The Wall Street Journal

What Is (and Isn't) Medicare for All


Medicare for All has dominated the Democratic presidential campaign. Some candidates support Sen. Bernie Sanders' plan, but others have different ideas for how to get to universal coverage. WSJ explains what Medicare for All is, what it isn't, and how some of the major health care plans out there would change the health insurance industry.

#WSJ #MedicareForAll #DemocraticDebates

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Demands mounted Thursday from lawmakers, business leaders and former government officials for the immediate removal of President Trump after a violent mob of his supporters stormed the U.S. Capitol in an attack that left four people dead. Many have called for Vice President Mike Pence to invoke the 25th Amendment to remove Trump. So what is the 25th Amendment? Here's a synopsis of the constitutional provision that allows for the president's removal under certain circumstances.

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- [Narrator] During the first
Democratic Presidential Debates in June,
moderator Lester Holt asked the same question
to both sets of candidates.
- [Both] Who here would abolish
their private health insurance
in favor of a government-run plan?
Just a show of hands.
- [Narrator] This question was referring
to Medicare for All, a proposal by Senator Bernie Sanders
that would create a new federally-run health care system
and make the U.S. government the sole provider
of health insurance in the United States.
Under Senator Sanders' plan, most employee-sponsored
private insurance would be eliminated,
and Medicare would be replaced with an entirely new program,
one that covers health care costs
for every single person in the United States.
This question about private insurance has dominated
the presidential debate on the left.
All candidates say they want universal health care,
meaning they want every American covered,
but they're split on how to get there.
Just look at how they answered the question.
Senators Bernie Sanders, Kamala Harris,
New York Mayor Bill de Blasio, and Senator Elizabeth Warren
all raised their hands to say they would eliminate
private insurance, but several co-sponsors
of Medicare for All legislation from both the House
and Senate were on stage both nights
and didn't raise their hands,
and Kamala Harris walked back her answer
after the debate by saying she'd misunderstood the question.
That's because several candidates have expressed concerns
about Medicare for All and are embracing
different approaches to universal coverage,
showing that this debate
isn't just Medicare for All or nothing.
We're going to explain what Medicare for All is,
what is isn't, and what other Democratic
health care proposals would do to health insurance
in the United States.
(pleasant electronic music)
- The problem surrounding the conversation
around Medicare for All is that many people really
just don't understand what Medicare for All means,
so while Medicare for All really does kind of refer
to one specific broad idea,
there are a lot of percolating ways to get there
that have been kind of carried
under the umbrella of Medicare for All.
- [Narrator] You can think of health care as a spectrum.
On one side, you have Medicare for All's
single-payer system, and on the other side,
you have private insurance.
The current system in the United States
falls in between the two, with a mix of private
and government-sponsored insurance
that operate alongside each other.
- Democrats have gotten themselves boxed into this corner
about whether their health plans
would get rid of private insurance.
That's kind of been the issue
that has taken over the general focus.
- [Narrator] This is significant because the vast majority
of Americans have private health insurance.
A little more than 156 million Americans
receive employer-sponsored insurance through work,
and private health insurance covers over 1/3
of all medical costs in the United States.
Medicare For All would introduce public insurance
that would muscle out employer-sponsored insurance
over four years.
It would also cover the uninsured,
creating a single-payer system by leaving very little room
for what private insurance could offer.
- The question about whether your health plan
would get rid of private plans
has taken up a lot of air in the room
when, in fact, if you look at other countries,
the vast majority have a system that still allows
for private plans for supplemental coverage.
- [Narrator] Medicare for All would ban
most private insurance from offering
the same coverage as the government,
but England has a universal health care system
that allows private insurance to offer duplicate coverage.
This private insurance provides access to private hospitals
and reduces wait times for certain treatments.
Senator Sanders has pointed to Canada's health care system
as a model his plan would emulate,
but Canada has a private insurance industry
that offers supplemental health insurance
to cover things the government doesn't
like vision and dental care.
About 2/3 of Canadians have supplemental health insurance.
Medicare for All would be more expansive
than its Canadian counterpart,
covering dental and vision services.
The only out-of-pocket expense
would be a copay on prescription drugs
that would be capped at $200 per year.
Patients with government-funded insurance
in both France and Australia
also incur some sort of out-of-pocket cost,
but private health insurance is available
in both places to cover these costs.
About 95% of people in France
have this complimentary private insurance
in addition to government insurance.
- Under the, for example, plan by Senator Bernie Sanders,
it does have a very, very limited role
for private insurance,
more limited than what you would see in other countries.
A big question about Medicare for All is how you pay for it.
The idea that has been proposed by Senator Bernie Sanders
does have some ideas attached to it,
no specific funding mechanism,
but it looks at a progressive tax, a tax on companies.
He has said that taxes would increase overall
to pay for the plan.
- Yes, they will pay more in taxes
but less in health care for what they get.
- Thank you, Senator. (crowd applauding)
- There's a lot of other plans out there
that Democrats are supporting, including options
that would let everybody or a limited number of people
buy into a plan like Medicare.
- I believe we need to get to universal health care
as a right, not a privilege, to single-payer.
The quickest way you get there
is you create competition with the insurers.
- [Narrator] While Medicare for All aggressively builds
a new single-payer system from the ground up,
other plans expand the existing Medicare program
to cover everyone in the U.S.
- Those ideas are considered more of a stepping stone
to this idea of universal health care
that the Democrats do support as their overall goal.
- [Narrator] Under these plans,
private insurance remains.
The Medicare for America Act automatically enrolls
the uninsured and newborns into Medicare
but allows employers to continue to offer private insurance.
However, workers can also choose to enroll in Medicare.
Premiums would remain but with caps,
and those close to the poverty line would receive subsidies.
(pleasant electronic music)
The Choose Medicare Act allows Medicare to be bought
through health care exchanges set up by the ACA.
Private insurance could remain
as long as it was gold-level coverage,
a level of coverage where insurance covers 80% of costs.
Out-of-pocket costs would be capped at $7900 per year.
The goal would be to level the playing field
and make private insurance compete with a public option.
- Some of the research that has been done
on Medicare buying plans do show that the premiums
for these would be lower than what's currently offered
on the individual markets.
One of the hope of supporters
of some of these buying options is that,
because they would be more affordable,
that more people would buy into these plans.
They would find them palatable,
they would find them things they could afford,
and this would be a kind of slow on-ramp
toward a universal health care system
or Medicare for All.
This is really the first time in our country's history
that we are looking at a total revamping
of the U.S. health care system,
and it's the first time
it's become really part of the public debate.
It could affect you, the consumer.
It could affect how much you pay out-of-pocket,
your ability to get access and coverage.
Even after the election, no matter who wins,
this is gonna be an issue that continues
to get debated for quite some time.
(bright electronic music)

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