FREQUENTLY ASKED QUESTIONS
1. What is single-payer healthcare? Single-payer healthcare is a way of financing healthcare. Instead of having thousands of private insurance companies and several government agencies paying providers and reimbursing patients for healthcare costs, one single agency is responsible for paying everybody for everything. Single-payer healthcare cuts down confusion and reduces administrative costs. Medicare for All is one type of single-payer healthcare. It does not require any changes in the way care is delivered, just the way it is paid for.
2. What is the difference between Medicare for All and a National Health Service? Medicare for All gives the kind of coverage people now have under Medicare (only better) with complete freedom of choice about who you can see. No restrictions on which doctors, hospitals or even on which state you go to for your care. Unlike a National Health Service, there will be no budget restrictions and providers will be independent of the government—there will be no change in who they work for.
3. Why do we need Medicare for All? What's wrong with private health insurance? Medicare for All will eliminate out-of-pocket costs and slash bureaucracy for patients and doctors. Most people with private health insurance get it from their employer. Health industry surveys show that only 30% of those with plans at work thought the current cost of insurance for most Americans was reasonable. Less than half of them thought the average American would be better off with the plan their employer gives them. So why does the insurance industry say most people are satisfied with the health insurance they get from their employer? Maybe because they think they can't do much better. Or perhaps because plans have gotten so confusing, they can't even be sure what they're paying for. They can't be all that satisfied if almost 80% of people say they expect the cost of health insurance to increase over the next two years. And wages have not been increasing along with health insurance costs. And when the insurance industry says people with health insurance from their employer “feel their health plan has their back” the question they asked them was, “If you had a medical emergency and were required to go the hospital, which of the following would you expect to occur? A. My coverage will protect me from the majority of my medical costs. B. My coverage will not protect me from the majority of my medical costs.” If you earn $75,000 a year and a hospitalization costs $75,000, does protecting you from the majority of those costs mean your health plan has your back? If fewer than 10% of those surveyed have ever been hospitalized, how can they know whether their health plan has their back? So many plans now have different tiers of provider networks, narrow networks that limit the choice of providers, and deductibles and copayments that increase in size each year, often combined with a confusing array of health savings plan options. Too often when an employee get a serious illness, they are surprised about hidden rules that cause large out-of-pocket costs or treatment delays. And the administrative burden on doctors and other providers is enormous—they have to keep track of all the rules of thousands of different insurance companies. And that costs money—money that could be better spent taking care of patients. Did you know that the administrative costs of private health insurance are more than four times as high as they are for Medicare? These are problems that would not be present with Medicare for All.
4. What if I have really good insurance now? If you are sure you have good insurance, you will be able to keep any private insurance you have. All medical insurance can be allowed under Medicare for All, but all private insurance would be secondary to Medicare. You will be responsible for submitting claims for your private insurance. The cost of your private insurance will become much lower because most of your care will be covered by Medicare. (You will still be required to have Medicare and pay premiums, unless you qualify for an exclusion as under current expanded Medicaid regulations.)
5. How much will my premium cost under Medicare for All? The plans in Congress would eliminate premiums and replace them with taxes instead--the more income you make, the higher the taxes. An alternative we present would keep premiums, but make sure they are affordable by not relying on the marketplace. If you currently are on standard Medicare and have a Medicare drug plan, your premiums will be about the same. If you are on a Medicare Advantage plan, your premium could be higher or lower but you will have complete freedom to choose your providers. If you currently get insurance from your employer, your premium will be lower than the average premium paid in today’s market. If you currently get coverage under the Affordable Care Act, you will also have premiums similar to those paid by employees in today's market, but if your family income is below 400% of the Federal Poverty Level you will be eligible for premium reductions. Either way, costs would be stable and less than they are now.
6. What about out-of-pocket costs? Deductibles will be eliminated immediately and copayments will be gradually reduced. By the time Medicare for All is fully implemented, out-of-pocket costs will be minimal. The only thing you will pay for will be care not covered by Medicare (like a private room that is not medically necessary, cosmetic surgery and certain dental procedures).
7. Is this the only plan for Medicare for All? No. We present a proposal for a well-implemented Medicare for All plan. There are two bills in the current Congress, one in the House, H.R.1384 (2019) and one in the Senate, S.1129 (2019) that have many sponsors, none of which are likely to be passed in their current form. All supporters of Medicare for All will be working together to get the best possible legislation passed by Congress. The proposal we present is a work in progress toward that goal. We want to empower you to voice your concerns and make Medicare for all the best healthcare legislation that will work for everyone.
8. Who will be eligible for Medicare under Medicare for All? All residents of the U.S. will be eligible. The Secretary of Health and Human Services will be responsible for defining what determines residency requirements.
9. When will Medicare for All take effect? There will be a gradual transition over four years after a bill is enacted before full implementation of Medicare for All. During transition there will be an opportunity for anyone who does not have Medicare to sign up for it. Those who don’t sign up will keep their current insurance. Each year, the benefits provided by Medicare will get more and more generous.
10. What about people who are eligible for Medicaid? The coverage provided to those eligible for Medicaid is much more comprehensive than the current coverage offered by Medicare, but the rates paid to providers is often much lower. For this reason, the coverage under Medicare will be gradually improved during transition so that by full implementation all those who are now on Medicaid will be able to receive Medicare instead. There will be some special additional benefits for those currently on Medicaid (they will pay no premiums and their transportation costs will be covered). Otherwise, everyone will have the same level of coverage with the same payments to providers. There will also be greater incentives for states to expand Medicaid eligibility during transition.
11. What will Medicare for All cover that is not covered under Medicare now? Annual visual and hearing exams for adults with yearly glasses for those who need them and hearing aids every 5 years, comprehensive short-term and long-term care (including nursing home care and home care), preventive dental care (including fillings), care by nurses and other professionals in doctors’ offices for patient education, all copayments and deductibles.
12. I am a veteran. Will I still be able to get care at the VA? Yes. Under our plan, there will be no recommended changes to the VA.
13. I am a Native American. Will Medicare for All affect services provided by Indian Affairs? No. Under our plan there will be no recommended changes to Indian Affairs.
14. How will we be able to afford Medicare for All? By providing coverage for less costly care, people will not need to use more costly care as much as they do now. By reducing the use of multiple private insurance companies, the cost of insurance, providers’ administrative costs and tax subsidies will all be reduced. By increasing the budget for Medicare’s administration, and streamlining care in one system the ability to monitor regulations and reduce fraud and waste will be improved. Altogether, the savings are vastly greater than the costs.
15. Are there any budget restrictions under Medicare for All? No. Under our plan we rely on methods that are shown to reduce costs rather than budget restrictions that could lead to unwanted rationing of care.
16. How do you plan to keep prices from increasing? We have some important initiatives. First, we will remove the restriction against negotiating directly with drug companies. Second, we recommend using Germany's model for negotiating prices to keep costs down but still allow drug companies a fair profit (Germany has the third highest drug costs in the world). This would lower drug prices one-third and put a brake on increases. Third, we will invest more in research so that private companies are not the only ones that are responsible for that cost. Fourth, we will use a formula we call SHIFT, the Sustainable Healthcare Index Formula Target. This formula will look at the prices of all medical goods and services doctors order and send quarterly reports to doctors comparing their spending with their peers. Doctors that vary significantly from others may be audited. Reports may also be sent to medical societies to help them develop educational tools. These reports will help doctors keep an eye on the costs of what they order and discuss the most cost-effective care with patients. Combined with better enforcement of regulations about improper use of services, cost control will be maintained.
17. What happens to Medicaid under Medicare for All? Medicaid will no longer exist as a separate program. This will save star and local governments over $175 billion. All those currently eligible for Medicaid as expanded under the Affordable Care Act (no matter what state they live in) will receive Medicare but will not have to pay premiums. Since Medicare is more efficient than Medicaid this will reduce overall healthcare expenses.
18. How much will Medicare for All cost businesses? Employers will continue to pay for a share of the premiums for their employees, but their cost will be much lower. The share employers pay will be about 40% instead of the current average of about 70%. Overall, this represents for all businesses a cost as a percentage of payroll of only 4% compared to their current cost of 8.3%. And to make sure small businesses will be able to afford even these much lower costs, those in need will be eligible for tax credits to help them pay their share of premiums. Businesses will be better able to budget their expenses and will no longer have to worry about rising costs (the share of premiums for businesses will be limited to keep their costs no higher than 4% of payroll). And they will no longer need to make complex decisions about healthcare coverage.
19. What if I am self-employed? If you are self-employed you will only pay your Medicare premiums. There will be no employer component to your costs.