“Medicare-for-all,” “single-payer” and “universal coverage” are going to be in the news a lot over the next few years – and confuse many people. While these terms often are used interchangeably, they all mean slightly different things.
Medicare-for-all (aka M4A in our jargony world) doesn’t necessarily mean opening up the current Medicare system to everyone. Many Medicare-for-all advocates in Congress are advocating a new health care system that might be called Medicare but, in fact, won’t be the same as the current Medicare.
Medicare-for-all can be considered a form of single payer – with the government as the health care payer – but there are other models in which there could be one payer but different ways of getting coverage (Medicaid buy-in, for instance, or some other “public option”).
Universal coverage, on the other hand, would cover everyone, but does not necessarily mean single payer, government-run or Medicare (although it’s often used that way). “Everyone” could be covered using a mix of payers, since our Medicare system has public, private, and beneficiary payments.
None of these necessarily mean “free” health care unless Congress decides patients don’t have to pay premiums, co-pays or deductibles, although there are some legislators who do advocate that. I recently discussed some of this in a tip sheet for the Shorenstein Center Journalist Resource website.
Moreover, since there are not yet agreed-upon definitions, reporting on this issue inevitably will cause some backlash from readers/viewers/listeners who insist otherwise.
We’ll come back to this topic. But for now, let’s start with one particularly relevant #HealthPolicyValentine, and then onto a reading list.
Roses are red
Diamonds are bling
Universal coverage and single-payer
Are not the same thing— Emma Wager (@emmawage) February 13, 2019
I’ve grouped these links by general topic. Many were suggested by Julie Rovner in preparation for a new “What the Health” podcast at Kaiser Health News, so a big thank you to her. Since many of the articles below are at least somewhat skeptical about Medicare-for-all, you may want to check out the website of Physicians for National Health Program, which has been advocating for single payer for many years and offers many resources.
- Some overviews of the political debate and lack of common definitions:
- What We Don’t Know About Bernie’s Favorite Healthcare Idea, by Politico’s Paul Demko.
- Politicians Hop Aboard ‘Medicare-For-All’ Train, Destination Unknown, published in TheNew York Times and Kaiser Health News by Elisabeth Rosenthal and Shefali Luthra.
- Some interesting perspectives on foreign models, including the role of private insurers in countries we think of as having “single-payer:”
- “If You Don’t Believe Single Payer Can Work, See How They Do It In Taiwan,” by Jonathan Cohn in The Huffington Post.
- Private Health Insurance Exists in Europe and Canada. Here’s How It Works. by Sarah Kliff in Vox.
- The Best Health Care System in the World: Which One Would You Pick, by Aaron Carroll and Austin Frakt in the NYT Upshot.
- Some info about some of the various plans and proposals:
- How to Build a Medicare-For-All Plan, Explained by Somebody Who’s Thought About It for 20 Years, Dylan Scott interviews Jacob Hacker for Vox.
- Medicare-for-All and Public Plan Buy-In Proposals: Overview and Key Issues, from the Kaiser Family Foundation. (These are bills from 2017-18, and some are being modified for 2019.)
- Words of caution – on the politics and the policy:
- The Pleasant Illusions of the Medicare-for-All Debate, by Paul Starr in The American Prospect.
- Medicare-for-All Isn’t the Solution for Universal Health Care, offers a this-is-harder-than-it-looks message – surprisingly, perhaps – from Joshua Holland in The Nation.
- How Democrats Could Lose on Health Care in 2020, a Washington Post op-ed by Ron Klain.
- Why Do Democrats Think Expanding Obamacare Would Be Easier Than Passing Medicare-For-All, by Jeff Spross in The Week.
