Everyone's Talking About Medicare-for-All: What You Need to Know

Medicare-for-all is making headlines again with presidential hopefuls shaping their platforms. But a recent poll shows that four in 10 adults 65 years old and older say Medicare-for-all would not impact them.

With numerous, different versions of Medicare-for-all proposals, there’s no singular known impact on anyone, whether you’re a Medicare beneficiary today or a privately insured, younger American. But you can count on Mature Health Center^® and our partners at Medicare MarketPlace^® to monitor the proposals and keep you informed of developments.

To help you understand the basic issue, let’s take a look at what Medicare-for-all is.

What Is Medicare-For-All?  

Loosely speaking, a Medicare-for-all heath care system would cover all Americans and be provided by the federal government. But other catchphrases — including “single-payer,” “public option,” and “universal health care” — are often used in place of or in conjunction with Medicare-for all, despite some differences.

 As Kaiser Health News reports, political candidates toss around these catchphrases vaguely and often incorrectly, resulting in voter confusion as to what each means.  

U.S. Senator Bernie Sanders (I-Vt.) is the politician who is perhaps the most associated with the Medicare-for-all terminology after advocating for a nationwide public insurance program in his 2016 presidential bid and introducing Medicare-for-all legislation in 2017. Medicare-for-all is often called “single-payer,” insurance, because there is one entity — in this case, the government — responsible for paying health care claims. But in reality, Medicare, the health insurance program for Americans age 65 and older, allows private insurance companies to manage care in the program, meaning the government is not the sole payer of claims. So Sanders’ use of the Medicare-for-all or single-payer terminology is somewhat misleading.

Universal vs. Single-Payer

Sanders and other politicians are calling for universal health care. In a universal health care system, every individual has coverage. Some politicians use the term vaguely, as a broad, philosophical idea with few details.

Universal and single-payer are not the same type of health care system. A single-payer system simplifies who is responsible for covering costs in an effort to eliminate some of the complex billing issues that exist in today’s U.S. health system. Single-payer systems generally include universal coverage, but not all universal health care systems are single-payer. And universal coverage could include a combination of public and private programs in which everyone has access to health care.

Public Option

A public option would be a government-run health insurance agency that would compete with other private health insurance companies. The Affordable Care Act had early drafts that included plans for a public option, but the public option didn’t make it into the final version.

With so many terms or types of health care systems, so many candidates and so much misuse of the terms, deciphering the details of each proposal and comparing proposals can be challenging. As the 2020 presidential campaign season kicks off, the Medicare-for-all catchphrase is being used by many Democrats running. Presidential hopefuls and senators Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren have all co-sponsored Sanders’ Medicare-for-all bill. Harris, D-Calif., drew fire most recently for saying Medicare-for-all government insurance should eliminate the private insurance industry.

Medicare-for-all critics say it’s not affordable, and despite public sentiment turning more favorable toward the idea of Medicare-for-all, the tax increases that may be necessary to pay for it are less favorable with the public. Some proposals call for a tax increase on employers similar to the Social Security tax, a 4% tax on everyone’s incomes, or higher earners paying more.

Shifting Public Opinion

The vast majority of Americans, 70%, now support Medicare-for-all, with only 20% of Americans saying they outright oppose the idea, according to a Reuters survey.

The Kaiser Family Foundation, which has been tracking public opinion on the idea of a national health plan since 1998, reports that more than 20 years ago, four in 10 Americans (42%) favored a national health plan in which all Americans would get their insurance from a single government plan. In the decades that have followed, support has increased modestly, accelerated after Sanders’ presidential bid in 2016 with his call for Medicare-for-all. Most recently, the poll finds 56% of the public favor “a national health plan, sometimes called Medicare-for-all, where Americans would get their insurance from a single government plan,” with four in 10 (42%) opposing such a plan.  

A Long History

It’s not a new debate.

Some of the earliest calls for national health insurance for Americans date back to 1912, when Teddy Roosevelt ran for president. In 1945, just seven months into his presidency, Harry S. Truman proposed his vision for a new national health care program that would be run by the federal government and open to all Americans. Although his proposal was eventually abandoned, President Lyndon B. Johnson would credit Truman’s vision for the 1965 creation of Medicare.

In September 2017, Sanders proposed his Medicare-for-all plan, which proposed enrolling everyone in a nationwide public insurance plan. But other plans are also being called Medicare-for-all — with eight proposals alone during the 115^th Congress to broaden the role of public health programs.

For more details on the different plans, read this Kaiser Family Foundation overview.