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