The US is the only developed country where basic healthcare is unaffordable for a significant percentage of the population. Even for those who can afford it, the costs are exorbitant, many times more than equivalent care in Canada or Western European countries.
You might be surprised by how much employers pays for employee healthcare (Hint: several thousand dollars per employee family member per year). And these costs keep increasing. Clearly, the beast needs to be tamed. And sooner the better.
Is “Medicare for All” the answer? Few dispute the promise it holds. It is the What, Who and How where a battle royal is brewing up – Paying for it, Taxes, Needed infrastructure, Impact on society, Public vs Private model, Transition, Disruption in Care, Impact on innovation, Wait times for needed services, and many other such topics are going to be fought over every inch of the way by players with deep support and deeper pockets.
Being such a hot and relevant topic, the leading Democratic presidential candidates have each carved out their positions on ‘Medicare for All’. While there are some similarities in approaches, many differences exist as well. Let us take a look.
SIMILARITIES IN PROPOSALS
As an intermediate step, practically ALL Democratic candidates support expanding Medicaid in States to enable people to buy into the program. This is typically known as the ‘Public Option’ in various ‘Medicare for All’ proposals. They also favour expanding Medicare to start at age 50 instead of the current 65.
You may not know that the federal government is legally barred from negotiating lower drug prices which remain a major healthcare concern. All Democratic candidates support removing this obstacle to make prescription drugs more affordable. Most also support allowing import of drugs from other countries where they are much cheaper.
MAJOR DIFFERENCES IN POSITION
The original ‘Medicare for All’ champion, Bernie favours a ‘Single Payor’ system where the government would pay care providers for all your healthcare needs. This would include medical, hospital, prescription drugs, dental, vision and mental health. The role of private insurance would be vastly reduced to offering additional services on top of this package.
You would pay a tax to the government in lieu of current premiums, deductibles and copays/coinsurance. Same for employers. There may be some out-of-pocket costs for prescription drugs. As mentioned earlier, there are proposals on the table to lower drug costs and make them more affordable. Bernie plans to go a step further and have the government even manufacture generic drugs to bring down their cost.
On ‘Single Payor’ and Medicaid expansion, Warren’s position is much the same as Bernie’s. She endorses Bernie’s proposal on these topics but the devil is in the details. Warren has also said that there may be “different ways” to provide universal healthcare coverage.
Like Sanders, Warren supports having the government manufacture generics to make them more affordable. She is also firmly in the camp advocating lowering of Medicare’s eligibility from 65 yrs to 50 yrs. Like Medicaid expansion, this may also entail a buy-in option.
Both Warren and Bernie have many other proposals on the table related to other topics like student loans, wealth tax, and banking reform. Both are leading contenders so significant change may be on the horizon if one of them wins.
With proposals like Medicaid Expansion and Medicare Opt-in, you may be wondering where this leaves ACA aka Obamacare. Why not focus on expanding ACA instead?
This is where Joe Biden comes in. He is critical of Bernie and Warren’s ‘Single Payor’ proposal with virtually non-existing private insurance as unrealistic. Many other Democratic candidates are of this opinion as well. Instead, Biden has promised to build on existing ACA, including a ‘Public Option’ which includes private insurance. His proposal would make a Medicare-like government plan available to everyone, with private insurance as an option.
It may be noted that this is how Medicare currently works. One can go with ‘Original Medicare’ (Part A and Part B) or opt for Part C which is private insurance. Biden’s proposal would also increase ACA’s subsidies for private plans, making them more affordable.
So what do you think? Which candidate has got it right? The actual implementation, whenever it happens, may very well be a combination of all the three positions plus some new ones. Healthcare is a significant portion of the US economy so expect the battle to be long and hard. History is going to be made. As to who makes it, only time will tell.
[ Kumar B Goel is President & CEO of Lighted Road Insurance , a web-based start-up helping people select and enroll in the right Medicare Plan for their needs and budget.]