By Sanjay Kishore, Micah Johnson, Don Berwick
Health Affairs Blog, December 3, 2018
Health care was the most important issue for voters in the 2018 Congressional elections, in which Democrats won a significant majority in the US House of Representatives. A major health care proposal supported by many Democrats is “Medicare for All”, which would create a publicly-financed, single-payer health insurance system for all Americans.
Many observers dismiss single-payer health care as a political non-starter, but this traditional view ignores an explosion of support for the idea in recent years. In one recent poll, over 70 percent of Americans said they would support “a policy of Medicare for All”, including 85 percent of Democrats and even 52 percent of Republicans. A subsequent poll asked “do you support providing Medicare for every American” and found nearly identical results, including majorities of support from respondents in the South, those who live in rural areas, and those who say they “lean conservative.”
What insights do the 2018 elections provide into the future political prospects of Medicare for All?
(The authors discuss the support for Medicare for All in the House of Representatives and in the Senate.)
Implications For The 116th Congress
Medicare for All will not become law in the next two years, but the incoming 116th Congress could play an important role in determining the future of the proposed reform.
First, this Congress will have an opportunity to distinguish Medicare for All from other Democratic proposals to expand public coverage. To capitalize on the popularity of Medicare for All, some organizations have released more moderate proposals with sound-alike names such as “Medicare Extra for All”; others have started to brand Medicare buy-in proposals with slogans like “Medicare Available to All” or “Medicare for Anyone.” These alternatives are essentially variations on a public option. These proposals vary in their details and scope, and their relative merits are worthy of debate in the upcoming Congress. However, they differ substantially from the actual Medicare for All bills that have been proposed in Congress for many years. The 116th Congress will have an opportunity to clarify these differences, and to build further public understanding of Medicare for All.
Second, the 116th Congress can start building consensus on key policy elements of a Medicare for All proposal, including knotty issues such as determining the covered benefits of the plan, exploring alternative revenue sources and cost controls, deciding how providers would be paid and at what prices, how to pave a practical transition pathway from current health plans, how to craft a soft landing for the employees of the current insurance industry, and more. Ideally, this exploration will help foster a deeper and more mature discussion of Medicare for All among legislators in the future.
Implications For 2020 Elections And Beyond
It is time to re-frame the public debate: the path to Medicare for All is difficult, not impossible. In a democracy, it is strange and basically untenable to insist that an idea at least nominally supported by 70 percent of the citizenry is not even worthy of serious consideration. Medicare for All, though difficult, is now within the realm of political possibility, and the surge of enthusiasm among new members in the House of Representatives is evidence of renewed public interest in expanding access to health coverage and controlling costs.
As Presidential contenders enter the 2020 primaries, Medicare for All will almost certainly become a focal point of national discourse. Instead of pretending that Medicare for All is impossible, health policy experts and Congressional leaders should deepen their knowledge of the promise and challenges of single-payer health reform, and start working seriously on the hard job of crafting the best possible version of Medicare for All.
Sanjay Kishore and Micah Johnson are fourth-year MD candidates at Harvard Medical School and Don Berwick, MD, MPP, FRCP is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and is the former Administrator of the Centers for Medicare & Medicaid Services.
By Don McCanne, M.D.
How could you ask for a more credible voice on the topic of Medicare for All than Don Berwick and two senior medical students at Harvard?
Their concluding remark: “Instead of pretending that Medicare for All is impossible, health policy experts and Congressional leaders should deepen their knowledge of the promise and challenges of single-payer health reform, and start working seriously on the hard job of crafting the best possible version of Medicare for All.”
Sage advice. Let’s go with it.
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