Here’s the thing about “Medicare for All”: It’s front and center in the upcoming presidential election. To sell Medicare for All to voters, especially voters who have private insurance, these are the questions Democrats who support it need to address squarely:
The obvious questions:
Left- and right-leaning policy shops put the Medicare for All price tag at around $32 trillion over 10 years, an astounding number that some analysts say would nevertheless represent a small decrease in overall health care spending. But what most folks — even the ones who believe in universal health care — want to know: What will it cost me?
Sens. Bernie Sanders and Elizabeth Warren, both of whom would raise taxes on the wealthiest Americans to pay for their programs, say any tax increase on middle class families would be offset by the elimination of insurance premiums and most other health care costs. But those numbers are incredibly hard to pin down. We’re taxed at different rates, and Americans with health insurance pay wildly varying amounts for premiums, co-pays, office visits, specialist visits and prescriptions, which we draw on at wildly varying rates.
It doesn’t help that there are multiple iterations of this kind of plan. But at the root, candidates should be able to give voters some sense of how we’ll pay for it and how it will work.
Why will it be better? Almost any kind of health coverage would be an improvement for those who are currently uninsured. But even for those us with employer-based health care plans — and really, these are the voters who will need to buy into Medicare for All — dealing with health insurance is often a nightmare.
For most of us, benefits have gotten worse, year after year. We’ve seen our employers change plans or insurers with little or no notice, rarely to our benefit. Getting authorization for routine care or prescriptions can consume hours. Those of us lucky enough to enjoy union representation have watched our negotiators fight a losing battle to keep what we’ve got.
You’d think we’d be ready to jump ship. But we’re used to it, and when it comes to health insurance, “change” has nearly always meant “worse.”
Candidates who support Medicare for All need to articulate clearly why a single-payer system will result in better outcomes with regard to cost, national health care spending, the stability of the system and the ease of interacting with it.
Health care is like plumbing. No one wants to have to think about it. We just want it to work.
What would abolishing private insurance mean?
Sanders’ Medicare for All proposal would bar private insurance companies from offering any product that duplicated government insurance. Insurance is a giant, profit-making industry. If the U.S. Congress makes it illegal, you’d be nuts not to expect lawsuits.
So I called someone who does: University of Michigan law professor Sam Bagenstos. Lawsuits, he said, would certainly happen.
Congress is on solid footing when it comes to regulating commerce, Bagenstos said, but whether a prohibition such as Sanders’ would stick depends on the makeup of the U.S. Supreme Court: “There is a line of thinking among conservative judges who don’t have a majority on the U.S. Supreme Court right now, but could at some point in the future, that the due process clause protects right to enter into contracts.”
What would happen to people who work for private insurers?
Not CEOs with infuriatingly high salaries. I mean the the poor schlub at the employee benefits call center, the one whose job is to explain why the company whiffed on your last big bill. The Insurance Information Institute says that of the roughly 2.7 million Americans who worked in the insurance industry in 2017, about 870,600 were employed in the health and life insurance sectors.
Nancy Kaffer is a Detroit Free Press columnist. She can be reached at firstname.lastname@example.org.