Introduction
The purpose of this post is to start a conversation, and establish what is known, or described in current legal documents, which exist to describe the proposed entity, as a starting point, for any rational discussion.
This requires some rules of decorum and rationality.
Mainly focusing on what is... not what is feared, what it could become or any other image based on the evolution of what is proposed. I wish to ground the discussion on what is written, and discus only that which is written as much as possible,
Let us discus not conjecture or emotion.
I can't gurantee success, but will gurantee my honest attempt, using simply what is written.
What is it?
The proposed healthcare insurance entity called : Medicare for All, would create a single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage.
Keypoints include: free at the point of service fees. No networks, no premiums, no deductibles, no copays, and no surprise bills.
Source: US Congress Proposed Law Page
source US Senator Bernie Sanders Webpage
My Summary
This proposal would do three things:**
First, merge the existing Medicare Healthcare Insurance System, which provides healthcare insurance to US Citizens age 65 and over, currently about 60 million Americans, with the US Medicaid Program: which covers low income Americans, from conception to age 65, and Medicaid currently covers over 80 million Americans.
Second, it expands upon those two programs, to create an entity called Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.
Third, it changes the scope of those two insurance programs benefits, coverages and cost structure. It adds services like Dental, Podiatry, Chiropractic, Skilled Nursing Facility and Longterm Care (nursing homes) which are not currently part of Medicare and avilable from Medicaid to certain qualifying reciepients. This substantially increases the cost of the program, which is believed to be offset by the new premium dollars flowing into the Program from every working U.S. Citizen, Resident Alien, non-rs on tempoarary working visas or non-resident aliens on extended working visas. The term non
source US Senator Bernie Sanders Webpage
Source: US Congress Proposed Law Page
Purpose
Introduced in Senate (05/17/2023)
Medicare for All Act
This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS).
Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, home- and community-based long-term care, gender affirming care, and reproductive care, including contraception and abortions.
The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services, with the exception of prescription drugs. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program.
Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs, TRICARE, or the Indian Health Service. Additionally, state Medicaid programs must cover certain institutional long-term care services.
The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs and establish a formulary.
Individuals who are age 18 or younger may enroll in the program starting one year after enactment of this bill; other individuals may buy into a transitional plan or an expanded Medicare program at this time, depending on age. The bill's program must be fully implemented four years after enactment.
Source: US Congress Bill S.1655
Discussion
So I have combined two elements, a short summary and the existing descriptive information on this proposal, from existing US Congress Bills describing it and the website of a proponent of the program; US Senator Bernie Sanders.
The Keypoints outlined above are chosen by it's proponents to eliminate the "Pain Points" of the current American Healthcare System, and make it more similar to it's counterparts in other western countries, like United Kingdom, France, Belgium, Netherlands, Germany, Switzerland, Denmark, Sweden, Norway, Finland, Italy, Greece, Australia and Japan.
The Big issue with Medicare for All will be the cost, which is a fairly complicated thing to measure because we can't look at the programs costs alone , we need to look at what we pay now for the programs already in existence like Medicare, Medicaid, Medicare and Private Insurance Premiums paid by working Americans.
So we have to ask questions like Whar=t do We Pay Now for the system we have?
Private Insurance?
A search on the internet of government and private accounting sources suggests over a trillion dollars was spent in America on Private insurance alone.
In 2023, Americans spent an estimated $1.29 trillion on private health insurance, representing 30.4% of overall healthcare spending.
https://www.peoplekeep.com/blog/group-coverage-vs-individual-health-insurance-cost
https://sgp.fas.org/crs/misc/IF10830.pdf)
How much do we pay for Medicare?
In 2023, the USA spent $839 billion on the Medicare program, which is about 14% of total federal government spending and the second-largest program in the federal budget after Social Security.
Medicare accounts for a significant portion of federal spending. In fiscal year 2023, the Medicare program cost $839 billion — about 14 percent of total federal government spending. Medicare was the second largest program in the federal budget last year, after Social Security.
Medicare spending on Part A, Part B, and Part D benefits in 2021 totaled $829 billion, up from $541 billion in 2011, according to the Medicare Trustees (Figure 3). These amounts reflect gross spending, not subtracting premiums or other offsetting receipts, and include spending on beneficiaries in both traditional Medicare and Medicare Advantage. Medicare benefit spending is expected to grow to $1.8 trillion in 2031 (Figure 3).
Sources
https://www.pgpf.org/article/medicare/
https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-spending-and-financing/#:~:text=Historical%20and%20Projected%20Medicare%20Spending,in%202031%20(Figure%203).
How much does Medicaid cost?
In fiscal year 2023, total Medicaid spending reached $880 billion, with the federal government contributing 69% ($606 billion) and states contributing 31% ($274 billion).
Overall, Medicaid spending totaled $880 billion in FFY 2023 with the federal government paying 69% ($606 billion) and states paying 31% ($274 billion).
Source
https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/
Total USA
3 Trillion Dollars per Year
How big is the USA population?
340 million
Source: US Government Census: https://www.census.gov/programs-surveys/popest.html
How much does the USA pay per person on healthcare?
3 Trillion divivded by 340 million equals 8823.52941176 USD per person
This is a starting point in the discussion.
Next we shold look at what other countries spend for healthcare and what do they get in exchange for their money??