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Sample Essay Paper on Medicare for All

Medicare for All

The talk and discussion about “Medicare for All” are gearing up day by day in the run to the 2020 U.S. presidential election. Democratic presidential hopefuls, led by Vermont Senator Bernie Sanders, Rep. Pramila Jayapal, D-Wash, and others, are pushing for the adoption of "Medicare for All" in emulation of other wealthy countries that have adopted and enforced an almost similar healthcare policy. With people having different opinions about the plan, it is essential to understand what it is all about.

What Does “Medicare for All” Mean?

Medicare for All is expected to be an expansion and upgrade of the Medicare program that has been in existence since 1965. Medicare is a health insurance program that is run by the government and offers healthcare coverage for all U.S. citizens aged 65 and older with taxpayers funding the initiative (Woolhandler & Himmelstein, 2019). A percentage is usually taken out of U.S. citizens’ paychecks for Social Security and then channeled to Medicare to cover many health care services such as doctors' visits and stays in hospitals. Individuals on Medicare also have the option of choosing to get additional coverage from private insurers that are Medicare-approved to cover other health care services such as prescription drugs, vision, and dental. Essentially, "Medicare for All" is a single-payer health care program whereby every American's healthcare coverage is under a more generous version of Medicare. This generous version will then replace every other existing private and public plans, thus leaving only a few plans. The plan has received massive support from some of the 2020 Democratic presidential candidates who continue to campaign on instituting single-payer health care. Other presidential hopefuls continue to describe a single-payer health care system as a broad goal going as far as co-sponsoring Medicare for All legislation both in the House and Senate. However, these candidates have also campaigned on alternatives that can be described as less-sweeping and with less budgetary implications.

Different stands and opinions on a single-payer health care system have made discerning of the candidates' position confusing because some candidates allege that the incremental approach could eventually result in Medicare becoming a default insurance option. According to the single-payer bill under the sponsorship of Senator Bernie Sanders, I-Vt., the “Medicare for All” plan is expected to cover key treatment for Americans with no deductibles or premiums. The plan is also expected to result in an expansion of the categories of benefits that fall under the current Medicare system, and this will lead to the inclusion of other health care areas such as vision and dental coverage alongside long-term care. The rollout or transition to Medicare for All will take four years after which private insurers will not be allowed to sell plans that offer similar coverage to that of the plan. That is, with Medicare for All in place, private insurers will be effectively banned from offering health care coverage (Friedman, 2013). The only option that will be available for private insurers will be to offer supplemental plans covering items that are excluded from Medicare. Such supplemental plans could include cosmetic surgery. However, some federal health programs will be allowed to continue, and these include the Indian Health Service and the Veterans Health Administration.

People in support of Medicare for All are seeking to expand Medicare to cover more than just U.S. citizens aged 65 years and older who benefit from the current Medicare program. Other proponents such as Sen. Bernie Sanders are also pushing to have Medicare cover lawful permanent residents of the U.S. as well. Others such as Michigan Sen. Debbie Stabenow are seeking for the lower age requirement. This follows her decision to introduce a bill in 2017 that sought to allow Americans aged 55 and older to buy into the Medicare program. In early 2019, Sen. Debbie Stabenow introduced a bill in the Senate seeking to lower the accepted age further to 50 years. The proponents of Medicare for All perceive access to health care as one of the fundamental human rights. Thus, with more people getting into the Medicare system, the growing costs in America's health care system could be reduced. With the anticipated health care benefits of Medicare for All, it is currently popular among U.S. citizens. According to a Gallup poll conducted in December 2018, 79 percent of Americans who are publicly insured through Medicaid or Medicare argue that they are happy with their quality of health care and are of the opinion that they have exemplary health coverage. Based on this poll, Americans who are publicly insured through Medicare are likely to welcome the Medicare for All plan.

Pros and Cons of Medicare for All

Pros of Medicare for All

Currently, there are several versions of Medicare for All including a separate House bill under the sponsorship of Rep. Pramila Jayapal, D-Wash that has 112 co-sponsors all of whom are Democrats. Other Democrats back more modest proposals; they refer to Medicare for All as a plan that would lead to an expansion of Medicare and Medicaid without necessarily bringing an end to the private insurance system as proposed by Sanders' and other similar plans. The alternative plans are all about allowing both Americans and/or their employers to buy a Medicare-like public option, which is an insurance plan of the government but would compete hand in hand with private plans instead of replacing them (Holahan & Blumberg, 2016). Despite the different Medicare for All alternatives, there are many benefits or pros that would accompany them once passed and implemented.

Thanks to Obama’s Affordable Care Act (ACA), the percentage of Americans with no health insurance has been on the decrease for the past decade but held steady in 2017. This can be seen in the graph below.

Source: American Community Survey, Census.

However, over the years, the ACA’s exchanges have struggled to attract insurance companies. As a result, many Americans have had a few choices of plans even though none has had zero options available. Moreover, customers making significant amounts of money to qualify for subsidies argue that the plans are unaffordable. There are also customers who complain of very high deductibles despite being capped under the law.

One of the pros of a single-payer Medicare for All, therefore, is that with health care as one of the fundamental rights for every American, enrolment of every American citizen and permanent residents of the United States could serve as the best way of ensuring universal coverage. This is particularly for economically vulnerable populations. According to the World Health Organization (WHO), universal health coverage (UHC) is one of the leading global healthcare objectives. UHC refers to a situation whereby every person and community has the opportunity to use the promotive, curative, preventive, palliative, and rehabilitative health services they direly need while also ensuring that the use of the mentioned services hardly exposes users to financial hardship. UHC revolves around three primary objectives of equity in access to health services, ensuring that the quality of health services is good enough to improve the health of people receiving those service, and protection of people against financial-risk (World Health Organization). The universal healthcare objective in the U.S. can best be achieved through a single-payer Medicare for All plan.

Currently, for people with insurance through their jobs or individual plans, deductibles seem to be increasing faster than wages. As a result, customers are likely to encounter surprise hospital bills from out-of-network specialists and doctors. This problem can best be avoided by a single-payer Medicare for All. According to a survey by the Kaiser Family Foundation, while wages for many Americans might be on the rise, health care costs are growing a whole lot faster as well (Sarlin & Kimelman, 2019). A 2018 survey by the Kaiser Family Foundation Found that the average deductible for a worker in an employer health plan in 2018 was $1,573, which was an increase of 4.5 percent from the figure in 2017 that stood at $1,505. According to benefits analysts, modest increases are also expected for 2019 (Coombs, 2018). Every small increase makes workers feel as though they are losing the battle on out-of-pocket health care costs. In as much as deductibles have doubled from 2008 to 2018, wages given to workers has risen to a mere 26 percent over the same period (Coombs, 2018). The challenge of deductibles increasing faster than wages, thus increasing out-of-pocket costs for Americans when it comes to accessing health care can be addressed by a single-payer Medicare for All plan.

One of the biggest challenges faced by Americans currently is that any change of jobs or employer leads to the loss of existing plans and health care network. This can be attributed to the current use of employer-sponsored insurance. However, the adoption of the single-payer Medicare for All plan would bring an end to the use of employer-sponsored insurance as a primary source of coverage for Americans. As a result, the plan would make free Americans shift from one job or employer or another without necessarily losing their existing plan and health care network (Sarlin & Kimelman, 2019).

Research shows that Americans are higher spenders on health care per person as compared to citizens of other wealthy nations such as the United Kingdom, Germany, and France. According to a 2016 report from the Commonwealth Fund that usually points to the shortcoming of the healthcare system of the United States, there has been an insignificant change in 15 years or longer in America's healthcare system (Fox, 2016). As of 2016, Americans still paid more for medical care as compared to people in other wealthy Western nations. The situation is even worsened by the fact that Americans have little to show for all that spending on medical care. According to the 2016 report from the Commonwealth Fund, approximately 43 percent of low-income Americans had no access to medical care as a result of increased costs (Fox, 2016). This was relatively higher than the rates in other Western nations such as Britain that had a rate of 8 percent and Switzerland that had a rate of 31 percent (Fox, 2016). In this regard, proponents of a single-payer Medicare for All plan believe that it could help to reduce health care costs by setting the stage for negotiation or requiring lower payment to hospitals, doctors, and drug companies while at the same time helping to eliminate overhead costs that are usually associated with private insurance.

Another pro of Medicare for All is that although the government would be forced to spend more in terms of health care under the plan than it does currently under Medicare, the plan would help to reduce the total national health spending by some estimates (Sarlin & Kimelman, 2019). The money currently channeled to premiums would be used to offset new taxes imposed on both families and individuals. In the same vein, wealthy Western nations seem to have a not only universal coverage though not always pure single-payer systems but also populations that are healthier than that of the United States. This suggests that there is a path that works, and that can be followed to guarantee health care. Medicare for All plans both in the Senate and the House would be more generous as compared to other universal health coverage plans to exist in other nations because, in other nations' plans, citizens still have the burden of shouldering more out-of-pocket spending or taking on supplemental private insurance, thus raising the cost to the government.

Cons of Medicare for All

In as much as there are numerous pros of a single-payer Medicare for All plan, the cons or shortcomings surpass the pros. A major shortcoming of Medicare for All is the high cost that is widely discussed by critics and opponents of the plan. According to a 2018 study by the RAND Corporation, with the enforcement of the Medicare for All plan throughout the United States, the federal government’s spending on healthcare would rise significantly from around $1.09 trillion annually to $3.5 trillion annually (Gupta, 2019). It is unfortunate that politicians who have introduced single-payer bills have made no effort to explain how the plan would be paid for. Moreover, there is difficulty in telling exactly the individuals who would pay more and who would pay less for health care. Based on the assumptions of Sen. Bernie Sanders, under Medicare for All, the national health care spending for the year 2017 would have been around $3.2 trillion. Between 2017 and 2016, the total national health care spending, according to Sanders, would have hit around $39 trillion, which is a significant increase in health care spending. In as much as Sanders comes with a suggestion to pay for the plan once rolled out, the suggestions appear untenable and would jeopardize America’s economic growth (Gupta, 2019).. Some of the options suggested by Sanders include a creation of a 4 percent income-based premium that should be paid by employees with exemption of the first $29,000 in income for a family of four, imposition of a 7.5 percent income-based premium to be paid by employers with exemption of the first $2 million in payroll to protect small businesses, elimination of health tax expenditures, making the estate tax more progressive, establishment of a tax on extreme wealth, imposition of a fee on large financial institutions, repealing “corporate accounting gimmicks,” as well as closure of the “Gingrich-Edwards Loophole” (Gupta, 2019). In addition to being untenable, these suggestions provide a rosy picture and tend to overestimate the amount of savings that would come from the single-payer system.

Still on the impact of Medicare for All on health care costs, proponents of the plan such as Sen. Bernie Sanders have by far underestimated the increase in cost from people using health services. Currently, the number of Americans who remain uninsured stands at 28.5 million and the provision of insurance for this uninsured population will be overly expensive (Gupta, 2019).  According to a survey conducted by the left-leaning Urban Institute, over the period between 2017 and 2026, Sanders projects that health care spending would increase by more than $6 trillion over the projected spending under the current Medicare plan.  The survey also estimated that Under Sanders’ plan, the national health care spending would be close to $51 trillion, which is way more than Sanders’ projected $41 trillion. According to the estimate of Urban Institute, the new federal spending would entail an additional $32 trillion (Gupta, 2019).

Under an umbrella organization known as the Partnership for America’s Health Care Future, leading groups in the healthcare industry argue that a single-payer Medicare for All plan could result in cutting payments to providers that could adversely impact hospital care while attracting fewer specialists and doctors (Sarlin & Kimelman, 2019). Under the current Medicare plan, private insurers offer more payments and at times much more for medical services than that offered by Medicare. It would be a tricky balance to set payment rates under the proposed single-payer Medicare for All plan. On the one hand, the set payment rates may be low, thus making health care services worse than they currently are. On the other hand, the set payment rates may be high, thus making the new system even more expensive than currently is.

Another con of Medicare for All plan is the anticipated federal government's inability to administer coverage on a large scale. This would result in longer wait times in care settings. Moreover, the adoption of Medicare for All would cause confusion in deciding whether providers are to be reimbursed on abortion services and whether the plan should include undocumented immigrants (Sarlin & Kimelman, 2019). There is also the likelihood of the transition to a single-payer Medicare for All plan being disruptive since over 155 million people currently receive health coverage through their employers. With many Americans who get employer insurance reporting satisfaction with their current plans, the requirement to join a new government program would be upsetting and frustrating for them (Sarlin & Kimelman, 2019).

One of the greatest debates in the United States today is whether or not a single-payer Medicare for All plan should be adopted. On the forefront of campaigning for the adoption of the plan are Democratic presidential hopefuls such as Sen. Bernie Sanders. Medicare for All has both pros and cons. Some of the pros of the plan are that the universal healthcare objective in the U.S. can best be achieved through a single-payer Medicare for All plan; the challenge of deductibles increasing faster than wages thus increasing out-of-pocket cost in accessing healthcare can best be addressed by the plan; the plan would free Americans to shift from one job to another without losing their existing plan and healthcare network; the plan could help to reduce healthcare costs by negotiating and requiring low payment to hospitals, doctors, and drug companies; and the plan would help to reduce the total national spending by some estimates. The cons of the plan surpass the pros; hence, it would be disastrous to adopt the proposed Medicare for All plan. Some of the cons of the plan include high costs, underestimation of the increase in costs from people using health services, it could result in cutting payments to providers thus affecting hospital care, government’s inability to administer coverage on a large scale, possible confusion in decision-making when it comes to provision of health care services, potential disruptiveness in the transition to the plan, as well as frustration from people who get employer insurance when they have to join a new government program.

 

References

Coombs, B. (2018, October 03). Kaiser study finds employee health insurance deductibles rise 4.5 percent. Retrieved from https://www.cnbc.com/2018/10/03/employee-health-insurance-deductibles-rose-4point5-percent-in-2018.html

Fox, M. (2016, November 16). The United States Comes in Last Again on Health, Compared to Other Countries. Retrieved from https://www.nbcnews.com/health/health-care/united-states-comes-last-again-health-compared-other-countries-n684851

Friedman, G. (2013). Funding HR 676: The Expanded and Improved Medicare for All Act How we can afford a national single-payer health plan. Retrieved February 10, 2015. Retrieved from http://healthoverprofit.org/wp-content/uploads/2017/02/Funding-HR-676_Friedman_7.31.13_proofed.pdf

Gupta, S. (2019, July 02). What 'Medicare for All' means, politically and practically. Retrieved from https://edition.cnn.com/2019/02/25/health/what-does-medicare-for-all-mean/index.html

Holahan, J., & Blumberg, L. J. (2016). Estimating the Cost of a Single-Payer Plan. Studies, 4. Retrieved from https://www.researchgate.net/profile/Linda_Blumberg/publication/330093574_Estimating_the_Cost_of_a_Single-Payer_Plan/links/5c2d1298299bf12be3a8513f/Estimating-the-Cost-of-a-Single-Payer-Plan.pdf

Sarlin, B., & Kimelman, J. (2019, June 20). What is 'Medicare for All' and how would it work? Retrieved from https://www.nbcnews.com/politics/elections/what-medicare-all-how-would-it-work-n1014256#anchor-WhysupporterslikeMedicareforAl

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