All Americans would be able to visit a provider of their choice for any behavioral or physical healthcare needs and the federal government would foot the bill directly under a single-payer health insurance plan outlined Wednesday by a group of Democrats in the U.S. Senate.
New Jersey Sen. Cory Booker joined the group in Washington, D.C, to roll out the “Medicare For All” proposal crafted by Bernie Sanders, the Vermont senator and former presidential candidate who has become a leading advocate for a single-payer system.
The measure would establish a single government-run healthcare program, like the federal program for seniors, to cover all citizens regardless of income level or employment status. This would eliminate the role of insurance companies — and the need for patients to pay monthly premiums — reduce and standardize treatment and pharmacy costs, improve health outcomes, and end the threat of bankruptcy from medical bills, they said.
A first step
While the announcement is a big step in a growing movement around single-payer healthcare, observers caution that it is unlikely to advance quickly in the U.S. Congress, where Republicans — including New Jersey Rep. Leonard Lance — and some key Democrats remain concerned about the cost and potential overreach of government. Some experts believe a hybrid version of public and private reforms may be more likely.
Past efforts to adopt a national universal healthcare plan have failed and state-based programs have not gained much traction; several Garden State lawmakers have introduced similar plans that have seen little momentum to date.
But others suggested it is time to consider a single-payer system more seriously. New Jersey Democratic gubernatorial candidate Phil Murphy supports Medicare for All at the federal level and praised Booker’s leadership, according to a spokesman. Republican contender Kim Guadagno, the current lieutenant governor, has called for improving the current system.
Praised in Trenton
Sanders’ plan also received praise from state Sen. Nia H. Gill, (D-Essex), who introduced a proposal (S-3138) in May to create a government-run insurance program to supplement existing options — one of several bills proposed as efforts to dismantle the ACA, or Obamacare, raged in the nation’s capital.
“There has to be meaningful change at the federal level, but states cannot wait for action to take place in Washington,” Gill said. “We must have a serious conversation at all levels about the need to make sure that all residents are covered.”
Sanders’ plan is estimated to cost $1.38 trillion a year — and would be funded by a variety of tax increases — but the senator stressed that it would actually reduce healthcare spending by $6 trillion over the coming decade, when compared to the current system. Savings would result from reduced administrative costs, negotiated prices, and the benefits of having a universal policy that enables all Americans to get regular care.
“Under Medicare for All the average American family will be much better off financially than under the current system, because you will no longer be writing checks to private insurance companies,” Sanders added, predicting an average annual savings of $5,000 for middle-class families. And while higher earners may see their taxes rise, Sanders said, “that expense will be more than offset by the money you are saving when you eliminate your private insurance.”
Next logical step?
Despite significant growth in coverage under the Affordable Care Act, today’s patchwork model of commercial plans, employee-sponsored coverage, and government programs left more than 27 million Americans without health insurance in 2016, including 8 percent of Garden State residents. Booker, Sanders and others framed the Medicare for All plan as the logical next step in the continued progression of national healthcare policy.
“This is the fight for our nation to live up to its ideals,” Booker said, placing single-payer as the next step in the American quest to expand liberty and justice that has so far involved securing ballot access, civil rights protections, and free public education.
“Because you cannot have justice in this country when you have millions of Americans who cannot get access to basic healthcare because of the amount of money they make. You cannot have liberty when millions of American families are shackled and chained to fear and illness and sickness because they can’t afford the medicine or can’t afford to go see a doctor,” he continued.
Attracting a crowd
Sanders’ Medicare for All rollout drew dozens of supporters and more than 10,000 people tuned in to watch the event on Facebook, many of whom cheered the effort and called it long overdue; a Gallup Poll taken in November showed more than half of Americans now favor such a concept. (One speaker at the event, a Canadian physician and hospital administrator, noted their nation’s single-payer system was more popular than ice hockey with citizens there, in part because it allowed patients to visit any doctor without ever considering the cost.)
Several senators stressed that Sanders’ plan could essentially end the “medical bankruptcies” faced by hundreds of thousands of Americans each year — three out of four of whom had health insurance at the start of their illness, according to Massachusetts Sen. Elizabeth Warren. “Under this plan, everyone gets covered, no one goes broke,” she said.
Since the proposal would involve a massive shift in how care is delivered, New York Sen. Kirsten Gillibrand said she insisted the plan be phased in over four years. During that time, the federal government would create and sell a public healthcare policy on the health insurance exchange market that was created as part of the ACA.
Eventually, everyone would be rolled into the single-payer government system and employee-based plans would end, severing ties that Sanders said bind many people to dead-end jobs they aren’t passionate about. He said the new model would save businesses an average of $9,400 annually for each employee’s healthcare cost.
Healthcare premium tax
Sanders said his plan would be funded by a 6.2 percent income-based healthcare premium tax to be paid by employers ($630 billion annually); a 2.2 percent income-based premium tax for households, projected at less than $500 for a family of four ($210 billion annually); and changes to other healthcare taxes.
It would also require heavier levies on wealthy Americans, including limits to tax deductions, changes to capital gains and estate taxes, and a more progressive income tax system that could rise as much as $110 billion a year, among other reforms.
But Lance, one of many Garden State Republicans who has seen his office picketed following his votes to reform Obamacare, said the nonpartisan Congressional Budget Office must first review Sanders’ bill to assess the true costs before there can be a “serious” debate on the measure. Lance said he supports centrist proposals that seek to bring down healthcare costs, making insurance more accessible for consumers, which now have momentum in Congress.
“Senator Sanders’ single-payer healthcare plan is one that my constituents cannot afford,” Lance said. “Most Americans would lose their health insurance plans if single-payer became law and dramatic tax increases would be unavoidable. Those tax increases would fall across the board to meet the tremendous cost of the program.”