Is Medicare for All really possible?

According to a recent report from the New York Times, the percentage of insured Americans declined in 2018, the first time it fell since the Affordable Care Act (ACA) was passed. As Democratic presidential candidates debate the weaknesses of private health insurance in the modern economy, individual voters have to ask: is the fabled Medicare for All promise made by some candidates really possible?

President Barack Obama helped to pass the ACA as part of an effort to cover uninsured Americans, arguing that if everyone had coverage, insurance would be cheaper overall. He wanted to create an affordable health insurance option that he promised would help lower the overall cost of coverage for everyone. However, due to several factors, including the repeal of the individual mandate, Americans have only seen increasingly high health insurance premiums.

The news that total coverage decreased in 2018 indicates that the ACA is no longer doing what it originally promised to do. Democratic presidential candidates and President Donald Trump will likely take this news as an opportunity to propose alternate solutions to the health insurance crisis in the United States. One proposal in particular that has come up time and time again is Medicare for All — but just what that would look like depends on who you’re talking to.

What is Medicare for all?

Medicare for All is a proposal to provide affordable health care by paying for the majority of treatment through taxes. However, the precise details of what different candidates mean when they repeat the phrase varies.

By far the most radical proposal comes from Bernie Sanders’s Medicare-For-All plan. When Sen. Sanders refers to this option, he is talking about a single-payer universal health care system. Under this plan, treatment is funded entirely through taxes, which abolishes the need for the private health care industry at large.

Individuals have few to no out-of-pocket costs. It would cover all Americans, and the government would regulate prices for treatments and medications. Sanders’s plan would also expand Medicare coverage to include vision, dental, hearing and long-term care. Individuals would still have the option for additional coverage through private insurance companies, but the insurance would be supplementary to their existing government health care.

However, many on the left and the right are hesitant to accept this plan because it would abolish all employer-based coverage. Many Americans who receive coverage through their employers generally like their health insurance plans. Therefore, Sanders and other proponents for the single-payer system would have to convince them that a government plan would be better.

More moderate Democrats have proposed cheap health insurance options through the government that exist alongside private health insurance options. Mayor Pete Buttiegieg referred to this option as “Medicare for all who want it.” This would create a public option that allows individuals to purchase affordable health care through the government if they are not satisfied with employer-provided coverage or are uninsured. It would most likely be added to the Health Insurance Marketplace created by Obamacare to compete with other insurance offerings.

Will Medicare for All reduce or increase costs?

One of the biggest debates around passing a Medicare-For-All bill is whether or not it would financially benefit the nation. Some point out that expanding Medicare to everyone would cost the government trillions of dollars over a decade, requiring a notable increase in taxes to cover.

However, proponents like Bernie Sanders claim that individual savings from no longer having to pay premiums, deductibles and copays would outweigh the tax increase they would have to shoulder.

How much do we spend on health care?

Today, U.S. taxpayers pay more than $800 billion per year for Medicare, more than $632 billion for Medicaid and hundreds of billions more for programs like the VA health care system. Despite that massive spending, not all Americans are covered.

Currently, Americans collectively pay nearly $3.6 trillion dollars per year on health care between taxes for government health insurance programs, private health insurance costs and out-of-pocket expenses.

Would Medicare for All lower this spending?

According to Bernie Sanders, Medicare for All would bring national health care expenses down to just under $2.77 trillion a year.

However, different economists provide different estimates for Medicare for All. The RAND Corporation, for example, estimates that it would cost nearly $3.9 trillion a year, while the Urban Institute predicts that national health care spending would exceed $4.5 trillion annually. Sanders’s economist, Gerald Friedman, is the only one that predicts health care expenses would decrease significantly.

While Friedman anticipates that health care spending could be as less than 14 percent of the total gross domestic product (GDP), the Urban Institute anticipates that it will make up well beyond 20 percent.

What could affect health care costs?

Proponents of Medicare for All that say the cost would be reduced point out that individuals would no longer need to take on the administrative costs associated with a private health insurance company serving as a middleman. Additionally, they say the government would be able to negotiate clear and fair health care prices for all hospitals and providers.

Critics say it won’t be that simple, and many individuals may still need to turn to private health care for supplementary coverage. Additionally, they argue that individuals will use their “free” health care more often, ultimately increasing the cost of care overall.

Proponents of the single-payer plan would answer that if they had better access to affordable care, Americans would be more likely to treat minor illnesses before they become major health risks that can often cost much more to treat.

National Support for Medicare for All

Given that there is plenty of debate about whether a single payer universal healthcare system would save money, the next best thing to look at to decide whether something is likely to pass is national support. On this front, Medicare for All as a catchphrase does well — but when voters are told the details of the plan, that support often drops.

According to a Kaiser Family Foundation poll released in January, more than 70 percent of Americans support the plan when told it would guarantee health care for all Americans. However, only 37 percent support the plan when told it would increase taxes, and 26 percent support it when told it could result in health care delays.

In polls, 36 percent of Americans rank health care as one of their top priorities in the coming election, making it the single most important subject for voters ahead of 2020. Therefore, the candidate with the plan that appeals to the widest audience may have the best chance of winning.