I spent a lot of time looking at Senator Warren’s plans for Medicare for All (M4A) because she committed to a lot of details on her official campaign website. Senator Sanders, on the other hand, had very little. But he did commit to many details in his Medicare for All Act of 2019.
Bear in mind, this is him working as a senator–not as a president–so it’s hard to know how much this represents what he would push for as president, although I suspect it would change very little. And, at the time of this writing, it’s looking less and less likely that he will become the democratic presidential nominee, so maybe this is all moot. However, you may have noticed that M4A is becoming a bigger conversation every year, and people who once said it’s impossible are starting to rethink their assessments, so I’m going to move forward with evaluating this proposal anyway because I believe considering different possible implementations of a single-payer system in the US will become increasingly important to getting it right if it is in fact going to happen.
Let me also give you a reminder about my approach to these things. I’m biased, as everyone is, but even if you’ve read my writings for a while, you probably still do not know where I fall on many issues. This is on purpose. Maybe its my apolitical Canadian upbringing, but I feel strongly that people should reserve judgment on any issue until they have a good grasp of both sides. In these posts, I am neither arguing for or against M4A; I am simply trying to supply some of those pros and cons of different proposed implementations.
Having said all that, one bias I am upfront about is that I believe markets work. Put more precisely, I fall on the decentralized side of the economic spectrum,which, as a reminder, is independent of the welfare spectrum.
Now, on to my evaluation of the Medicare for All Act of 2019 (hereafter referred to as the Act). It has 11 titles, so let’s go through them one by one to see what kind of fun they contain. I’ll be focusing on the main details that will determine the overall structure of the system and how the healthcare system is likely to function.
This is the general stuff. Every resident and, from what I can tell, every non-resident too, will get benefits and be auto-enrolled and receive a Medicare card, at which point they will have the freedom to see any qualified healthcare provider. The only people who will not receive benefits will be those who are coming to the U.S. specifically to freeload off the free benefits.
Until the Act takes effect, people can continue any current health insurance. But, after that, no one will be allowed to sell coverage that duplicates the benefits provided under M4A. That doesn’t mean they can’t sell supplemental benefit plans though.
There will certainly be arguments about who should be covered by M4A, and, unsurprisingly, this falls on the “cover basically everyone” side of the spectrum. There are other options. I’m not an immigration expert, but it looks like there are four main immigration statuses in the U.S.: citizen, permanent or conditional resident, non-immigrants (because they’re only here temporarily with a visa), and undocumented. It might be easier to only send Medicare cards to citizens and residents. But, from the provider side, it sure would be nice to just treat everyone who walks in the door without regard to their immigration status. There’s also a charity aspect to consider here–how do we care for these people who are undocumented? I have a hard time with this because I want to provide compassion and improve others’ lives, but I also don’t want to reward illegal behaviors with free health insurance at the cost of taxpayers.
Straight up getting rid of employer-sponsored insurance is a great move and will enhance simplicity so much in the healthcare system and in the tax code, plus it will enhance job portability. Insurance should never have been paired with employment anyway–it was just an accident of historical policies.
Ok I’ll leave off right there for this week. If anyone has a strong argument one way or the other about covering undocumented people with M4A, please share below.