The Facts
After Thursday night’s Democratic debate, it is clear where the future of American healthcare should go. There are tremendous differences among the candidates, but they all have common goals:
- For every American to have access to affordable health care
- To reduce the costs of prescription medications
- To protect Americans from extremes in health coverage costs, medical bankruptcy, and to include covering pre-existing conditions.
This is the alternative that Democrats are offering. So far, the President and the Republican Party have offered no new ideas. They seem willing to go back in time, when private insurance companies denied those with pre-existing conditions, or stuck them with extreme costs for coverage.
The facts are that in the United States medical care costs $3.5 trillion a year; an average of $10,739 per person (CMS.) It is the most expensive medical care in the world. And while it’s among the best medical care in the world, that doesn’t do any good for those who can’t afford to access it.
All of the Democratic plans would address ways to control costs. The price of medical care, prescription drugs, and expanding insurance industry profits all need to be restrained in order to reduce current escalating prices.
How do Democrats plan on getting this done?
Incremental Plans
The more moderate plans, including Vice President Biden and Senator Klobuchar, seek to expand the Affordable Care Act. That would cover all Americans, and add a public insurance option. That option was discussed but later removed from the original ACA legislation. The public option would be a government sponsored health insurance plan that would compete with private insurance.
In this way, Americans could have medical coverage in multiple ways. Many would continue their existing private insurance through their employer. Others without employer provided insurance could choose to purchase through a revitalized insurance marketplace. Or they could buy the public option insurance at a sliding scale price, dependent on income. Those at the lowest income levels could continue to access Medicaid. Others over 65 years of age would still have Medicare.
These plans have the advantage of maintaining the current insurance structure, allowing folks to “keep their insurance”. They are incremental ways to expand coverage, without the tremendous upheaval of an entirely new system.
Medicare for Some
The next level of plans would expand the already existing Medicare plan. The first level, proposed by Senator Booker, would be to expand an optional Medicare from 65 down to 55 years old. In the United States, the most expensive health care costs are those in the current Medicare age range, from 65 years on. The next most expensive is the 55 to 65 age group. By extending Medicare to that level, it would cover that expensive age group, removing them from the private insurance pool and reducing overall insurance costs.
Medicare for Most
Other candidates, including Mayor Pete Buttigieg, would use this as a first step, then continue over several years to expand Medicare until it ultimately covered all ages. This would be an addition to, and in competition with, private insurance. The expectation would be that the increasing scale of Medicare would reduce costs, making it more affordable, and eventually private insurers would be unable to compete. Over decades then, by consumer choice, the US would become a mostly “single-payer” insurance nation.
The problem with the “hybrid” plans, is that the insurance pool of healthy people is divided among private and public plans. Even more, people can currently “go bare” without any insurance coverage. While it seems to be a “choice” that some Americans want to make, when those folks do need medical care, they access it in the most expensive way. The law mandates that they are cared for, and if they are unable to pay, their costs are folded into the costs of everyone else’s bills and insurance costs.
In order to keep the plans affordable, the government would have to reinstate the individual mandate, requiring everyone to either buy health insurance or pay a fine. This was a part of the original ACA, but was rescinded by the Republican Congress in an attempt to destroy the program. So far, that hasn’t worked.
Medicare for All
And finally, Senators Warren and Sanders want to make a simple, radical, change: end private insurance and provide Medicare for all. This would model successful systems in other countries, most specifically Canada. The costs of these plans would be paid for by increased taxation, but it would remove the need to pay for private insurance.
It’s Not a Choice
One question remains unanswered. Employer provided insurance usually means that the employer covers a percentage of the insurance costs, typically 75% or more. The employee then pays the remainder. The personal tax cost of a full Medicare for All plan would be significantly less than the current cost of insurance. But it wouldn’t necessarily be less than the employee costs. Employers would either have to pay to Medicare, or pay employees the difference. Otherwise employees would be stuck with increased net costs.
Health care costs are skyrocketing. A serious illness could bankrupt even those with insurance. There are 44 million people in the US without insurance, and another 38 million with inadequate coverage (PBS). It’s not just a moral thing to do; the cost of providing care for the uninsured is a key factor in escalating costs for everyone.
It needs to be fixed; at least Democrats have ways to do it.
