Regardless of political persuasion, most Americans want Congress to expand Medicare to every American. Some people talk about the benefits of “single payer” health care, which generally means improved Medicare for all. Whatever people call it, the question is whether we can get to a health care system that builds on Medicare and gives everyone health care coverage automatically.
Daniel Marans at The Huffington Post reports that just recently House Democrats showed greater support than ever before for John Conyers’ Medicare for All bill. The Expanded and Improved Medicare for All Act has 111 sponsors in the House, a majority of House Democrats. Unlike Medicare, this improved Medicare for All legislation recognizes that cost-sharing threatens access to care and does away with copays and deductibles for everyone.
Conyers makes a compelling case that Democrats shouldn’t simply be against repeal of the Affordable Care Act. They need a health care plan to stand behind that contains costs and extends health insurance to everyone in the U.S. Conyers’ Medicare for All plan can do just that. It’s a smart alternative to a health care system that builds on a foundation of for-profit insurance companies, which can’t guarantee universal coverage, let alone affordable coverage.
To cover the cost of Medicare for all in the U.S., the Conyers bill raises taxes by 5 percent on the wealthiest Americans and imposes a payroll tax and a financial transaction tax. To keep costs down, it relies on the government’s bargaining power. But, will a majority in Congress have the spine to take on the medical industrial complex or the ability to help the public understand that new taxes to support Medicare for All will be offset for almost all Americans by not having to pay health insurance premiums, deductibles and copays?
Because of the ACA and the health insurance market writ large, many Americans now understand that state-based health insurance is tenuous at best; insurers enter and leave the market and change provider networks and cost-sharing as they will. People cannot count on them for continuity of care. Perhaps in part for this reason, a Gallup poll found last year that about six in ten Americans support expanding Medicare to all and fewer than four in ten Americans oppose it.
Eric Levitz of New York magazine reports that at least one insurance company CEO, Aetna’s Mark Bertolini, is ready to engage in a debate about single payer, a version of improved Medicare for All. He sees a role for the insurers as Medicare’s fiscal intermediaries, processing claims, as health insurers have done since Medicare’s inception as well as offering Medicare Advantage plans. That’s a far cry from endorsing improved Medicare for All, but an opening.
The greatest resistance to expanding Medicare to all Americans is likely to come from the pharmaceutical companies and the medical device companies, who have the most to lose financially if Congress focuses on reining in health care costs as it needs to do. Hospitals and doctors could also oppose Medicare for all, depending upon rates negotiated for services and the amount they would save on administrative costs.
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