'Medicare-For-All': Making Sense Of What Some Democrats Are Proposing

Download Audio
Supporters line up to get into a news conference held by Sen. Bernie Sanders, I-Vt., and other Democratic Senators on Capitol Hill in Washington, Sept. 13, 2017, to unveil their "Medicare-for-all" legislation to overhaul health care. (Andrew Harnik/AP)
Supporters line up to get into a news conference held by Sen. Bernie Sanders, I-Vt., and other Democratic Senators on Capitol Hill in Washington, Sept. 13, 2017, to unveil their "Medicare-for-all" legislation to overhaul health care. (Andrew Harnik/AP)

Many Democratic presidential candidates are calling for some type of health care overhaul. One of the most common is "Medicare-for-all."

But as Vox policy reporter Dylan Scott (@dylanlscott) explains, the term “Medicare-for-all” has encompassed a variety of proposals on the left to expand health care coverage.

It all started with a bill introduced by Sen. Bernie Sanders called the Expanded and Improved Medicare For All Act, which would establish a national health insurance program that would cover every American, Scott tells Here & Now’s Lisa Mullins.

“Over a period of a few years, every person would transition into this new government health care plan, and it would cover basically every medical service that most of us would need, and it would cover that at little cost to the patients,” Scott says. “You wouldn't really have to pay any money out of your pocket when you went to the doctor or picked up a prescription or ended up in the emergency room.”

Scott says the Sanders bill acts as a "North Star" of sorts for other Medicare-for-all proposals. There are a number of competing plans that are using that label, but “they would not go nearly as far,” he says.  

What Other Proposals Use the Medicare-For-All Label?

“There’s one version of this where people 50 and over, between 50 and 65, could buy into Medicare. You have more expansive versions of that that would allow any American to buy into Medicare if they wanted to, but it would be left a choice. There would not be basically a requirement that you sign on to the government plan.

“And then there are a few plans that get a little bit closer to Medicare-for-all but don't go all the way. They would basically get rid of Medicaid. They would get rid of the Affordable Care Act, everybody who is uninsured, all of those populations would be enrolled into a new Medicare government program. That plan would still preserve employer-based insurance, which is what about half of Americans get their insurance through work — it's kind of the bedrock of our system — and the political challenge for a program like what Bernie Sanders wants to put into place is you're going to disrupt insurance for those 150 million people and ask them to go join a government program. And so what [a Medicare cap] and this Medicare For America plan would do is preserve that kind of foundation of work-based insurance.

“And all of these plans are working toward the same goal, which is expanding health coverage, allowing more people to join a government program that's based on Medicare. The question is whether you're trying to get everyone into that program in a very short time whether they want to do it or not, or whether you are more opening up an option and giving people a choice. And that obviously creates a much longer time horizon and preserves a lot of the system that we have today, which is more maybe politically palatable, but for people who believe that single-payer is the best way to get to universal health coverage, it's really a half measure in their eyes.”

Do Single Payer And Medicare-For-All Essentially Mean The Same Thing?

“I would say yes. Universal health care is sort of the goal of making sure everybody has health coverage. Single payer is one way to achieve that, which is having every single person covered by one government insurance plan. Medicare-for-all is kind of the uniquely American brand that has been put on to the idea of universal health coverage and single payer. Like I said, the Bernie Sanders bill, the single-payer bill that he's put forward, is called Medicare-for-all. There are some of these more incremental plans that have tried to attach themselves to that slogan because it's quite popular. And that's one of the debates that Democrats are going to have over the next couple of years is what does Medicare-for-all really mean? Is the only solution a single-payer system or can some of these more limited approaches still end up being the right approach here in the near term?”

"All of these plans are working toward the same goal, which is expanding health coverage, allowing more people to join a government program that's based on Medicare."

Dylan Scott

What Proposals Are Gaining Steam In The Polls?

“One thing that I think we've seen is that Medicare-for-all, those three words, poll very well, but opinions are still malleable. People are still figuring out how they feel about this. If they hear they have to pay higher taxes or that they're going to be forced off of their private insurance, they might not be as fond of it. Something that's been pretty consistent is that while Medicare-for-all is pretty popular, the idea of a Medicare buy-in — of just creating a choice and allowing people to join Medicare if they want to — usually polls even higher than a Medicare-for-all single-payer system. And so that's, I think, why you've seen a lot more mainstream Democrats say like, 'Well, maybe we should look at these more incremental approaches that seem to be more popular with Americans and wouldn't risk the same kind of political backlash that a single-payer system might.' ”

What Is The Driving Factor Behind Support For Medicare-For-All?

“There is some evidence that Medicare-for-all would help to reduce costs. We've seen projections from liberal-leaning groups and from even conservative-leaning groups that show a single-payer system would actually cost less than the system that we have right now. So that's one of the arguments that supporters make. The other one is the idea that health care is a human right, and we should provide health insurance to everybody.”

Would Medicare-For-All Mean Higher Taxes?

“It would. Now the tradeoff its supporters would argue is that instead of paying insurance premiums to your insurance company, you're going to pay taxes to the government, and hopefully that's close to a one-for-one trade. But in the end, yes. Like the tax bill that people would be paying to the government seems likely to rise given that there's just not enough money in existence right now to pay for a single-payer program.”

What Would Medicare-For-All Mean For Private Insurance?

“Well, that's one of the questions Democratic candidates are facing. For, I think, the single-payer true believers, the idea of getting rid of the insurance industry is a feature of this kind of program. I think there's obviously more mainstream Democrats who are less comfortable with that idea, who see a role for preserving private insurance, and so that's one of the things they're going to be debating over the next couple of years is what kind of role should private insurance have, or should the goal of this whole project be eliminating it?”

Where Do Republicans Stand On Access To Health Care And Costs?

“I think Republicans are still in the wilderness a little bit after the failure of repealing Obamacare a couple of years ago. They clearly see some political salience in running against the idea of socialism. You hear President Trump talk about Medicare-for-all as socialism, and candidates lower down the ballot have adopted that language as well. But right now, I think Republicans are still trying to figure out what their more proactive health care vision is.”

Julia Corcoran and Chris Bentley produced and edited this interview with help from Kathleen McKenna. Samantha Raphelson adapted it for the web. 

This segment aired on February 25, 2019.


Headshot of Lisa Mullins

Lisa Mullins Host, All Things Considered
Lisa Mullins is the voice of WBUR’s All Things Considered. She anchors the program, conducts interviews and reports from the field.



More from Here & Now

Listen Live