Most Americans support “Medicare-for-all”, at least when described very broadly as "a publicly financed, privately delivered system with all Americans enrolled and all medically necessary services covered." But would they support Bernie Sanders’ Medicare-for-all plan if well-informed of its details? Let’s look at some of those details, starting with what would be covered and how costs would be controlled. This straight from Bernie's online description:
Basic Features
“Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
As a patient, all you need to do is go to the doctor and show your insurance card. Bernie’s plan means no more co-pays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges."
Cost-Control:
“Creating a single, public insurance system will go a long way towards getting health care spending under control. The United States has thousands of different health insurance plans, all of which set different reimbursement rates across different networks for providers and procedures resulting in high administrative costs. …Health care providers and patients must navigate this complex and bewildering system wasting precious time and resources…By moving to an integrated system, the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively.”
So it sounds like everything would be paid for by the government, patients would be free to see the doctor of their choice, and costs would be controlled though streamlined procedures and the power of a single payer to negotiate lower prices for drugs. Is this realistic? Exploring my way to an answer, I put together the following comparison of the healthcare systems of 18 developed countries (which took me forever, so please linger over it):
Except for the US, all the above countries have universal healthcare coverage - although not necessarily single-payer systems. All require cost sharing, usually in the form of deductibles and/or co-pays. Almost all use a gatekeeper system, in which patients go through primary care providers for referral to specialists. All have other cost-containment strategies. For example, regulated fees and care limit what providers can do and what they can be paid. Market-based controls include the availability of low-cost insurance plans that limit patient choice. Local or national budget controls limit what will be paid over a fiscal period. Some countries also appear to save a lot on physician compensation, probably the result of regulated fees, treatment oversight, and/or stingy public-sector salaries.
I included “secondary insurance market development” as a proxy for how satisfied people are with the main healthcare system in their countries. For instance, long wait-times, high-co-pays, and limited physician or treatment choice may encourage a secondary for-profit market. Just six of the above eighteen countries have a weak secondary market. Draw your own conclusions.
Next: How much can Medicare-for-all save in drug costs?
Updated 12/30/18