Last week, Senator Bernie Sanders introduced a reform bill called Medicare for All, following through on a 2016 presidential campaign promise to advance a plan to implement a single-payer health care system in the United States. Those who know Sanders’s politics weren’t shocked to find him behind the proposed legislation; but the 15 other Democrats signing on with their support were a more surprising development, signaling that the leftward shift epitomized by Sanders is gaining mainstream political appeal. As Chuck Schumer and Nancy Pelosi continue to fight the latest version of Affordable Care Act repeal in the Senate, there are some Americans who might be galvanized enough to not just save the expanded coverage of Obamacare, but to push it even further. With that in mind, here is an explainer of Medicare for All and single-payer, because you’re probably going to keep hearing about it:
What is single-payer?
Broadly speaking, single-payer refers to health care systems in which residents pay taxes that finance health coverage for all citizens, ranging from basic services to major surgeries—as opposed to our current largely for-profit system, in which individuals or employers buy insurance and services themselves. (The Affordable Care Act helped cover more Americans through public funding.) In a single-payer system, the government collects fees, and health services are paid for by the government instead of multiple parties in a multi-payer system.
Sanders can be credited for helping to bring universal health care into the mainstream, but the U.S. has a longstanding grassroots movement organized around the belief that all people deserve healthcare, and that the U.S. should join the many other countries around the world (including the United Kingdom and most of Europe) that offer universal systems.
What’s in Sanders’s Medicare for All bill, and how do we pay for it?
Sanders’s bill, which he explained further in an interview with The Washington Post, expands Medicare into universal health insurance, in which all Americans under the age of 18 at the time the bill passed would be issued a “universal Medicare card.” For others, there would be a four-year transition from their current health care into the new system, which would be funded through higher taxes. Coverage would include mental health, eye care, prescriptions, and emergencies, while private insurers would still provide elective treatments.
Who supports it?
Many of the Democratic Party’s star senators, and rumored 2020 presidential frontrunners, are included in the 15 who cosponsored the Medicare for All bill. Among them are Tammy Baldwin of Wisconsin, a swing state; Cory Booker of New Jersey; Al Franken of Minnesota; Kirsten Gillibrand of New York; Kamala Harris of California; Jeff Merkley of Oregon; Brian Schatz of Hawaii; and Elizabeth Warren of Massachusetts. Baldwin even wrote an op-ed in the Milwaukee Journal Sentinel detailing her support.
What’s controversial about it?
As has always been the case with universal health care, many things are in the way of passing Medicare for All, which will certainly stall in a Republican-controlled Congress. Politicians on the right are generally not in favor of increasing taxes or strengthening the scope of the government; but there are more Republicans and centrist Democrats and liberals who also find the lack of detail in the bill troubling. There are also those who would argue that the GOP will simply block “pie in the sky” goals like universal health care, and that we need more feasible goals.
Why is it important?
Even if Medicare for All is aspirational, the amount of mainstream support it’s getting from Democratic senators, especially those like Cory Booker, who has voted in the past against more expansive healthcare legislation, shows that the revolutionary vision espoused by Sanders is looking more and more like the most viable future for the Democratic Party. With Hillary Clinton still exploring what went wrong in her 2016 run for president, there’s an energy vacuum to be filled in the leadership of the left. What’s more, as Sanders spoke of today in a speech at Westminster College, health care and how we pay for it is tied to our defense budget and military spending, $700 billion of which made headlines this week. Considering single-payer, if anything, and the $32 trillion it would cost, asks us to think critically about what our government is already paying for—and why.