Medicare for all -- what is it? -- Oct. 11, 2018 column (posted belatedly, so out of order)

By MARSHA MERCER

Candidate Donald Trump promised better, cheaper healthcare for all.

Just days before his inauguration, he said he’d deliver “insurance for everybody.” His plan to repeal and replace the Affordable Care Act would come “in a much simplified form – much less expensive and much better,” he told The Washington Post.

It never happened. About 28 million Americans remained uninsured last year, up from 27.3 million from 2016, according to a Census Bureau report released last month.  

Despite Trump’s repeated attacks, Obamacare keeps ticking. Nearly 12 million Americans signed up for coverage this year.

Trump finally did come up with an alternative, of sorts. His administration unveiled new rules in August to allow skimpy, low-cost, short-term insurance plans that critics called junk.

These plans lack the 10 essential health benefits required in ACA exchange plans. If healthy people choose the new plans to save money, it could raise insurance costs for sicker people in the plans, analysts warn.

Coverage of pre-existing conditions -- the most popular element of Obamacare – animates many midterm contests, as House Republicans who voted to repeal Obamacare scramble to assure voters they’ll protect that coverage.

Emerging in the midterms and likely a hot issue for the 2020 presidential race is “Medicare for all.”

Asked if they support Medicare for all, seven in 10 people said they do, a Reuters-Ipsos poll in August reported. That includes 85 percent of Democrats and 52 percent of Republicans.

But what, to paraphrase Freud, do consumers want?

“Medicare for all” is shorthand for a range of plans.

Medicare for All – with a capital A -- would throw out the current employer-based health insurance system and replace it with a single-payer, government plan. It is what Sen. Bernie Sanders, independent of Vermont, proposes. 

But Medicare for all -- lower case a – could describe various national plans proposed by Democrats that would move incrementally toward universal healthcare coverage.  

Two questions in a Kaiser Family Foundation survey in March illustrate how wording of the question matters.

Asked: “Do you favor or oppose having a national health plan, or Medicare-for-all, in which all Americans would get their insurance from a single government plan?” about 60 percent said they favor it.

But when asked about “having a national Medicare-for-all plan open to anyone who wants it but people who currently have other coverage could keep what they have,” support surged to 75 percent.  

Sanders, who first introduced a single-payer bill in 1993, is not as lonely as he once was. His Medicare for All bill has about 15 cosponsors.

About 70 Democrats in Congress have formed a Medicare for All Caucus, and a Democratic House member from Washington state announced a Medicare for All PAC to back candidates financially. 

On his website, Sanders is unequivocal: “Health care must be recognized as a right, not a privilege . . . The only solution to America’s health care crisis is a single-payer national health care program.”

The sticking point, of course, is the cost. Sanders insists individuals would save money on insurance and medical bills, but both the liberal Urban Institute and libertarian-leaning Mercatus Institute at George Mason University estimated federal expenditures would rise at least $32 trillion in the first 10 years.

The Congressional Budget Office has not run estimates, apparently because Sanders’ plan has so little chance in the Republican-controlled Congress.

As president, Barack Obama backed away from a single-payer plan, but he now calls Medicare for all a “good new idea.”

Democratic Sens. Tim Kaine of Virginia and Michael Bennet of Colorado are cosponsors of Medicare X, a phased-in plan that would allow all Americans to buy into Medicare. Starting in counties where the ACA exchanges lack competition, it  would open nationwide in 2023 and to businesses in 2024.

Corey Stewart, Kaine’s Republican opponent for the Senate in November, promises “full repeal” of Obamacare.

Critical to the debate is the 56 percent of Americans who get health insurance through their employers. In a strong economy, they may have little incentive to switch to a government plan.

Virginians as well as voters in other states soon will start deciding what Medicare for all might mean for them.

©2018 Marsha Mercer. All rights reserved.