase in demand for healthcare at the same time that you're potentially cutting payments to providers," Katherine Baicker, a healthcare policy expert at the University of Chicago, previously told Business Insider.
The American Medical Association the largest physician group in the US opposes Medicare for All, though there are signs that doctors within their ranks may be shifting their views, according to Vox. The group pulled out of an industry group fighting the proposal.
In January, the American College of Physicians, the second-largest doctors' group, endorsed both Medicare for All and the public option as a pathway to universal health coverage in a big win for their supporters.
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