WEBVTT - What Would 'Medicare for All' Really Mean? 0:00:02.040 --> 0:00:07.200 Welcome to brain Stuff from how Stuff Works, Hey, brain Stuff, 0:00:07.240 --> 0:00:12.080 Lauren vogelbam here. In the American presidential race, Senator Bernie 0:00:12.160 --> 0:00:14.400 Sanders was the first candidate to float the idea of 0:00:14.480 --> 0:00:18.079 Medicare for All, a massive expansion of the popular government 0:00:18.079 --> 0:00:21.640 funded health program to cover all Americans, not just those 0:00:21.680 --> 0:00:25.120 sixty five years of age and older. While hailed by 0:00:25.160 --> 0:00:28.400 Sanders progressive supporters, the proposal failed to gain traction with 0:00:28.440 --> 0:00:32.440 mainstream Democratic voters and was ridiculed as a wildly expensive 0:00:32.440 --> 0:00:36.600 and even socialist idea by Republican critics. The crowded field 0:00:36.600 --> 0:00:41.239 of Democratic presidential hopefuls has now swelled to twelve official candidates, 0:00:41.280 --> 0:00:44.840 including Sanders, and Medicare for All is now being embraced 0:00:44.840 --> 0:00:49.040 by a larger swath of politicians and voters alike. According 0:00:49.040 --> 0:00:53.160 to recent polls, fifty percent of Americans, including of Republicans, 0:00:53.360 --> 0:00:56.240 now support the creation of some kind of national health plan, 0:00:56.600 --> 0:00:59.360 and Sanders is no longer the only congress person trying 0:00:59.440 --> 0:01:04.160 to pass comprehensive Medicare for all legislation. In February of 0:01:04.160 --> 0:01:08.039 twenty nineteen, Representative Promelagia Paul, a Democrat in Washington State, 0:01:08.240 --> 0:01:10.800 and progressive colleagues in the U. S. House of Representatives 0:01:10.840 --> 0:01:13.840 released their own Medicare for All Act of twenty nineteen, 0:01:14.160 --> 0:01:18.440 which goes even farther than Sanders original seventeen bill. Not 0:01:18.560 --> 0:01:21.800 only would the Giapaul proposal do away entirely with private 0:01:21.800 --> 0:01:24.880 health insurance and require absolutely no premiums or co pays 0:01:24.920 --> 0:01:27.880 of any kind, it would significantly extend Medicare to cover 0:01:27.959 --> 0:01:32.920 comprehensive dental, vision and long term care. Giapaul wrote in 0:01:32.959 --> 0:01:36.119 a statement, our bill will cover everyone, not just those 0:01:36.160 --> 0:01:39.360 who are fortunate enough to have employer sponsored insurance, not 0:01:39.440 --> 0:01:42.959 just children, not just seniors, not just those who are healthy. 0:01:43.120 --> 0:01:45.640 It's time to ensure that healthcare is a right and 0:01:45.720 --> 0:01:48.880 not a privilege, guaranteed to every single person in our country. 0:01:49.120 --> 0:01:53.520 It is time for Medicare for All. Let's break down 0:01:53.520 --> 0:01:57.440 what that might entail. First, some history. Medicare was created 0:01:57.440 --> 0:02:00.000 in nineteen sixty five as a safety net health insurance 0:02:00.080 --> 0:02:04.040 program for older Americans. All Americans over sixty five years 0:02:04.080 --> 0:02:07.440 of age qualify for Medicare health coverage regardless of pre 0:02:07.480 --> 0:02:10.760 existing conditions, and Medicare covers a significant portion of the 0:02:10.800 --> 0:02:15.400 costs of doctor's office visits. Treatments and surgeries, plus prescription medications. 0:02:15.440 --> 0:02:18.640 Although Medicare recipients also pay annual premiums and out of 0:02:18.639 --> 0:02:23.480 pocket costs, Medicare for All proposals, like gypaulse would make 0:02:23.560 --> 0:02:27.920 three monumental changes to the current Medicare system. First, there 0:02:27.919 --> 0:02:31.920 would be absolutely no age limit. Every American from newborns 0:02:31.919 --> 0:02:34.960 to centenarians would be covered by the same government funded 0:02:34.960 --> 0:02:39.240 health insurance. Second, private health insurance carriers would be barred 0:02:39.240 --> 0:02:42.919 from offering plans to compete with Medicare for All. Third, 0:02:43.120 --> 0:02:46.800 patients would pay absolutely nothing, no premiums, deductibles, co pays, 0:02:46.919 --> 0:02:50.679 or coinsurance for all covered health care services, which under 0:02:50.720 --> 0:02:53.320 the Jipol bill include just about everything under the sun, 0:02:53.600 --> 0:02:57.600 including expensive long term care insurance to cover nursing homestays. 0:02:59.120 --> 0:03:01.600 All of this potential lee spells doom for the one 0:03:01.639 --> 0:03:06.400 point to twillion dollar private health insurance industry. We spoke 0:03:06.440 --> 0:03:09.400 with one Care and Politz, who studies healthcare reform and 0:03:09.440 --> 0:03:12.560 private health insurance for the Henry J. Kaiser Family Foundation, 0:03:12.880 --> 0:03:16.280 a nonpartisan nonprofit group that analyzes major health care issues 0:03:16.280 --> 0:03:19.960 fasic America and beyond. She jokes that Medicare for All 0:03:20.000 --> 0:03:23.680 would even put her out of business. Pault said, the 0:03:23.720 --> 0:03:26.920 Medicare for All proposals that have been discussed are very comprehensive. 0:03:27.000 --> 0:03:29.360 Would cover everything you're used to having covered in private 0:03:29.360 --> 0:03:33.600 health insurance today, plus dental, vision, hearing, long term care, nursing, 0:03:33.600 --> 0:03:36.000 home care. You would get this red, white and blue 0:03:36.040 --> 0:03:38.320 Medicare for All card show that when you go to 0:03:38.360 --> 0:03:42.760 the doctor and you'd get taken care of. Simple. Okay. 0:03:42.880 --> 0:03:45.600 So that's the basics of what Medicare for All could be. 0:03:46.360 --> 0:03:51.080 What wouldn't it be. Medicare for All is not socialized 0:03:51.160 --> 0:03:55.200 medicine like the United Kingdom's National Health Service. Under that system, 0:03:55.360 --> 0:03:57.720 the government is not only the soul insurer, but it 0:03:57.800 --> 0:04:01.280 also runs most of the medical clinics and hospitals. That's 0:04:01.320 --> 0:04:03.640 not the case under any of the proposed Medicare for 0:04:03.680 --> 0:04:07.680 All plans, which more closely resemble Canada's healthcare system, also 0:04:07.760 --> 0:04:12.360 called Medicare. Doctors and hospitals would remain private businesses, but 0:04:12.440 --> 0:04:15.920 all insurance coverage and therefore all reimbursements paid to doctors 0:04:15.920 --> 0:04:21.080 and hospitals would be provided through Medicare A. Canada's healthcare system, 0:04:21.160 --> 0:04:24.159 by the way, doesn't cover vision, dental, prescription, drugs or 0:04:24.240 --> 0:04:28.920 long term care. Those are covered by private insurance, which 0:04:29.000 --> 0:04:32.720 brings us to an important question. The important question who 0:04:32.760 --> 0:04:36.680 would be paying for all this? Medicare for All is 0:04:36.720 --> 0:04:40.440 also what's known as a single payer healthcare system. Technically, 0:04:40.480 --> 0:04:43.320 the single payer will be the federal government. But where 0:04:43.360 --> 0:04:46.920 will the government get its money? New taxes, of course, 0:04:47.200 --> 0:04:50.520 not only income taxes, but also payroll taxes, corporate taxes, 0:04:50.560 --> 0:04:56.880 excise taxes, et cetera. In Medicare alone cost American taxpayers 0:04:56.920 --> 0:05:00.240 five and nineties seven billion dollars, or nearly five teen 0:05:00.240 --> 0:05:04.040 percent of the entire four trillion dollar federal budget. The 0:05:04.040 --> 0:05:07.559 projected cost of Sanders seventeen Medicare for All bill, which 0:05:07.600 --> 0:05:10.200 did not include expensive add ons like long term care, 0:05:10.640 --> 0:05:15.080 is thirty two trillion dollars over ten years. So, although 0:05:15.080 --> 0:05:17.400 it's important to note the costs could even out over 0:05:17.440 --> 0:05:20.160 the long term, in the short term that's about six 0:05:20.240 --> 0:05:24.680 times what Medicare currently costs US per year. As Paul 0:05:24.680 --> 0:05:27.800 It said, quote, that's a lot of money. Right now, 0:05:27.960 --> 0:05:30.720 the federal government and states together are paying almost half 0:05:30.720 --> 0:05:33.559 of the nation's healthcare bill. But if we stop paying 0:05:33.600 --> 0:05:36.159 premiums and deductibles and co pays, there would have to 0:05:36.160 --> 0:05:39.480 be a new way to raise revenue. When Americans learned 0:05:39.520 --> 0:05:41.600 that the switch to Medicare for all would almost certainly 0:05:41.600 --> 0:05:44.839 mean higher income taxes, support for the national healthcare concept 0:05:44.960 --> 0:05:49.599 drops by. But while the exorbitant cost of Medicare for 0:05:49.640 --> 0:05:52.279 all is a favorite talking point of its critics, the 0:05:52.360 --> 0:05:56.320 numbers are deceiving. Americans will certainly pay more in taxes 0:05:56.360 --> 0:05:58.919 under such a plan, but they will pay absolutely nothing 0:05:58.920 --> 0:06:03.520 in premiums and other out of pocket healthcare costs. Paul said, 0:06:03.760 --> 0:06:07.080 American households and the government combined are currently spending three 0:06:07.120 --> 0:06:10.160 point five trillion dollars a year on healthcare, more than 0:06:10.160 --> 0:06:13.520 any other country on the planet. When you multiply that 0:06:13.560 --> 0:06:17.119 out by ten years, it's thirty five trillion dollars greater 0:06:17.160 --> 0:06:19.600 than the cost of Sanders Medicare for all proposal by 0:06:19.600 --> 0:06:22.479 a full three trillion. So a switch to a single 0:06:22.520 --> 0:06:27.640 payer system could actually save money overall, but money aside. 0:06:27.880 --> 0:06:32.880 Would Medicare for all mean worse healthcare. There's no doubt 0:06:32.880 --> 0:06:35.200 that a massive overhaul of the U S healthcare system 0:06:35.279 --> 0:06:39.040 like Medicare for all would be hugely disruptive. Most private 0:06:39.040 --> 0:06:42.600 insurers would go out of business, pharmaceutical companies would lose 0:06:42.640 --> 0:06:46.480 profits as drug prices were capped, and since Medicare typically 0:06:46.520 --> 0:06:50.160 reimburses doctors and hospitals at lower rates than private insurers, 0:06:50.200 --> 0:06:53.320 there would be wins and losses for private medical practices. 0:06:54.640 --> 0:06:57.479 That said, there's no indication that switching to a Medicare 0:06:57.480 --> 0:07:00.320 for All system would result in fewer covered treat mints. 0:07:00.680 --> 0:07:04.680 Jiapaul's proposal promises the opposite, and neither should the new 0:07:04.720 --> 0:07:08.040 insurance concept result in long ways for life saving procedures 0:07:08.040 --> 0:07:12.480 and medications. Paul It said, we don't currently have that 0:07:12.560 --> 0:07:15.360 in Medicare. You don't see senior citizens queuing up for 0:07:15.360 --> 0:07:18.720 doctor's appointments and prescriptions. It's all quick and easy. The 0:07:18.800 --> 0:07:21.360 key question is what will those payment rates be for 0:07:21.520 --> 0:07:25.280 doctors and hospitals. The Giapaul bill doesn't really say. That's 0:07:25.280 --> 0:07:29.480 still a key question to be addressed and debated. Currently, 0:07:29.600 --> 0:07:32.680 a growing number of doctors don't accept Medicare patients because 0:07:32.720 --> 0:07:35.240 of the low reimbursement rates and large amount of paperwork 0:07:35.280 --> 0:07:38.800 required for reimbursement. The Medicare for All Act of twenty 0:07:38.880 --> 0:07:41.720 nineteen does allow doctors and patients to opt out of 0:07:41.720 --> 0:07:44.360 the single payer system and simply pay in cash for 0:07:44.480 --> 0:07:48.120 medical services, and giapaulse Plan is only one type of 0:07:48.200 --> 0:07:52.040 universal health coverage being proposed in Congress. Other versions include 0:07:52.080 --> 0:07:54.640 keeping the current system but adding a public option based 0:07:54.640 --> 0:07:57.280 on Medicare, as well as allowing older people not yet 0:07:57.280 --> 0:08:01.040 eligible for Medicare to buy into the system. All of 0:08:01.080 --> 0:08:02.960 that is a primer for now. We will keep you 0:08:03.080 --> 0:08:11.080 updated as developments occur. Today's episode was written by Day 0:08:11.080 --> 0:08:13.520 Bruise and produced by Tyler Clang for iHeartMedia and How 0:08:13.560 --> 0:08:15.880 Stuff Works. For more on this and lots of other 0:08:15.920 --> 0:08:30.520 expansive topics, visit our home planet, how stuff Works dot com.