What is “Medicare for All”?

A political scientist and an economist explain Democratic presidential candidates’ proposals for health care reform
September 27, 2019

In a little over a year, Americans will elect our next president, and Democrats are hard at work narrowing down whom they will select to run against President Trump. As Democratic primary debates continue (three of 12 have occurred), candidates have focused on three major issues: climate, guns and health care. At the Texas A&M Health Science Center, we are closely monitoring discussions on the last point and how potential policy changes could impact how we and our future health professionals will deliver care.

We sat down with health policy experts Timothy Callaghan, PhD, and Michael Morrisey, PhD, both with the Texas A&M School of Public Health, to break down the various Democratic proposals for health care reform and implications for each. Callaghan is a political scientist and assistant professor in the Department of Health Policy and Management. Morrisey is an economist and head of the Department of Health Policy and Management. Here’s what they know so far.

What are the candidates proposing?

Democratic health care reform proposals fall into three buckets (for the most part) that span from very progressive to somewhat moderate.

Progressive

Major candidates: Sen. Elizabeth Warren and Sen. Bernie Sanders

Proposal: True “Medicare for All”

What they’ve said so far: In the most progressive camp, candidates have said that in their plans, everyone in the country will lose the private insurance they currently have and instead will be covered by a form of Medicare that everyone in the country will be enrolled in. There are several different plans out there that various Democrats have suggested, but all of them involve that over a certain number of years we will transition from the system we have now to a new system in which everyone is covered by a government insurance.

Middle

Major candidates: Pete Buttigieg and Kamala Harris

Proposal: “Medicare for All Who Want It”

What they’ve said so far: The candidates who take the middle position are calling for a public option. The public option was originally incorporated into the Affordable Care Act, but ultimately had to be separated from it in order to get it passed. It essentially says that the government is going to compete as an insurer with all other insurance companies. The idea is that if the government has its own insurance plan, and it’s a highly competitive plan, it will force other insurers to compete, and prices will go down everywhere. There are debates about whether that public option competes forever with private insurers or if eventually those private insurers will be forced to give in and allow the public option to become much bigger.

Moderate

Major candidates: Joe Biden and Amy Klobuchar

Proposal: Build upon the current system

What they’ve said so far: Former Vice President Joe Biden was a major architect of the Affordable Care Act, so he is a serious proponent for keeping it. However, he and others in his camp have ideas for improvements, which have included suggestions for introducing a public option. At minimum, they have said they want to strengthen the Affordable Care Act so it survives long-term, despite the Trump administration’s current efforts to cut it down.

What should we keep in mind while watching the Democratic primary debates?

Even for the most detailed of plans, we don’t have many details at this point, which has made it difficult to know what exactly the various candidates’ proposals really entail. While watching the debates, pay attention to whether the candidate is proposing a plan or is simply supporting a broad principle. Notice if they are saying, “I support Medicare for All,” or “I support Medicare for All, here is how I would actually implement it, and here’s how it would work.”

Additionally, pay attention to what the candidates say they would do to overcome Republican opposition. If a Democrat is elected, they will still have to face Republicans in the House and Senate that will be opposed to the idea of universal health coverage. How would they get their plan through if they would need essentially 60 votes in the Senate to get major pieces of health care reform through? The Affordable Care Act almost failed because a Democratic senator from Massachusetts passed away and left them with only 59 votes instead of 60.

What are some major pros and cons to expanding health care coverage?

The major pro to all of these proposals is that they would provide health care coverage to more Americans, including some of those who have fallen into the cracks after the Affordable Care Act was implemented or who are uncovered for various reasons. A concern with any of these proposals is the cost, which some estimates have valuated at more than $30 trillion over the first 10 years. Finally, if more people receive health coverage, there will be a greater demand for health care services, which means more health care professionals will be needed. Listen to how candidates propose addressing these concerns.

What is the big takeaway so far?

It is still early in the primary election process, and as the field of candidates continues to narrow, the three major ideas listed here may also be whittled down. In the end, even if a Democrat is elected to office, that doesn’t necessarily mean anything will happen on health. National events could dictate that we focus on foreign affairs, the economy, climate or something else. Or, health reform could be stagnated by partisan polarization. It is also important to keep in mind that major reform does not happen overnight, so it is likely that if change is implemented, it will occur through gradual steps over a span of many years.

— Lindsey Hendrix

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