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Sen. Bernie Sanders is introducing a somewhat updated version of his Medicare For All bill in the Senate today, and with nearly a dozen Democratic presidential contenders saying they support some version of universal and/or single-payer healthcare, we have to admit it's nice to be saying "OK, so how does this one compare to the other proposals?" instead of "No, really, this isn't just pie in the sky and ponies for everyone." In the year and a half since the last time Sanders introduced Medicare for All, support for a transition to single payer has become far more palatable to the party, and to voters, for that matter. (It doesn't hurt that Donald Trump seems obsessed with blowing up Obamacare.) Of course, that broader support for single payer also means Sanders no longer owns the issue exclusively. But hey, let's focus for the moment on what's in this sucker.

Sanders's 2019 iteration of Medicare for All is largely the same as his 2017 version, says Vox's Sarah Kliff, with one very big (and pricey) addition. This time out, in addition to providing all Americans with full medical coverage (plus dental and vision benefits), the plan would also cover long-term care for the elderly and disabled. Why yes, that's pretty much like the M4A plan introduced in the House by Pramila Jayapal earlier this year. Now the only substantial difference between the two bills is that Jayapal's bill would be phased in over just two years, while the Senate version would be phased in over four, with the option for people to buy into Medicare coverage through some sort of public option as the transition is taking place. The existing Medicare and Medicaid programs would also wither away as the new program came into being; the Indian Health Service and Veterans Affairs health systems would remain as they are today. Except Pete Hegseth would be forced to wash his hands now and then.


Both houses' versions of Medicare for All seek a far more generous package of benefits than the single-payer systems in other countries. (Suck it, Old Europe!) Most other countries with national healthcare don't cover vision or dental, which gives private insurers something to do at least. And unlike many other national healthcare systems, this plan would mean no out-of-pocket costs to the consumer: No copay, no deductible, no charge when you go to the emergency room. And since regular doctor visits would be covered, for everyone, there'd be no uninsured people ending up in the ER after trying to save money by trying to tough it out and praying until a minor problem becomes a health crisis. We have a feeling that would bring down emergency costs dramatically.

The Sanders bill would save money in other way, too, as Kliff notes (we will never stop saying that), particularly when it comes to administrative costs.

American doctors spend lots of money dealing with insurers because there are thousands of them, each negotiating their own rate with every hospital and doctor. An appendectomy, for example, can cost anywhere from $1,529 to $186,955, depending on how good of a deal an insurer can get from a hospital [...]

One 2003 article in the New England Journal of Medicine estimates that the United States spends twice as much on administrative costs as Canada. A 2011 study in the journal Health Affairs estimates American doctors spend four times as much dealing with insurance companies compared with Canada.

And sure, a lot of people employed by private insurers would need to find new jobs, but quite a few could no doubt get work in the new M4A offices -- the Jayapal bill includes a proposal to fund at least five years of job transition programs; the Sanders version does not.

Another big savings would come from having the government negotiate or otherwise set the costs of prescription drugs and all the services the plan would cover. The Sanders plan envisions using current Medicare reimbursement rates for medical services, which are lower than reimbursements from private insurers. (Somewhere, a pharmaceutical industry lobbyist just screamed.)

Beyond what's in the bill now, we imagine Euro-style price controls on medical services might be necessary, which would again lead to squeals of protest from Big Medical and Big Pharma, and probably little squeals from anyone involved in the medical tourism biz. Americans able to get hip replacements in America? COMMUNISM.

As Kliff points out, the lack of any out-of-pocket costs has a downside for health spending. The Sanders M4A plan's

robust benefit package with no cost sharing would likely lead to more doctor visits and hospital trips. As the classic RAND Health Insurance Experiment found, patients respond to lower cost sharing in health care by seeking more treatment. Some of that treatment is necessary, but other services provided are not.

Our perspective on this? Start by proposing 100 percent coverage, and then be willing to compromise to allow modest copays like you'd see in other countries. As I've said before, when I taught in Japan, I went to the hospital for chest pain one time (it was nothing), and paid only about $20 for the doctor visit, EKG, and blood work. Whatever real plan develops may need to have some similar costs to patients, if only to allay fears that people will run off to a doctor for every headache.

But won't it be unaffordable? As Sanders likes to point out, our current system spends twice as much per capita as any other country and doesn't come close to covering everyone. Hell, let's not forget that the Koch-funded Mercatus Center determined that Medicare for All would actually save trillions of dollars over a decade compared to our current "system" -- although that calculation was done before the inclusion of long-term care. So Oh Dear We Might Only Break Even And Cover Everyone, HOW TRAGIC.

Republicans think they have a hell of an issue to bash Democrats with, insisting Americans love their awful insurance too much to swap it for comprehensive coverage. We have a feeling the fearmongers have no idea just how terrified Americans already are by the prospect of trying to pay for a major illness by relying on GoFundMe and the kindness of strangers.

PS This is not a post for still being mad at Bernie Sanders about 2016, we know already, okay?

[Vox / WaPo]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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