Medicare For All Vs. Public Option
Senate Democrats introduce the Medicare For Any Act of 2017 – September 13, 2018
As concerned citizens and voters who will be affected by whatever the next healthcare proposal that lands on the president’s desk is, we need to have a clear sense of how the two major health care proposals compare.
Read on to learn the basic similarities and differences in these two dominant approaches to achieving universal health care in America.
What is Medicare for All?
Medicare for All is the term being used to describe a single-payer, government-run approach to universal health for Americans. Only two of the remaining Democratic presidential candidates—Bernie Sanders and Elizabeth Warren—are pitching it. There are currently two bills in Congress proposing this approach, one in the House (Rep. Primila Jaypal and the House Progressive Caucus) and one in the Senate (Senator Bernie Sanders). Although they use the term “Medicare,” in fact if adopted these proposals would replace that program as it currently stands.
Medicare involves multiple payers, somewhat limited coverage, complicated administration, and even private insurance options for those who wouldn’t be adequately covered by Medicare Basic. Medicare for All would be single-payer (ie the government), require funding (some estimates for Bernie Sanders’ proposal go as high as $32 trillion per decade), eliminate private insurance, and expand on what Medicare currently covers at no cost to the patient.
What is The Public Option?
The Public Option was first proposed as a minor part of the ACA, but didn’t make the final cut. It is currently getting a lot of play as a way to accomplish universal (or near-universal, depending upon the proposal) health care for Americans, without the kind of radical change that Medicare for All would entail. Simply put, it leaves health care the way it is, but adds a government-run plan that people could opt into. In fact, the terms “opt-in” and “public option” are used interchangeably. Who could opt in, and what they would be getting, and how much they would be paying all varies depending upon the proposal.
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The table below compares the basic features of each plan at a high level. Keep in mind that how these concepts are being fleshed out is fluid, and with the exception of Bernie Sanders, even candidates who were gung-ho on Medicare for All did a bit of back-tracking once they heard from voters. This fluidity is especially the case for iterations of the Public Option. Since it is beyond our scope to go into the weeds about every variation, we offer this as a scaffolding upon which you can build more deeper knowledge as you see fit.
| Features | Medicare for All | Public Option |
| Covers all Americans | Yes. Bernie Sanders’ bill goes so far as to cover all residents of the U.S., which includes green-card holders and undocumented immigrants. | No. The public option is a “buy-in” option. People would be able to choose whether or not to be insured, and which type of insurance to get. |
| Automatic enrollment | Yes | It varies. Some plans call for automatic enrollment for low-income, otherwise uninsured people. |
| Eligibility limitations such as age or income | No | Variable. Some are available to everybody, but some have age and/or income limitations, eg being eligible for coverage under the ACA. People on Medicare would stay on Medicare. |
| Eliminates private insurance | Yes | No. Public option is an addition to what is currently available in the insurance market, not a replacement. |
| Allows choice regarding coverage, such as keeping union-negotiated and other employer-based plans | No | Yes. In general, the public option is about giving Americans the choice between a government plan and a private sector plan. Some proposals allow employers to offer the public option plan as part of their benefits package. |
| Costs to enrollees | None, except for some prescription drugs. The Sanders plan eliminates premiums, deductibles, co-pays, and balance billing. | Premiums, deductibles, co-pays, etc. except for low-income enrollees. |
| Coverage | Everything currently mandated by ACA plus mental health, reproductive care, vision and dental, and long-term services. | Variable. Most cover the basics of ACA. Some add vision and dental. |
| Administration | At the federal level, except for medical facilities. | Varies. Most are at the federal level, but some plans hand off to individual states. |
Which is the better plan?
Which is the better plan really depends upon who you ask, right down to the level of the individual American. Some would prefer that neither are implemented, but something is done to bring down healthcare costs in a different way. Some believe that healthcare is a right, and are passionate about making sure that everybody is covered by Medicare for All. Some think it’s better to provide choice, and work within the system that already exists to make incremental improvement. Ultimately, the goal is to provide every American with affordable healthcare. Each plan has strengths and weaknesses, but each offers movement in that direction.
Pros & Cons of Medicare for All
Medicare for All is hotly debated. It seems that those who love it really love it, and those who don’t hate it. In truth, there is probably a middle ground. What follows is a short list of possible pros and cons to help you make up your own mind.
Pros
Universal coverage. All Americans will be covered. It will eliminate the gap in coverage for the millions of Americans who can’t afford health insurance but fall between the cracks of the ACA.- Automatic enrollment. Nobody falls through the cracks, because everybody is enrolled. Nobody has to worry about what will happen when they change jobs, or huge COBRA payments when they get laid off. The same healthcare follows them through all life circumstances.
- Expanded benefits. In addition to what is already covered under the ACA and Medicare, such “extras” as vision, dental, mental health, long-term care, and reproductive health will be included.
- Elimination of premiums, deductibles, co-pays, and balance billing. This pretty much speaks for itself. The up-front costs of getting medical care won’t be there, so issues of payment will not impede getting needed treatment. And no surprises in the mail when you think you’ve paid everything but get billed again at the back end.
- Standardization of prices, coverage, and administration. The federal government will negotiate and set everything that has to do with medical care, including dealing with medical facilities, paying providers, and negotiating pharmaceutical prices.
- Cost-savings across the board. Since prices will no longer be determined by the for-profit healthcare industry, ultimately costs should go down significantly.
Cons
Lack of choice. This is a big one for many people who either don’t like the idea of the government making decisions for them, or don’t want to lose the private insurance they have. It’s especially fraught for union members, who make trade-offs for benefits during negotiations.- Downgrades in facilities and services. Most providers and facilities accept Medicare, which pays much less than private insurance. Without private insurance to offset the lower prices, the quality of care could go down.
- The money has to come from somewhere. When we hear about the benefits of Medicare for All, it sounds heavenly. All that care, and we don’t have to pay anything! But of course, we do have to pay for it. It’s a matter of how, and out of what bucket. It’s going to come out of taxes. The question is whose taxes? And how are these tax increases going to get through Congress?
- The elimination of health-care and insurance industry jobs. This is a big one. The health-care sector represents 18% of the U.S. GDP. And private insurance is a big part of that. Millions of workers will lose their jobs when there is no more private insurance industry.
- It’s a hard sell. All you have to do is take a quick look back at how Hillary Clinton tried and failed to get a national health plan passed, fast forward to the Obama era and how long and hard a road the ACA was, and land in the present, when the ACA is still under fire from the GOP. That will tell you that beatific as the idea of universal affordable health care is, it’s going to be very hard to get it through Congress. Even progressives can’t agree on what it should look like.
Pros & Cons of a Public Option
The public option garners far less controversy than does Medicare for All. Even so, it too has arguments for and against, and a wide variety of suggestions for how it could be implemented.
Pros
- Lower overall costs. Overall costs could come down significantly because of the federal government’s bargaining power, and its nonprofit status.
- Insurance stays with you wherever you go. With a public option, people would not lose their insurance when they change jobs or get laid off. No expensive COBRA payments and no gap in coverage. No need to start all over with a new plan.
- Simpler sign-up process. Signing up for insurance and receiving benefits would be a more simplified, unified process across the board.
- Pre-existing conditions covered. No denial of service or insurance and no exorbitant charges because of pre-existing conditions.
- Lower up-front costs for enrollees. Deductibles could be reduced, as could fees for service.
- Expanded financial support for those who need it. Premium subsidies could be expanded, and in some cases, low-income enrollees would not have to pay any at all.
- Choice. Unlike Medicare for All, individuals would have the choice to enroll. Those who prefer their job-based or union-negotiated plans could keep them.
- Glide path for Medicare for All. It could pave the way for single-payer or Medicare for All over time.
Cons
- Glide path for Medicare for All. It could pave the way for single-payer or Medicare or All. From the point of view of private insurance companies, and those who wish to retain their current insurance, that is a huge drawback.
- Disruptions to private market. Private insurers might not be able to compete, and could ultimately be forced out of the market.
- Unclear price tag overall. Without a specific proposal adopted, it’s difficult to ascertain what the costs will be to the federal government, providers, and individuals.
- Potential cost-related downgrade in services. Right now, healthcare providers who take Medicare get paid a lot less than they do with private insurance. If a public option is widely adopted, they may find themselves struggling to provide adequate services because they can’t meet the costs.
- Political vulnerabilities. In light of the attacks on the ACA—and ongoing threats to Medicare, Medicaid, and Social Security—any government program is vulnerable to political winds.
The Rantt Rundown
How to fix American healthcare is one of the most contentious debates of this election season. With a goal of universal affordable healthcare, proponents of Medicare for All contend against those for a public option. Both concepts have strengths and weaknesses, some of which intersect. Single-payer Medicare for All replaces private insurance with a government-run plan.
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