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Here's What's In Bernie Sanders' 'Medicare For All' Bill

Sen. Bernie Sanders, I-Vt., discusses his "Medicare for All" legislation on Capitol Hill on Wednesday.
Jim Watson AFP/Getty Images
Sen. Bernie Sanders, I-Vt., discusses his "Medicare for All" legislation on Capitol Hill on Wednesday.

Here's What's In Bernie Sanders' 'Medicare For All' Bill
Here's What's In Bernie Sanders' 'Medicare For All' Bill GUEST: Dr. Bob Hertzka, health care policy instructor, UC San Diego School of Medicine

Healthcare is back and a spotlight on Capitol Hill. Bernie Sanders received an unprecedented amount of Democratic support as he announced his Medicare for all proposal. On the other side of the out come Lindsey Graham continued to push to repeal Obama care with a GOP proposal to give block grant money to state's two pay for healthcare.Joining me is Bob with UC San Diego school of medicine and he is a practicing the zoologist. Welcome.Sick thing Senators came out in support of the matter care for all proposal. The plan is gaining momentum among Democrats. What are the highlights of the proposal ?It is designed to cover everyone so healthcare would be an inherent right so no one would have to pay bills for healthcare they would not pay premiums. You would ask ask the healthcare system and it would be taken care of. On the service, that is extremely appealing.If this were to go through, it would be phased with the people who were older who would be covered and then younger people until everyone was covered ?This is the basis. You have access to Medicare and you have plenty of expenses but those would be zeroed out and the new Medicare would extend to 55-year-olds the first year and I do not remember the ages but by the time you are four years into it, it would cover every age group.One criticism by the legislature is wherewith the funding come from? What does Bernie Sanders say about the funding ?I will point out the numbers. The urban Institute, which is a well-respected think tank but is clearly viewed as a left of center think tank. It provides a background. They said this proposal over 10 years will cost $32 trillion. The federal government is slated to spend $40 trillion or 52 trillion. That is a very legitimate question. Cerner -- Bernie Sanders likes to say that the money is taken away by wild profits with the insurance company and drug companies. In fact, most of the money goes to pay hospital bills and doctor bills. The overwhelming amount. The only way -- one problem is the way it would work is to pay hospitals and physicians dramatically less.Also, as you said before, you made the point that it sounds great that everybody would be covered by the part that you would say does not sound that great is how high taxes would have to go in order to cover this.The single-payer is assessed. The state proposal has looked at it better. It would take a 60% -- 16% tax on all income which is significant. Whether you are a millionaire or a janitor, that is a big hit. At the federal level, you're talking about comparable amounts but doubled the federal budget. Whatever your taxes are now to the government, imagine they are doubled and that get you in the ballpark of what we need to do.The GOP plan for block grant is called the last gasp to dismantle Obamacare. It would replace the money the government spends to subsidized insurance. Some critics called this even more complicated than Obamacare. What do you think of it ?It is complicated. Conceptually, just like what Senator Graham put together, it is simple on the surface in what they would do is take the money that Obamacare is spending right now -- it is spending a couple of hundred dollars per year, take that money and put it in a big pot. Reallocated to the states based on complicated formulas that benefits sums states and hurt others but they could then decide what to do with it.Today what I limited Medicaid expansion? Did they want to heavily subsidize certain people. On the surface, it is great. Do what you want. One benefit would be that every state would have some level of Medicaid expansion. Some do not like how that is done.Everyone likes it this way and you can expand it however you want. In that sense, you would add people to the roles but overall, there is less money.As you mentioned, this has not been reviewed by the Congressional budget office. The new Republican proposal would have to be supported by the GOP leadership. Mitch McConnell said he is moving away from the healthcare debate. Do you think the Obamacare repeal is dead for now ?I was honored to be here a few weeks ago. It is 50 out of 52 people. They are spending way too much to support and they are cutting too much for Susan Collins. I have not talked to them personally but you see the dynamic. The magic formula to get 50 out of 52 senators to agree on anything, this does not appear to do that. They are working hard. It is a worthy effort but they would like to see state control. They think that is a much more fair way to do it.Healthcare is still a major topic for legislators on both side. Is that because the affordable care act coverage is increasingly threatened by unstable insurance markets ?Let's say President Hillary Collette -- presidency and everyone was all in the Obamacare and it is here to stay. The premiums that were announced just before the president election in 2016, the silver plan, $544 per month with a $3700 deductible. If you make $50,000 or more, there is a 2% likelihood that you sign up for an Obama care plan. Republicans coming you know they say oh my God. This is an unaffordable product. People are worse off than they were before Obamacare.That will continue to bother people who want to do that. Now, add to the Donald Trump effect and the name -- negative commentary and it could get worse, people are focusing on the destabilization. The stabilization point was something that was unaffordable to anyone who did not get a massive subsidy from the government. There will be work on this because there are great people making $50,000 who does not have insurance and they are shut out. While people have got benefits of Medicaid, they have done well but clearly, there will be more discussion because there has to be a significant Obamacare fix and readjustment but the political dynamic is completely -- it is not in the right place for that discussion do happen. It will. In 2019 or 2021, we will talk about a comprehensive fix that will be a good thing.I have been speaking with Dr. Hertzka. Thank you .It is a pleasure.

The Capitol Hill health care fight sure seemed dead. After Republican proposals to overhaul the Affordable Care Act, also known as Obamacare, failed to pass a Republican-controlled Congress, lawmakers looked poised to move on to other topics, like a tax overhaul. But this week, proposals from both the left and the right are grabbing headlines. (Meanwhile, some members are also wrangling over how they can stabilize Obamacare.)

On Wednesday came a "Medicare for All" bill from Vermont Independent Sen. Bernie Sanders — his attempt to push single-payer health care, long one of his favorite causes.

In a Wednesday op-ed in the New York Times, the former presidential candidate wrote about single-payer health care as a moral issue, giving it his familiar populist framing.

"We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can't get the health care they need," he wrote. "This is not what the United States should be about."

Spoiler: It's not going to pass this Congress. But with 2020 (already) on people's minds, single-payer seems primed to be something Democrats will be talking about for the next few years.

So here's a quick primer on what is in Sanders' bill — and why it matters, despite being dead on arrival.

The basics

Sanders' plan is a "single-payer" plan. That means the government will be the "single payer" on any health expenses. Right now, there are lots and lots of payers in the U.S. health care system — insurance companies, the federal government, states and so on.

"Medicare for All"? Not quite. Sanders calls his plan "Medicare for All," but that's more of a handy slogan than reality, as this plan would greatly expand Medicare and overhaul it — for example, it would greatly expand the type of coverage offered and also eliminate deductibles, copays and premiums. Private insurance companies are also currently a part of the Medicare system. That wouldn't be the case under Sanders' plan.

Phased in over time. The Sanders plan wouldn't extend insurance to all Americans immediately; rather, it would do it over four years (and would, as stated above, greatly change the program). The first year, the Medicare eligibility age would be lowered to 55. That would move to 45 and then to 35 over the following two years, until finally, in the fourth year, everyone would be covered.

Covers all sorts of things. Sanders proposes generous coverage that goes well beyond what Medicare currently covers, and even well beyond what many people's private insurance plans cover. His plan would cover dental and vision care, for example, which are, for the most part, not covered by Medicare.

Payment is unclear. A generous plan that covers all Americans is going to require more revenue. There's no exact plan for how to pay for Sanders' bill, but he did on Wednesday afternoon release a list of potential payment options. Among the proposals: a 7.5 percent payroll tax on employers, a 4 percent individual income tax and an array of taxes on wealthier Americans, as well as corporations. In addition, Sanders' plan says the end of big health insurance-related tax expenditures, like employers' ability to deduct insurance premiums, would save trillions of dollars.

But even with all of those potential revenue-boosters, Sanders may still fall far short of the total amount of money needed to pay for his ambitious program. Altogether, his estimates of how much money his funding mechanisms would generate totals up to around $16 trillion over 10 years. In a 2016 report on his presidential campaign's "Medicare for All" plan, the Urban Institute estimated that the plan would cost $32 trillion over 10 years.

What problems would it solve?

Reducing the number of uninsured. (Duh.) A byproduct of universal health care is that, well, people are universally covered.

Out-of-pocket spending: up or down? This would most likely vary from person to person, according to one health care expert.

"The dollars they're currently paying out of pocket would go down, but government costs would go up substantially," said Linda Blumberg, a senior fellow in health policy at the Urban Institute, a Washington think tank. "So depending on the person's income and the way the program is financed, which is not in this proposal yet, people's taxes are likely to go up substantially."

For some people, the tax increase will exceed what they're saving on out-of-pocket costs — looking at Sanders' proposed taxes, this may apply to high-income people. For other people, the savings could exceed any tax increases.

Health care costs: up or down? It's hard to answer this one, as some aspects of this plan would push costs down, while others would push it up.

"The single-payer, government-run system has the potential to control prices much better than our current system," said Larry Levitt, a senior vice president at the Kaiser Family Foundation. With a simpler system would come lower administrative costs, making health care much more efficient, for example; and the government would negotiate drug prices, bringing health care costs down, as well as the price per service.

On the other hand, getting rid of those out-of-pocket costs has the potential to push overall spending up.

"More people would be covered — and that would drive up spending — and having no deductibles and copays will sound great to patients, but it means that people will be going to the doctor a lot more than they are now, and that will drive spending up," he said.

The politics

This bill will not pass. ... And Sanders knows it, as NPR's Scott Detrow wrote in August. "The whole thing is more about political framing — getting Democrats to the point where this would be a top priority whenever the party is back in power," Detrow wrote.

Political signaling. Sanders' bill is the latest piece of evidence that Democrats are moving further and further to the left on health care. Sanders is an independent who considers himself a "democratic socialist," but he caucuses with the Democrats. His popularity in the 2016 Democratic primary signaled a party willing to move further left.

Sanders didn't win over a single co-sponsor when he introduced a similar measure in 2013. On Wednesday, he had 16, including several other high-profile Democratic senators who are being talked about as potential 2020 presidential candidates, including California's Kamala Harris, Massachusetts' Elizabeth Warren, New Jersey's Cory Booker and New York's Kirsten Gillibrand.

Positioning themselves as proponents of socialized insurance could help Democratic candidates win over some voters in the party's base. Now they each have video for their possible 2020 primary campaign ads, speaking next to Sanders during Wednesday's rollout in support of his bill.

But people on the left disagree on how central single-payer should be to Democrats' messaging going forward.

"A commitment to universal health coverage — bringing in the people currently falling through Obamacare's cracks — should definitely be a litmus test," wrote Paul Krugman in the New York Times in August. "But single-payer, while it has many virtues, isn't the only way to get there."

Single-payer has grown more popular, but polling is tricky. Recent polls have shown that the idea of single-payer has grown more popular in recent years. But as with a lot of issue polling, people's opinions on single-payer are pretty movable, as NPR reported in July. Tell them about the potential for higher taxes, and support for single-payer slips substantially. Tell them about the potential for lower administrative costs, and support grows.

Republicans appear eager to do that. On Wednesday they were already branding "Berniecare" as the latest Democratic push for socialized medicine and higher taxes. Sen. John Barrasso, R-Wyo., called it "a complete Washington takeover of America's health care system."

Sanders dismissed those attacks. "You, the Republican Party, have no credibility on the issue of health care," he said Wednesday. "In the last few months, you, the Republican Party, have shown the American people what you stand for when you voted for legislation that would throw up to 32 million Americans off the health insurance they have."

NPR congressional reporter Scott Detrow contributed to this report.

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