Medicare for All
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, and long-term care.
The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. 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 or the Indian Health Service.
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.
Individuals who are age 18 or younger, age 55 or older, or already enrolled in Medicare may enroll in the program starting one year after enactment of this bill; other individuals may buy into the program at this time. The program must be fully implemented two years after enactment.
The transformative potential of Medicare for All. “Medicare-for-All” should be more than a badge of political identity or opposition. This Article examines the concept’s potential to catalyze policy innovation in the U.S. health care system. After suggesting that the half century of existing Medicare has been as much “Gilded Age” as “Golden Age,” the Article arrays the operational possibilities for a Medicare-for-All initiative. It revisits America’s recent history of pragmatic rather than principled health policy, and identifies professional and political barriers to more sweeping reform. It focuses on four aspects of health policy that have become apparent: simultaneous inefficiency and injustice in medical care, neglect of the social determinants of health, inertia resulting from the legal architecture of health care, and the latent power of generational change. It concludes by explaining how a Medicare-for-All frame might prompt ethical re-engagement by the medical profession and help the health care system take specific steps on a path to improvement.
Economic analysis of Medicare for All This study provides an economic analysis of the Medicare for All Act of 2017, which was introduced before the United States Senate by Senator Bernie Sanders (S. 1804). Our analysis also addresses, more broadly, a range of issues that need to be examined seriously in considering any specific proposals for a single-payer health care system for the United States. The most fundamental goals of Medicare for All are to significantly improve health care outcomes for U.S. residents while also establishing effective cost controls throughout the health care system. We conclude that these two purposes are both achievable.
Status Quo Costs
National Health Spending Estimates Under Medicaid for All We estimate that total health expenditures under a Medicare for All plan that provides comprehensive coverage and long-term care benefits would be $3.89 trillion in 2019 (assuming such a plan was in place for all of the year), or a 1.8 percent increase relative to expenditures under current law. This estimate accounts for a variety of factors including increased demand for health services, changes in payment and prices, and lower administrative costs. We also include a supply constraint that results in unmet demand equal to 50 percent of the new demand. If there were no supply constraint, we estimate that total health expenditures would increase by 9.8 percent to $4.20 trillion.
While the 1.8 percent increase is a relatively small change in national spending, the federal government’s health care spending would increase substantially, rising from $1.09 trillion to $3.50 trillion, an increase of 221 percent.
The Sanders Single-Payer Health Care Plan. Our central findings of the effects of the Sanders approach are shown in table 1 and include the following:
All American residents would be automatically enrolled in acute care coverage, increasing insurance coverage by an estimated 28.3 million people in 2017, from an uninsurance rate for nonelderly adults of 10.4 percent under current law in 2017. In 2026, the Sanders plan would decrease the number of nonelderly uninsured by 30.9 million, or 11.0 percent of the population, relative to current law. (The uninsurance rate under current law in 2026 is projected to be larger than the rate in 2017 as a result of demographic changes and a slight decrease in the rate of employer-sponsored insurance.) Although the intent is unspecified in the campaign’s materials, this finding assumes that the plan would cover the undocumented population as well as citizens and other legal residents.
National health expenditures for acute care for the nonelderly would increase by $412.0 billion (22.9 percent) in 2017. Aggregate spending on acute care services for those otherwise enrolled in Medicare would increase by $38.5 billion (3.8 percent) in 2017. Long-term service and support expenditures would increase by $68.4 billion (28.6 percent) in 2017. Together, national health expenditures would increase by a total of $518.9 billion (16.9 percent) in 2017, and by 6.6 trillion (16.6 percent) between 2017 and 2026.
The increase in federal expenditures would be considerably larger than the increase in national health expenditures because substantial spending borne by states, employers, and households under current law would shift to the federal government under the Sanders plan. Federal expenditures in 2017 would increase by $1.9 trillion for acute care for the nonelderly, by $465.9 billion for those otherwise enrolled in Medicare, and by $212.1 billion for long-term services and supports.
In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.
Chris Jacobs, “Democrats’ New Single Payer Bill Will Destroy Everything Good about Your Health Care,” Federalist, March 1, 2019, h.
Medicare for All Doesn’t Save Lives
Roy A. Beveridge, et al., “Mortality Differences Between Traditional Medicare and Medicare Advantage,” Inquiry, June 2017, .
12 John Z. Ayanian, “Medicare Beneficiaries More Likely to Receive Appropriate Ambulatory Services in HMOs than in Traditional Medicare,” Health Affairs, July 2013,.
Charles Blahous, “The Costs of a National Single Payer Health Care System,” Mercatus Center, July 30, 2018,
Chris Jacobs, “The CBO Report on Single Payer Isn’t the One We Deserve to See,” The Federalist May 3, 2019,
John Holahan and Linda Blumberg, “Estimating the Cost of a Single Payer Plan” Urban Institute, October 9, 2018,
Jodi Liu and Christine Eibner, “National Health Spending Estimates Under Medicare for All,” Rand Corporation, April 2019, https://www.rand.org/pubs/research_reports/RR3106.html.
Josh Katz, Kevin Quealy, and Margot Sanger-Katz, “Would ‘Medicare for All’ Save Billions or Cost Billions?” New York Times, April 10, 2019,
Cost Savings Answers
Collapse of Private Insurance
“Kamala Harris Reveals That Medicare for All Involves Ending All Private Insurance,” The Federalist, January 31, 2019
General Solvency Answers
Medicare Advantage Good/Better to Keep it than replace with Medicare for All
Health Care Stocks