Under a plan proposed by Senator Bernie Sanders of Vermont on Wednesday, all Americans would get government-funded health insurance: “Medicare for all.” What that would mean for you as a consumer depends on whether you currently have insurance, and if so how you’re covered. People insured through work would have new taxes, but no more premiums. 156 million people People with Medicaid would have more choices, but possibly higher taxes. 73 million people People currently with Medicare would have more generous coverage. 61 million people The uninsured would all get health care. 28 million people People who buy their own insurance would have new taxes, but less out-of-pocket spending. 21 million people Veterans would keep their existing health care system. 9 million people Native Americans could also keep their current source of care. 2 million people The plan would also have big effects on the health care industry, since it would eliminate private health insurance and change the way medical providers and drug companies are paid. Doctors and hospitals would probably face pay cuts, but would no longer face unpaid bills. Drug companies would most likely have smaller profits. Health insurance companies would mostly be eliminated. With Republicans in control of the Senate, the plan has no chance of becoming law anytime soon, but its co-sponsors include several Democratic presidential hopefuls, including Mr. Sanders, meaning it will feature in the policy debates of the 2020 election. The Sanders legislation leaves certain things unclear, including how the plan would be financed. Here’s a general sense of the spectrum of changes for different groups of consumers, and for the health care industry, which makes up 18 percent of the nation’s gross domestic product. People insured through work New taxes, but no more premiums. The employer-based insurance that now covers 156 million people would be eliminated. Those people would lose their current coverage and be enrolled in the new program instead. Both employers and workers would probably face new taxes to pay for the coverage but would not have to pay the premiums or deductibles they’re paying now. For some people, the tax increases could be lower than current premium costs, but not necessarily for everyone. Without a detailed financing plan, it’s impossible to say for sure. People with Medicaid More choices, but possibly higher taxes. Medicaid would be eliminated, and everyone who currently gets medical benefits from Medicaid — about 73 million people — would switch to the new single-payer system. They now pay very low fees when they receive medical care, and that would not change much. But the current Medicaid beneficiaries would probably gain access to more choices of doctors and hospitals in the new program. Some who work might need to pay higher payroll taxes. The part of Medicaid that currently pays for institutional long-term care, like nursing homes, would remain in place. That means that some Medicaid beneficiaries would be enrolled in both programs. Other kinds of long-term care, such as home-based services, would become part of the new Medicare system. People with Medicare More generous coverage. Medicare is now available to about 61 million people age 65 and older and to some younger people with disabilities. Coverage for these people would become more generous because the Sanders bill would expand to cover dental, vision and hearing aids, which are not covered under current law. The bill would also get rid of nearly all cost-sharing requirements in the program. Beneficiaries could go to the doctor or hospital without having to pay any money out of their pocket. The program would require co-payments for certain prescription drugs. Currently, Medicare beneficiaries pay premiums every year to be enrolled in the program. Those would go away. But the overhaul would also eliminate private Medicare Advantage health plans, which enroll more than a third of beneficiaries, bringing all beneficiaries into the government program. The uninsured All get health care. Around 28 million u ninsured Americans would be able to obtain coverage through the new universal Medicare for all program, within four years of the bill’s passage. Children could join right away, and any American 55 or older could join traditional Medicare, if they paid premiums. People who buy their own insurance New taxes, less out-of-pocket spending. The 21 million people who currently buy their own coverage, either in the Obamacare marketplaces or directly from insurance companies, would instead get Medicare. The Affordable Care Act exchanges would be eliminated. It’s unclear if new taxes would make it cheaper or costlier for this group. For many, coverage under the new program would involve substantially less out-of-pocket spending and would permit access to a wider choice of doctors and hospitals. Veterans and Native Americans Keep existing system. The more than 9 million veterans who get their health care from the Veterans Administration health care system would be able to preserve that access for at least 10 years. About 2 million Native Americans who use the Indian Health Service could also keep their current source of care for at least 10 years. These two government programs would be the only forms of health insurance not substantially changed by the bill. Doctors and hospitals Pay cuts likely, but no more unpaid bills. Doctors and hospitals may have to take pay cuts, since the current Medicare program typically pays them less than commercial insurers pay for the same services. But the bill’s expansion of coverage means that hospitals and doctors would no longer need to worry about unpaid bills from patients who lack insurance or can’t afford to pay their insurance deductible. They may also save on administrative costs, since they would not need to interact with as many insurers or to bill patients for services. The bill does not specify exactly what doctors and hospitals would be paid, and the effects would depend on those details. But decreases and changes in payment policy could cause changes to the business of health care as hospitals, doctors, nurses and others adjust to lower payment rates and salaries. Universal Medicare-like payment rates would almost certainly cause some major disruptions, like hospital closings. Drug companies Less profit. Drug companies would most likely earn substantially less from American patients under this system. The new Medicare system would negotiate with drug companies on behalf of all Americans, and would deny coverage of drugs that cost too much. That policy would probably reduce prices paid to pharmaceutical companies, bringing them closer to what other large government systems pay. Those reductions could have ripple effects, lowering the profitability of the pharmaceutical sector and discouraging investments in new medicines. Insurance companies Would mostly be eliminated. Because everyone would eventually get insurance from Medicare, private insurance companies would essentially be eliminated . The bill would bar employers from offering private insurance once the new system becomes universal. The bill does establish a program to help the industry’s workers transition to new careers. Insurance would be allowed to cover services that are not part of the Medicare system, but they would probably be marginal, since the bill establishes a robust set of Medicare benefits.

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T eresa Ghilarducci , Contributor, Forbes, July 2018. U.S. Senator Bernie Sanders (I-VT) speaks during a health care rally at the 2017 Convention of the California Nurses Association/National Nurses Organizing Committee on September 22, 2017 in San Francisco, California. Sen. Bernie Sanders addressed the California Nurses Association about his Medicare for All Act of 2017 bill. (Photo by Justin Sullivan/Getty Images) A leading Democrat in the House of Representatives lost in the New York Democratic primary when 28-year-old Alexandria Ocasio-Costa upset Joe Crowley. She credited her victory to her policy recommendations, including a plan for “Medicare for All.” What is “Medicare for All?” How does it differ from Obamacare? How would “Medicare for All” affect key constituencies in the nation? Below is a basic primer on the proposal. Advocates for “Medicare for All” say Medicare updates the U.S. by “joining the rest of the industrialized world, where health care is universal” and will save money and improve health outcomes. Pretty compelling. The detractors say that the program is too expensive and other solutions will get similar outcomes for cheaper. That said, no expert advocates going back to the system before Medicare. Medicare was established in 1965 and was structured to be expanded. Primarily universal health care for people over 65, Medicare covered people with disabilities in 1972. Many thought Medicare for children, Medikids, was coming soon. Drug benefits, Part D was added in 2006. Advocates like Columbia Professor Linda Fried supports lowering the initial age of Medicare eligibility to 50. Lowering the age would end the so-called age tax where private insurance charges more for covering people between ages 50 and 64. Because of political and business pressure from the medical and insurance industries, Princeton Sociologist Paul Starr argues the momentum to expand Medicare slowed down. Incremental solutions that focused on private-sector, market-based solutions to cover all residents became the American way of health insurance reform. Economists have long identified the inefficient incentives of private insurers to avoid insuring the sick and people over age 40 and use administrative measures to avoid paying claims. Adverse selection and active trimming of risk are unavoidable problems with private insurance. Moreover, only big pools, like the government, have enough bargaining power to lower drug prices and other vendor costs. Senator Bernie Sanders has introduced the Medicare for All Act of 2017, and many Democrats support “Medicare for All” legislation in the House. Currently, advocates argue the program would help young, low-income, and self-employed workers many who are among the 41 million underinsured Americans and another 27.6 million Americans with no health insurance. But many more groups would be affected. New York Times writers Katz-Sanger and Park identify the constituencies who would be affected, and how, if “Medicare for All” passed: 156 million people insured through work would probably pay higher new taxes but would be insulated from premium hikes and coverage shrinkage. 80% like their current insurance and Medicare Care for All would mean they get something else. 74 million people with Medicaid would have more choices, but possibly higher taxes. 56 million people currently with Medicare would have more generous coverage. 28 million uninsured would get health care insurance coverage. 22 million people who buy their own insurance would have new taxes, but less out-of-pocket spending. 9 million veterans would keep their existing health care system. 2 million Native Americans could also keep their current source of care. Drug company profits would likely fall as the government would have more bargaining power to negotiate lower prices. This certainly will cause political resistance from drug companies but may be popular among voters. In early July Pfizer raised the cost of Viagra, a nervy move attributed to the lack of political risk from Trump and the Administration to curb drug costs. Health insurance companies would mostly be eliminated, and executives – among the highest paid in the nation – would lose their jobs. Doctors and hospitals would likely face pay cuts, but would no longer face unpaid bills so they may be winners. Then there are the direct and upfront costs of the policy. Everyone agrees “Medicare for All” would be costly and would require new taxes. Senator Sanders puts the bill at $1.3 trillion because the coverage is wider and better than existing programs. There will be massive administrative cost savings, especially in advertising – what economists call a deadweight loss. More neutral experts double the estimate. Kenneth Thorpe, at Emory University, puts the cost at $2.4 trillion a year. The Urban Institute estimates $2.5 trillion a year. The Committee for a Responsible Federal Budget projects a cost of $2.8 trillion a year, or 16% of GDP. To put that in perspective, health care spending in the U.S. is 20% of GDP. That is almost twice the share of other nations. “Medicare for All” would raise that share with more coverage before it lowered it with efficiency savings. And, if you think you have heard programs similar to “Medicare for All,” it is because it was once described as “Single Payer.” Focus groups found the “Medicare for All” label sells better than “Single Payer” and that has been true for awhile.