Medicare-for-all bill to be introduced in Senate

Legislation to move the U.S. to a single-payer, “Medicare-for-all” healthcare system will be introduced Wednesday, Sept. 13, by former presidential candidate Sen. Bernie Sanders, I-Vermont, with several potential presidential contenders in 2020 already lining up behind the bill.

In a New York Times op-ed published before the bill was released, Sanders said support for moving away from the current healthcare system, which he called “dysfunctional,” has been growing, citing examples from within the healthcare industry.

“Doctors have told me about patients who died because they put off their medical visits until it was too late,” Sanders wrote. “Oncologists have told me about cancer patients who have been unable to acquire lifesaving treatments because they could not afford them. This should not be happening in the world’s wealthiest country.”

Here are some of the features of this proposed government-run system:

• A large set of benefits would be covered with no co-payments, including hospital visits, primary care, medical devices, lab services, maternity care, vision and dental services.
• Employer-sponsored health plans would cease to exist, with employers paying higher taxes but not on the hook for providing health benefits
• As in other single-payer systems, private, supplemental insurance would be needed for elective treatments such as plastic surgery

The new system would be rolled out over a four-year period. There would be some immediate expansion of coverage, with the Medicare eligibility age be lowered to 55 and benefits expanded to include dental care, vision coverage and hearing aids. Every American under 18 would also be covered immediately. The following three years would use the Medicare eligibility gradually lowered—to age 45 in year two and age 35 in year three—until everyone is covered in the fourth year and beyond.

15 co-sponsors have signed onto to support Sanders’ bill in the Senate. Some of them announced their support ahead of the bill’s release, like Sens. Elizabeth Warren, D-Massachusetts, Kamala Harris, D-California, Kristen Gillibrand, D-New York, and Cory Booker, D-New Jersey—all of whom have been touted as possible Democratic presidential candidates in 2020.

Even more centrist Democrats have changed their tunes on the policy, with a former opponent of single-payer during the ACA debate, ex-Sen. Max Baucus, D-Montana, coming out in support of the change and Sen. Joe Manchin, D-West Virginia saying he wanted to know more about how other countries have made such a system work.

"It should be explored," he said, according to Bloomberg.

Support appears to be growing amongst the public as well, though along party lines. A July analysis of single-payer polls by the Kaiser Family Foundation put support of single-payer at 53 percent overall. Democrats had the highest level of support at 64 percent, followed by 55 percent support among independents, but Republican support was weak at only 28 percent. Attitudes on the subject were “quite malleable,” according to the analysis, as respondents tended to change their minds when opponents’ arguments, like single-payer would raise taxes or result in more government control of healthcare, were explained.

The plan would also stir up fierce opposition among segments of the healthcare industry. Payers and employee benefit managers have been shown to be more opposed to single-payer than clinicians, with greater support for some universal coverage mechanism which maintains private healthcare options. Other lawmakers have proposed these more incremental shifts, like Hawaii Sen. Brian Schatz’s Medicaid buy-in legislation.

Sanders’ plan stands no chance of passing while Republicans control both Congress and the White House—he said so himself in an August interview with NPR. The point of introducing the bill, he said, was to get a conversation going on a more drastic shift in the U.S. healthcare system.

The proposal leaves out a major part of the discussion: how to pay for it. Taxes would have to be raised substantially, Sanders acknowledged, and that’s where many other governments have hit a wall when crafting single-payer plans. Sanders’s own state of Vermont proposed moving towards such a system, but abandoned the plan after estimating it would require tax hikes of 11.5 percent on payroll and 9 percent on income. The state has since moved to a different mechanism to achieve universal coverage with an all-payer, accountable care organization-like system.

Financing details can be worked out later, Sanders said to the Washington Post, and he challenged the conclusions drawn by healthcare organizations which argue the cost of “Medicare-for-all” will be too high.

“Rather than give a detailed proposal about how we’re going to raise $3 trillion a year, we’d rather give the American people options,” Sanders said. “The truth is, embarrassingly, that on this enormously important issue, there has not been the kind of research and study that we need. You’ve got think tanks, in many cases funded by the drug companies and the insurance companies, telling us how terribly expensive it’s going to be. We have economists looking at it who are coming up with different numbers.”