It’s not just Bernie Sanders’ vision any more.  Even more cen­trist Democ­rats have tak­en the pledge, with Sen­a­tors Har­ris, Gilli­brand and Book­er hav­ing cosigned Sanders’ bill.  The basics? Health insur­ance would now no longer be paid direct­ly by employ­ers, but indi­rect­ly through a 7.5% pay­roll tax and a con­tri­bu­tion by employ­ees of 4%.  Medicare and Med­ic­aid would be elim­i­nat­ed and every­one would be cov­ered.  Insur­ance com­pa­nies would still exist, but only to sell sup­ple­men­tal or ancil­lary plans; they may not com­pete direct­ly with the gov­ern­ment plan.  Insur­ers are, of course, wor­ried and pub­licly pledg­ing to come up with a way to build upon the exist­ing system.

As if the bill for expand­ed cov­er­age is not large enough, the Medicare for All pro­pos­al has been expand­ed fur­ther to include Long Term Care.  This pro­vi­sion, which had been part of the ini­tial Afford­able Care Act, was aban­doned almost as soon as it began once law­mak­ers saw the poten­tial size of that cov­er­age bill.

Things recent­ly got more inter­est­ing when Seema Ver­ma, the direc­tor of CMS (which runs Medicare) went on Fox News and said “Medicare for all is the biggest threat to the Amer­i­can health care sys­tem.”  She not­ed that social­ized health care sys­tems in oth­er coun­tries have prob­lems of their own, includ­ing long wait times and poor care, which leads cit­i­zens to trav­el to the U.S. for drugs and care they can’t secure at home.  More to the point, she said “the real­i­ty is we’re hav­ing prob­lems today pay­ing for the Medicare pro­gram and the trustees have warned about sol­ven­cy, so adding more peo­ple to the pro­gram is only going to exac­er­bate it.”

Argu­ments pro and con – why and why not:

            Pro      Advo­cates say the change is sim­ple – mon­ey spent on pri­vate health insur­ance and health care would be shift­ed to the fed­er­al gov­ern­ment in the form of taxation

                        The fed­er­al gov­ern­ment would set prices and force health care providers to accept cur­rent Medicare pay­ment rates, which is rough­ly 40% below what pri­vate insur­ers pay

                        The gov­ern­ment run sys­tem would mean every­one would be insured and peo­ple would access health care ser­vices more fre­quent­ly because they would be free (maybe copay­ments would be required, though this has not yet been decided)

            Con     “Trust US” – 70% say they are sat­is­fied with their cov­er­age, but all 181 mil­lion Amer­i­cans now cov­ered by employ­ers would have to make a move to a pro­gram that is unex­plained, unproven and about which the results are unsure

                        There are those who are not crazy about cen­tral­ized big gov­ern­ment in any aspect of our lives – and then, of course, there are the addi­tion­al taxes

                        No mat­ter how they slice it, hos­pi­tals, physi­cians and affil­i­at­ed providers are going to take a big pay cut, and there won’t be much room for nego­ti­a­tion when the gov­ern­ment is the only game in town (think Walmart)

                        Patients will have to make a shift in expec­ta­tions – seen the wait­ing list and lines in Cana­da lately?

                        The Sanders plan would increase fed­er­al spend­ing by about $32 tril­lion over its first ten years, or $3 tril­lion per year.  The Con­gres­sion­al Bud­get Office projects fed­er­al spend­ing for the entire 2019 fis­cal year at $4.4 trillion