Questions & Answers
Health care costs are spiraling out of control. How can a single payer health care system like Medicare for All control costs?
Our current healthcare system is wildly inefficient and costs continue to climb with no end in sight. Total health care subsidies under our current system cost nearly 700 billion annually, a number expected to double over the next decade. Medicare for All will curb this waste and make it easier to ensure that we can guarantee comprehensive, high-quality care for all at a lower cost than what we currently pay.
- A single payer system dramatically reduces administrative bloat by reducing billing complexity. The increasing complexity of our fragmented health care system is a primary driver of increasing costs. In fact, we currently spend an unnecessary 503 billion annually in bureaucratic costs. Medicare for All will simplify our system by eliminating fragmentation and ensuring more seamless, efficient, and streamlined administration.
- Competitive advertising can make up as high as 15 percent of an insurer’s operating costs, costs that will not exist under Medicare for All. A major source of waste in our current healthcare system is the 30 billion dollars annually spent by insurers on advertising. Private insurance will have nothing to advertise under Medicare for All, saving billions a year in costs that do nothing to improve health.
- A single payer for health care can negotiate much lower prices for services and drugs, resulting in substantial savings overall. A fragmented healthcare system makes it much harder to negotiate favorable rates on drugs and services for patients, and Medicare is outright prohibited from negotiating for lower drug prices. Medicare for All ends this ban and creates one payer large enough to force down drug prices since it would be the only insurer with which drug companies negotiate.
Our current system rewards doctors who enter specialized fields and penalizes primary care physicians. This specialist-centric system affects people’s ability to get primary care, as doctors entering the profession can no longer afford to run small family or internal medicine practices and as healthcare corporations prioritize high-reimbursement specialty care over primary care. We must reverse this trend and ensure that primary care physicians receive fair compensation for their services. Medicare for All, far from resulting in a pay cut, would actually be a massive boon for doctors who provide primary care services.
- Primary care physicians would be fairly reimbursed in a system that is not driven by profit-making. Amongst the various types of doctors that practice in the United States, primary care physicians ranked near the bottom in terms of salary as a share of the revenue they generate. By prioritizing care, Medicare for All would address the payment structures that undervalue primary care and overvalue specialist procedures.
- The billing process consumes hours of time that could be spent seeing more patients. Under our multipayer system, doctors waste precious time that could be spent seeing patients fighting with dozens of different insurance companies and health administrators to get services that their patients need covered. Under Medicare for All, precious time that doctors and other health care providers currently spend on preauthorizing medical treatments, billing, and coding would be freed up, allowing providers to do more of what they do best—care for patients. Medicare for All would simplify the administrative process for doctors and other providers by having one payer.
A common industry talking point against Medicare for All is the claim that it will force hospitals to close. In reality, Medicare for All will stop the current epidemic of hospital closures and ensure that hospitals have the resources they need to deliver high quality care to patients.
- Medicare for All, specifically HR 1384, implements a different service delivery mechanism for hospitals: the global budget. Global budgets are lump sum payments to a hospital to cover all of its operating expenses. Tailored to each hospital, global budgets ensure that providers get the appropriate funding for the services that their patients need. This is opposed to the way things are, where hospitals, particularly rural hospitals, are closing at a record rate under our private, market-driven system.
- Separate capital expenditures and special projects budgets will help ensure hospitals in medically underserved areas can stay open and modernize. These budgets will help underfunded hospitals renovate and modernize their facilities, purchase new equipment, and hire the staff needed to ensure they can stay open and continue to provide high quality care to their patients and communities.
- Medicare for All also helps curb out of control costs that currently burden hospitals in other ways. Under Medicare for All all patients will have insurance and be able to seek care. Uncompensated care for uninsured patients and patients with insurance who can’t afford their copay or deductible, won’t exist anymore since Medicare for All pays for the full cost of services. Hospitals will also save money in lower administrative costs. Finally, hospitals will pay less for prescription drugs under Medicare for All than they currently do.
HR 1384, the Medicare for All Act, doesn’t just expand the size of the Medicare program. It also improves the program in ways that make it much stronger than it currently is.
- Medicare for All eliminates cost barriers that prevent participants from getting the care they need under current traditional Medicare. Currently, traditional Medicare requires you to pay monthly premiums and deductibles. In addition, Part B typically only covers 80 percent of the cost of care, leaving participants with a 20 percent coinsurance. There is no cost sharing under Medicare for All, meaning there are no costs at the point of service.
- Medicare for All eliminates the need for supplemental or alternative plans, as well as the need to enroll in different parts of Medicare. Medicare is confusing, with Parts A, B, and D all covering different things and requiring different types of cost sharing, inducing many seniors to purchase supplemental plans to cover what Medicare itself doesn’t. In addition, Medicare Advantage (Part C) plans, which are marketed to seniors with the promise of more benefits and lower costs, overcharge the government by billions, restrict choice of doctors, and price the neediest seniors out of care. Medicare for All makes supplemental and Advantage plans unnecessary by offering comprehensive benefits and eliminating cost sharing
- Medicare for All expands the benefits package of Medicare to include all needed care. Dental, vision, and hearing, currently left uncovered by Medicare, are included in Medicare for All, making the program much more robust in its benefits. In addition, Medicare for All includes full coverage for long term care in the home and community, as well as institutional long term care, that many seniors struggle to pay for currently.
Currently, the United States spends over $3.5 trillion a year on healthcare, and that number is only growing. $3.5 trillion a year, all for a system that is not universal, not comprehensive, and rife with inequality and inefficiency. Medicare for All will cost less than our current system while guaranteeing comprehensive health care to everyone, free at the point of service.
- There have been two recent studies on the cost of Medicare for All, one by a university ($2.9 trillion) and one by a libertarian think-tank ($3.2 trillion). Both cost estimates are less than the $3.5 trillion our current system costs.
- Those $2.9 trillion and $3.2 trillion numbers do not reflect new spending: they replace the $3.5 trillion that we are currently spending, resulting in a net reduction in the amount we spend on healthcare.
- Federal health care spending currently amounts to about $1.88 trillion a year, meaning that $1.88 trillion dollars in federal spending is already there. That means the government only needs to raise $1.05 trillion to fully fund the program.
- There are several ways that we could make up the $1.05 trillion needed to fund the program. Payroll taxes, a more progressive income tax structure, a national sales tax with exemptions for necessities, repealing the Trump tax cuts, a tax on Wall Street transactions, and a wealth tax are just some of several ways proposed to fund the program.
- At the end of the day, instead of paying premiums to a for-profit insurer, corporations and families will pay taxes to the government to fund a single-payer system. The difference is, any tax revenue raised to fund the system will only fund the system, instead of being used to line the pockets of insurance, drug companies, and hospital industry executives.
A common argument made among opponents and well-meaning skeptics alike is “I like my current insurance.” Yet, when you really get down to it, people don’t care about how they are covered, they care about what their care looks like.
- There is a difference between liking your coverage and liking your care. Insurance coverage refers to how services are paid for. Care refers to who provides the services. Insurance plans do not provide services, they pay for them.
- When people say they like their plan, they are really saying they like their nurses and doctors and their hospital. People want to see the health professional of their choice, go to the hospital of their choice, and get the care they need without their insurer getting in the way. People don’t care if it’s Blue Shield or Aetna paying for their care: they care what doctor, nurse, or other practitioner provides it.
- Doctor and hospital choice is NEVER positively impacted by private insurance. In the most ideal scenario, your insurance plan will stay out of the way and let you see the doctor you want and pay for the care your doctor recommends. This is very rare under private insurance, which often restricts the care you can receive and who can provide it to limited networks.
- Medicare for All increases freedom and choice where it matters. You can see virtually any doctor, go to any hospital, and get the care they recommend with no premiums, copayments, or deductibles. Doctors, nurses, and their patients will decide what care is appropriate, not insurance company bureaucrats.
Long-term care needs vary wildly from person to person and is extremely costly even for many who have insurance. HR 1384 will fully cover long-term care and ensure it is tailored to each individual’s needs.
- Medicare for All provides long-term care with the goal to cause as little disruption to a person’s life as possible. One of the hardest aspects of needing long-term care is the fear of losing the ability to live a healthy and independent lifestyle. Medicare for All addresses this by prioritizing home and community-based care over institutionalization, allowing people to continue to live their daily lives to the maximum extent possible.
- Medicare for All’s long-term care plan will consult heavily with those who have direct experience with long-term care, either by receiving or administering it. People with disabilities who use long-term care services, caretakers, providers, and disability rights organizations are all tasked with playing a key role in implementing long-term care policies under Medicare for All.
- Institutional care is fully paid for under Medicare for All. There are times where living a life outside of an assisted-care facility is no longer possible. Medicare for All provides full coverage for institutional long-term care services.
- HR 1384 will provide equitable coverage regardless of where you live. Currently, long-term care is covered by Medicaid on a state-by-state basis and is available only for those who qualify based on their income. Medicare for All guarantees comprehensive coverage to all regardless of the state in which you live.
There is nothing inherent to a single payer system that increases wait times. More importantly, Medicare for All will end the most severe wait time of all: people’s outright inability to get the care they need because they can’t afford it.
- We already have a single payer system in the form of Medicare, which has some of the shortest wait times in the world. Medicare as it exists now has some of the shortest wait times in the world for seniors, with only 21 percent of seniors ever having to wait four weeks to see a specialist. It’s perfectly possible to design a single payer system that avoids long wait times and guarantees everybody gets the care they need.
- Medicare for All will eliminate self-imposed wait times by redirecting money to care that is currently spent on overpriced prescription drugs and administrative waste. Over half of all Americans delay getting or outright deny themselves care because they can’t afford it. This is the ultimate form of extended wait times, and a form that does not exist in any other country with guaranteed health care. Medicare for All uses savings from its strong negotiating power and the reduction of administrative waste to eliminate premiums, copays, and deductibles that serve as barriers to care thereby ensuring that nobody ever has to delay care because they can’t afford it.
- Medicare for All ensures that there are sufficient doctors, nurses, and hospitals to provide timely care to all. The capital expenditures budget in HR 1384 will ensure that under-resourced facilities can modernize and upgrade, while the special projects budget will ensure adequate resources go to staffing rural and medically underserved areas. Finally, the office of primary care will implement policies that maximize the retention and facilitate a new influx of providers into the current system.
Great change always requires great struggle. It is true that Medicare for All will be a great challenge to get passed. So was virtually every major change in this country’s history. The movement to pass Medicare for All is our best hope of overcoming the opposition of the insurance and drug companies and truly transforming our profit-driven health care system.
- No matter what form of health reform we pursue, we are up against the same powerful interests, making an all-in effort to pass Medicare for All the right choice. The Partnership for America’s Healthcare Future, a group of insurance and drug companies established to fight health care expansion, states on its own website that any major overhaul of our failed health care system is unacceptable, no matter what form it takes. There’s no reason to settle for less than a much-needed overhaul of our system since anything we do will face the same opposition.
- No great change has ever occurred in this country without a mass movement driving it. The Civil Rights Act, Social Security, and Medicare were all transformational changes in this country’s history that would not have occurred without a broad-based grassroots movement. A national movement will be required to pass any substantial change to our country’s health care system. The movement to pass Medicare for All already exists. And it is growing stronger every day!
- Medicare for All has the energy, the enthusiasm, and the public support needed to overcome big money opposition. 70 percent of Americans support Medicare for All, and the plan has continued to dominate any discussion of health care reform. No other plan to reform our healthcare system has anywhere near the level of activist buy-in as Medicare for All. A majority of the House Democratic Caucus supports HR 1384, including the Caucus Chair Hakeem Jeffries and Assistant Speaker Ben Ray Luján. Medicare for All has the energy, momentum, and organization needed to overcome the opposition and transform our health care system.
True freedom to choose your own care provider is a luxury very few people have in this country. Most private insurance plans have limited networks of providers from whom you can choose to receive care. Under Medicare for All, there will be true freedom to choose your own provider, and the ability to keep that provider, without fear of disruption.
- Most Americans do not have the unfettered ability to choose where they get care. Most plans have restrictive networks that limit who a patient is allowed to see. When a plan allows you to see an out-of-network provider, they almost never cover the full cost. Also, plans change all the time, whether it be because someone changed or lost their job, their employer switched their plans, or the list of plans in the marketplace changed. People could lose their preferred provider at any time.
- High premiums are increasingly forcing people into insurance plans with narrow networks. For example, those with a choice of plans through their employer often find that HMO plans, which are much more likely to severely restrict choice of doctors, have the lowest premiums. Similarly, those who purchase plans through the ACA marketplaces find that most feature narrow networks.
- Medicare for All ensures the ability to see any doctor you choose and will never force you to stop seeing a doctor you like. Medicare for All has no networks, and since the government is the only payer, virtually every provider will participate. That means you will be able to see any doctor you want with no cost considerations, no network limitations, and no risk you could lose your doctor when you lose your coverage.
There aren’t enough nurses and doctors to take care of everyone who has coverage now. How can we possibly make Medicare for All work?
It is structural issues with our healthcare system that create these artificial “provider shortages.” Medicare for All will correct those systemic issues and ensure enough nurses and doctors will be on hand to take care of everybody.
- Corporate greed, budget cuts, a lack of adequate support staff, and burnout are responsible for the nursing “shortage.” In an attempt to minimize labor costs, hospitals are unwilling to hire sufficient nurses and instead are increasingly trying to make nurses do more with less. More than half of all doctors are experiencing burnout with only slightly lower rates for nurses. This is leading to higher turnover rates as well as causing providers to change their profession or retire early.
- Doctor shortages are mainly in the field of primary care, because they are paid so poorly under our current system. Primary care doctors are paid less than most specialists creating a scarcity in the form of care patients rely on most. Medicare for All will give most primary care physicians a pay raise and reverse this trend.
- Medicare for All mandates sufficient staffing and ensures hospitals and other institutions are resourced sufficiently to implement reforms. Funding health institutions with global budgets, as well as requiring that these institutions have an appropriate number of nurses on hand, will end the artificial shortage of nurses.
- Medicare for All will also create a new governmental division to specifically address these concerns. A new Office of Primary Care will be created specifically to come up with new policies and guidelines to ensure we have an appropriate number of providers in the system. The special projects budget can also be used to hire staff in medically underserved areas.
Reproductive rights and freedom are being threatened more now than any time since Roe v Wade. Medicare for All would go a long way towards shielding people from attacks on reproductive freedom while ensuring that they can get the reproductive care they need.
- Medicare for All includes comprehensive reproductive healthcare and prohibits the Hyde Amendment from restricting Medicare for All funding for abortion. As a part of the benefits package, abortion, birth control and other contraceptive services, maternal and newborn care, amongst other things, will be covered.
- Medicare for All includes multiple safeguards in the event a hostile administration tries to curb reproductive freedom. States have the right to expand the benefits package of the system further in the event that there is federal interference in delivery of reproductive care. In addition, doctors can override federal guidelines that may restrict access to abortion or reproductive care if, in their professional judgment, they deem it medically necessary or appropriate for the patient. This ensures patients can receive reproductive care even if a hostile administration tries to eliminate coverage for certain reproductive procedures.
- Targeted restrictions on abortion providers (TRAP) laws that force clinics to close or restrict access to abortion services will be much harder to implement under Medicare for All. Under Medicare for All, states are prohibited from adding provider regulations that would decrease access to reproductive services. Today, a number of state laws require excessive and unnecessary requirements on providers who offer abortion services, which result in reduced access to safe, high-quality abortion services and other reproductive care. These kinds of state laws that use civil and criminal penalties against providers to reduce access to abortion would be unlawful under Medicare for All.
Rural areas have unique health care challenges, ranging from a shortage of available doctors, less modernized facilities, and a hospital closure crisis. Medicare for All will help rectify these issues and improve the quality and accessibility of care provided in rural areas.
- One quarter of rural hospitals are currently at risk of closure under the current system, a trend that will be reversed by enacting Medicare for All. Medicare for All under HR 1384 will stabilize these hospitals through global budgets, which will make sure these hospitals always have the resources they need to keep their doors open.
- Rural health facilities will receive priority grants to upgrade and modernize their facilities under Medicare for All, as well as address doctor shortages. Medicare for All under HR 1384 includes both capital expenditures and special project budgets to provide grants to build, upgrade, and modernize facilities and hire staff. These grants are crafted to ensure rural areas will get their fair share of those funds. These budgets, plus a new Office of Primary Care, will help address shortages in underserved areas.
- Reducing the number of uninsured will have a substantial effect on health care access for people who live in rural areas. Rural Americans are more likely to be uninsured or underinsured than those living in urban or suburban areas. Eliminating uninsurance and underinsurance will remove a critical barrier to care for many people in rural areas.
- Medicare for All will give most primary care doctors a raise, making it easier for new doctors to provide primary care instead of specialty services. Currently, many primary care physicians are underpaid, while many specialists make out extremely well. Medicare for All addresses this imbalance to ensure primary care physicians practicing in rural areas are compensated fairly.
Currently, we in the United States spend absurd amounts, both individually and as a nation, on a healthcare system that fails to cover everybody and is riddled with bloat, waste, and inefficiency. Both businesses and individuals could save a lot of money under Medicare for All, and everyone will receive comprehensive, high quality care.
- Premiums are taxes, as are copays. In reality, we are the highest taxed nation in the world for our health care system. Americans spend twice as much per capita on health care as other countries which have universal coverage and provide better outcomes. Our taxes, instead of going to health care as they do in other countries, are paid in the form of premiums and copays to line the pockets of insurance executives.
- Virtually everybody except the wealthiest Americans will benefit under Medicare for All. Low- and middle-income families stand to benefit from substantially reduced costs with much higher access to the care they need.
- Businesses, small businesses in particular, will also benefit from Medicare for All. Currently, small businesses are constrained from growth by skyrocketing healthcare costs. Many business owners that want to provide coverage to their employees can’t afford to. This hurts their competitiveness in attracting the best workers when compared to more established businesses. Medicare for All could also reduce costs for most businesses that currently provide coverage to their employees.
- The tax proposals put forward to fund Medicare for All will all amount to far less overall than what we currently pay for health care in this country. Whether it be a Wall St transactions tax or a repeal of the Trump tax cuts, the various tax proposals out there to fund the remaining third of health care spending not already paid for by the federal government could amount to far less than what individuals currently pay for care.
The longer we maintain the current market-driven system of private insurance, the more people will die because they cannot get the care they need. The longer a transition takes, the greater opportunity opponents of Medicare for All will have to sabotage its implementation. That is why H.R. 1384, the Medicare for All Act, implements a quick two-year transition to ensure people get the care they need, all the while minimizing the disruption felt during the change. It’s important to note that we’ve done major transitions to programs like Medicare in shorter time frames, with less sophisticated technology than we have now.
- The transition to Medicare for All happens in stages over a two-year period. One year after the bill is enacted, adults over 55 and minors can enroll in and start receiving Medicare for All benefits. Those who are eligible, including current Medicare recipients, will be automatically enrolled in the Medicare for All program and will be able to access the new expanded benefits package at no additional cost. After two years, every U.S. resident will eligible for and enrolled in the Medicare for All program.
- A temporary Medicare for All Buy-In is included as a safety net during the transition. This buy-in will ensure that people who need coverage can get it. This buy-in exists only during the transition, is open to anyone who wants to enroll, and will be paid for by premiums established on a sliding income scale, with cost-sharing subsidies available under the ACA.
- Continuity of care is explicitly ensured during the 2-year transition to Medicare for All to ensure as little disruption as possible. Insurance companies will be prohibited from kicking people off of their healthcare plans during the transition to Medicare for All. In addition, insurance companies would be prohibited from altering or attempting to exclude anybody from their coverage on the basis of disability or chronic illness.
For union members, there is a direct trade off between the skyrocketing costs of healthcare and wages, benefits, and working conditions for workers. Unions expend much collective bargaining power merely trying to protect current healthcare coverage. Medicare for All is as comprehensive as even the best union plans, will protect workers from hostile employers, and allows unions to negotiate for better wages, improved benefits, and better working conditions.
- The current system of employer-provided health insurance is unsustainable, even for unionized workers. Insurance costs for workers are often growing faster than their incomes. Deductibles have grown ten times faster than inflation over the last decade. Families spent an average of nearly $5,000 on premiums and another $3,000 on cost-sharing in 2018, an amount expected to skyrocket over the next decade.
- Health insurance depresses wages and other benefits. To prevent cuts in health benefits, workers often must directly trade off wage growth and other workplace benefits and protections. Removing the cost of health care from contract negotiations frees up bargaining power to negotiate higher wages, better benefits, and improved working conditions.
- Employers can hold union health plans hostage during disputes, as seen during the 2019 GM strike. Our healthcare system leaves unions on the defensive, as workers’ health care is constantly used as leverage to extract concessions from workers. Untying healthcare from the workplace removes a major weapon employers have against workers during strikes and other disputes.
- Savings under Medicare for All could be used to expand other union benefits, such as disability, childcare, legal services, and tuition. Union-negotiated plans could use the additional revenue to expand other non-health benefits or potentially to shore up pension plans.
Although suffering from underfunding, both the Veterans Health Administration (VA) and the Indian Health Service (IHS) offer critically important and culturally competent services to their respective constituencies. Medicare for All will preserve these institutions while ensuring they have the ability to provide care to those that need it.
- The Veterans Health Administration and the Indian Health Service will be preserved under Medicare for All. The Medicare for All Act does not end or alter the Veterans Health Administration or the Indian Health Service. This ensures that the specialized care that these institutions provide can continue.
- Veterans and Native Americans could choose to seek care through their respective institutions, if eligible, or see any provider they want outside of them. Under Medicare for All, the VA and IHS will still exist to provide specialized care to their respective constituencies. However, if Veterans and Native Americans so choose, they can see any provider outside of those institutions and receive full coverage under Medicare for All.
- The IHS is protected from alterations under Medicare for All. The Medicare for All Act prohibits any reevaluation of the Indian Health Service without consultation with the tribes that participate.
A common misconception is that a public option could get us to universal healthcare easier and quicker than trying to pass Medicare for All outright. In reality, a public option will not be any easier to pass than Medicare for All and it won’t fix our broken healthcare system.
- The insurance and drug industries will fight against a public option as aggressively as they would fight against Medicare for All, as they have proven in prior efforts to pass reforms. The Partnership for America’s Healthcare Future, a conglomerate of insurance and drug companies formed to oppose universal healthcare, state on their own website that to them, a public option is just as unacceptable as Medicare for All. These industries have proven that they will stop at nothing to block even small reforms. A coalition of drug companies spent over 100 million in 2016 to kill Proposition 61 in California, a ballot initiative that would have controlled prescription drug prices. If they’re willing to spend that much to kill one cost control over one sector of healthcare in only one state in the country, they will spend much more to kill any substantial national reform.
- A public option won’t fix our system. A 2013 CBO study predicted that a public option would have minimal effect on the number of uninsured because any increase in the number of people with coverage through a public option would be offset by a reduction in the number of people who get coverage through their employer. In addition, a public option won’t reduce administrative costs, lower the price of drugs, end underinsurance, or otherwise solve the host of problems in our current system.
- A public option could cost even more for patients than private insurance. Private insurance companies aggressively avoid sicker, costlier patients. They use unethical practices such as narrow networks, tiered cost-sharing requirements, and selective advertising, to exclude expensive patients. These practices would push sicker, more costly patients into the public option resulting in higher costs for patients.
Workers who administer our current fractured health insurance system shouldn’t be punished by the transition to Medicare for All. That is why the Medicare for All Act is written to ensure a just transition for workers who stand to be impacted by the change in our healthcare system.
- Revenue from the Medicare for All trust fund will be set aside to ensure people who may be displaced from jobs related to the administration of health insurance by the transition to Medicare for All are taken care of. For up to 5 years after the Act is implemented, at least 1 percent of a multi-trillion dollar budget will be set aside to implement programs to assist those who are adversely affected by the change to Medicare for All.
- A robust series of programs will ensure that people can find new work or pursue job training and education, and that people are financially supported in the transition. The displacement fund created by the bill will be used to implement programs to ensure wage replacement, retirement benefits, job training, and education benefits, including covering tuition if people seek to return to school to learn a new trade. This ensures the greatest amount of flexibility possible.
- There will still be an opportunity to pursue the same sort of work as Medicare expands to cover all Americans. While private insurance jobs will be lost under Medicare for All, health administration jobs will still exist within the new Medicare for All program. In fact, there will be a great need for these sorts of jobs, as Medicare is made more robust, and is expanded to cover all Americans. There will be opportunities for people to pursue similar jobs as what they held prior to the transition to Medicare for All.