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Medicare-for-All

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Medicare-for-all (often styled “Medicare for All” or “Medicare for all”) is a proposed policy to create a government-run “single-payer” socialist healthcare system in the United States by expanding the existing Medicare program from covering primarily older individuals to covering all citizens.

While proposals for government-sponsored healthcare date back to the 1910s, the concept of expanding Medicare to universal coverage was first proposed in 1970 by liberal Republican Senator Jacob Javits (R-NY). Medicare-for-all and similar healthcare socialization schemes re-emerged in the mid-2010s when Democratic and left-wing leaders like U.S. Senator Bernie Sanders (I-VT) began to champion the policy. In the 2020 Democratic Presidential primaries, Sanders, Sen. Elizabeth Warren (D-MA), and New York City Mayor Bill de Blasio (D) all expressed support for Medicare-for-all, while nearly all other Democratic nominees supported some other form of government healthcare expansion. 1 Medicare-for-all bills were proposed in both the U.S. House and U.S. Senate in 2019.

Proponents of Medicare-for-all claim the policy would increase health insurance coverage to all Americans, regardless of income and employment, while reducing overall costs by simplifying the health insurance industry, regulating pricing and profits, and collectivizing all insurance plans into a single, massive insurance pool.

Opponents of Medicare-for-all claim that the policy will further increase spiraling costs by separating healthcare services from prices by a burgeoning inefficient government bureaucracy. Depending on the particulars of the proposal, Medicare-for-all could mandate that all private insurance plans be replaced by government-controlled offerings.

History

Early Socialized Health Care Plans

The first government-run healthcare system was established in 1884 in Germany under the leadership of Chancellor Otto von Bismarck. While other European countries adopted similar policies over the 50 years, the US government was more reluctant to place its healthcare system under government control, especially given such policies’ associations with burgeoning international socialist movements. 2

Government-funded healthcare was first seriously suggested in the United States by President Teddy Roosevelt who listed the policy in his campaign platform, but took no action to establish such policies in office. 3 In 1935, President Franklin Roosevelt attempted to add government-sponsored healthcare coverage to the Social Security Act, but the amendment was rejected in Congress, largely due to the influence of the American Medical Association (AMA). President Harry Truman announced government-run healthcare as a major goal of his presidency in 1945, but he failed to get any legislation passed. 4

The first form of government-sponsored health insurance was created in the US in 1956 under President Dwight Eisenhower as the Dependents’ Medical Care Act, which provided health insurance for family members of military personnel. 5 President John F. Kennedy endorsed government-sponsored healthcare for Americans over 65, but was unable to get any legislation passed. 6

Medicare

In 1965, President Lyndon Johnson enacted Medicare and Medicaid as amendments to the Social Security Act. Medicare provided single-payer government-run health insurance to all Americans over 65, though it was initially designed as a universal healthcare program. Medicaid provided partial-to-full funding for healthcare for low-income individuals. 7

Since its establishment, Medicare has steadily expanded in scope. In 1972, President Richard Nixon added coverage for disabled individuals and certain late-stage diseases. In 1982, President Ronald Reagan added coverage for hospice care. In 1988, Medicare out-of-pocket expenses were capped, though this provision was quickly repealed. In 2003, President George W. Bush passed Medicare Part D to partially cover medication costs. Numerous other smaller provisions had adjusted the structure of Medicare over the last thirty years. 8

As of 2019, Medicare provides insurance to about 60 million Americans9 at a cost of $582 billion, or 14% of the total federal budget. 10

Contemporary Government-Run Healthcare Proposals

In 1971, Senator Ted Kennedy (D-MA) proposed a new national socialized health care plan which was to be financed by payroll taxes. The plan was voted down in Congress. 11

Significant expansions of government intervention in the health care system was not explored again until 1992 when President Bill Clinton campaigned to establish of a national healthcare system. Once Clinton was elected, Congressional Democrats failed to put forth a successful package despite Clinton’s appointment of then-First Lady Hillary Clinton to lead the health care task force. In 1994, the final plan, which mostly consisted of government-subsidized insurance policies, was rejected in Congress. 12

In 2009, President Barack Obama outlined a national universal healthcare program which would establish a heavily subsidized government-backed insurance plan to compete with private plans. 13 However, due to pushback from Republicans and moderate Democrats, the Obama administration reformed the plan. In 2010, President Obama passed the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. The Act attempted to increase insurance coverage by expanding Medicaid eligibility, increasing subsidies, establishing a centralized marketplace for insurance plans in each state, prohibiting coverage discrimination based on pre-existing conditions, and permitting children to stay on parents’ plans until age 26. 14

Medicare-for-All Plans

In 1970, Senator Jacob Javits, a liberal Republican from New York, proposed expanding Medicare to all US citizens. The plan proposed financing the program with a payroll tax of up to 3.3% and an increase in annual federal subsidies to health insurers from $3.5 billion to $22.7 billion. 15

In 2003, then-U.S. Rep. John Conyers Jr. (D-MI) proposed the Expanded and Improved Medicare For All Act, which in addition to expanding Medicare to universal coverage, would establish a National Board of Quality and Access to oversee all American healthcare. 16 Conyers Jr. would propose the same bill at every session of Congress until he resigned from office in December 2017 amid sexual harassment allegations. 17

In 2006, Senator Ted Kennedy (D-MA) proposed the Medicare For All Act, which would pay for Medicare expansion with a flat 1.7% income tax on all individuals, a 7% payroll tax, and an unspecified self-employment tax. 18

Post-2016 Medicare-for-All Plans

Senate

In 2017 self-described socialist U.S. Senator Bernie Sanders (I-VT) introduced the Medicare for All Act with 16 co-sponsors, all Democrats. Despite the bill’s name, the proposed restricting of Medicare would essentially create an entirely new program overseen by the Department of Health and Human Services. A government-run insurance product would be guaranteed for all citizens, including dental, vision, and medications. Most private insurance plans would be banned; the only private insurance products could not duplicate public plans. The bill had no financing plan, but rather a list of tax hikes to consider, including a 7.5% payroll tax, a 4% income surtax, increased corporate taxes, and a wealth tax on high-income Americans. 1920 A slightly altered version of the bill was introduced in 2019. 21

House

In the House, Conyers Jr.’s long-standing bill was re-packaged as the Medicare for All Act in 2019. The bill was introduced by Rep. Pramila Jayapal (D-WA) and co-sponsored by 106 Democrats. As of November 2019, the bill had 116 co-sponsors, nearly half of the House Democratic Caucus. 22

While the House bill is broadly similar to the Senate bill, it aims to go into effect in two years rather than four. The House plan would also absorb the Veterans Administration and Indian Health Service gradually. 23

COVID-19

In response to the COVID-19 pandemic, the Trump administration enacted a policy said to resemble “Medicare for all COVID-19 patients.” The measure provides $100 billion to reimburse hospitals treating COVID-19 patients “at Medicare rates,”24 though the plan later brought reimbursements above standard Medicare rates. The policy has been criticized for incentivizing hospitals to inflate their coronavirus diagnosis and death numbers to receive federal subsidies. 25

Public Response

Medicare-for-all and other government-run healthcare schemes have been unpopular throughout most of modern American history. President Clinton was unable to pass a public-private health care reform despite presiding over a Democratic Congress. 26 However, over the last four years, public support for some form of Medicare-for-all has increased, likely starting from the 2016 presidential election, when Sanders made the policy a key platform in his campaign and he openly debated the subject with eventual Democratic nominee Hillary Clinton. 27

A Kaiser poll from 2015 found that 58% of Americans supported something called Medicare-for-all, including 81% of Democrats and 60% of Independents, though 63% of Republicans opposed the policy. However, Democratic voters did not consider Medicare-for-all to be an important issue, with only 5% saying it was the most important issue in the election. 28

Support for plans called Medicare-for-all has remained stubbornly high, though contingent on misunderstanding the Sanders-style government-plan-replacement approach. A Marist poll from July 2019 found that 70% of voters support a Medicare-for-all plan with a “private option.” 29 However, Nate Silver of FiveThirtyEight pointed out that according to the Marist Poll, a plan that allows for private competition more closely resembles reforms suggested by Joe Biden (D-DE) is far more popular than Sanders’s Medicare-for-all without private options, which differs in this regard from his proposed Senate bill. Only 41% of voters and 64% of Democrats support Medicare-for-all with no private option, and 81% of Republicans opposed the policy. 30

References

  1. “Medicare-for-all: Where Democrats stand on health-care issues.” Washington Post. Accessed May 31, 2020. https://www.washingtonpost.com/graphics/politics/policy-2020/medicare-for-all/.
  2. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  3. “A brief history of Medicare in America.” Medicare Resources. Accessed May 30, 2020. https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/.
  4. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  5. “Dependents’ Medical Care.” CQ Press. Accessed May 30, 2020. https://library.cqpress.com/cqalmanac/document.php?id=cqal56-1349374.
  6. Anderson, Steve. “A brief history of Medicare in America.” Medicare Resources. September 1, 2019. Accessed May 30, 2020. https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/.
  7. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  8. “50 Years of Medicare.” Commonwealth Fund. Accessed May 30, 2020. https://interactives.commonwealthfund.org/medicare-timeline/.
  9. “An Overview of Medicare.” KFF. February 13, 2019. Accessed May 30, 2020. https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/.
  10. “Budget Basics: Medicare.” Peter G. Foundation. April 30, 2019. Accessed May 30, 2020. https://www.pgpf.org/budget-basics/medicare.
  11. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  12. Skocpol, Theda. “The Rise and Resounding Demise of the Clinton Plan.” Health Affairs. Spring 1995. Accessed May 30, 2020. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.14.1.66.
  13. MacAskill, Ewan. “Obama outlines plan for universal healthcare system in US.” Guardian. June 11, 2009. Accessed May 30, 2020. https://www.theguardian.com/world/2009/jun/11/obama-administration-universal-healthcare-reform.
  14. Kenton, Will. “Affordable Care Act.” Investopedia. Accessed May 30, 2020. https://www.investopedia.com/terms/a/affordable-care-act.asp.
  15. “Medicare for all is asked by Javits.” New York Times. April 15, 1970. Accessed May 30, 2020. https://www.nytimes.com/1970/04/15/archives/medicare-for-all-is-asked-by-javits.html?searchResultPosition=1.
  16. “H.R.676 – 108th Congress (2003-2004).” Congress.gov. Accessed May 30, 2020. https://www.congress.gov/bill/108th-congress/house-bill/676.
  17. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  18. “S.2229 – 109th Congress (2005-2006).” Congress.gov. Accessed May 30, 2020. https://www.congress.gov/bill/109th-congress/senate-bill/2229.
  19. “S.1804 – 115th Congress (2017-2018).” Congress.gov. Accessed May 30, 2020. https://www.congress.gov/bill/115th-congress/senate-bill/1804.
  20. Kurtzleben, Danielle. “Here’s What’s In Bernie Sanders’ ‘Medicare for All’ Bill. NPR. September 14, 2017. Accessed May 30, 2020. https://www.npr.org/2017/09/14/550768280/heres-whats-in-bernie-sanders-medicare-for-all-bill.
  21. “S.1129.” Congress.gov. Accessed May 30, 2020. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text.
  22. “All Information (Except Text) for H.R. 1384 – Medicare for all Act of 2019.” Congress.gov. Accessed May 30, 2020. https://www.congress.gov/bill/116th-congress/house-bill/1384/all-info#cosponsors-content.
  23. “Comparison Chart: House and Senate Medicare for All Act.” Health Over Profit. Accessed May 30, 2020. http://healthoverprofit.org/comparison-chart/.
  24. Charles, Dan. “Medicare For All Coronavirus Patients? But Who Exactly Qualifies?” NPR. April 3, 2020. Accessed May 30, 2020. https://www.npr.org/sections/coronavirus-live-updates/2020/04/03/827121928/medicare-for-all-coronavirus-patients-but-who-exactly-qualifies.
  25. Fichera, Angelo. “Hospital Payments and the COVID-19 Death Count.” FactCheck.org. April 21, 2020. Accessed May 30, 2020. https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/.
  26. Abrams, Abigail. “The Surprising Origins of ‘Medicare for All’.” Time. May 30, 2019. Accessed May 30, 2020. https://time.com/5586744/medicare-for-all-history/.
  27. DiJulio, Bianca; Firth, Jamie; Brodie Mollyann. “Kaiser Poll: 58% of Americans Support Medicare for All.” PNHP. December17, 2015. Accessed May 30, 2020. https://pnhp.org/news/kaiser-poll-58-of-americans-support-medicare-for-all/.
  28. DiJulio, Bianca; Firth, Jamie; Brodie Mollyann. “Kaiser Poll: 58% of Americans Support Medicare for All.” PNHP. December17, 2015. Accessed May 30, 2020. https://pnhp.org/news/kaiser-poll-58-of-americans-support-medicare-for-all/.
  29. “NPR/PBS NewsHour/Marist Poll of 1,346 National Adults.” Marist Poll. Accessed May 30, 2020. http://maristpoll.marist.edu/wp-content/uploads/2019/07/NPR_PBS-NewsHour_Marist-Poll_USA-NOS-and-Tables_1907190926.pdf#page=3.
  30. Silver, Nate. “Medicare For All Isn’t That Popular – Even Among Democrats.” Fivethirtyeight. July 25, 2019. Accessed May 30, 2020. https://fivethirtyeight.com/features/medicare-for-all-isnt-that-popular-even-among-democrats/.
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