‘Medicare for All’ exceeds what other nations offer
House budget panel to hold hearing on health care proposal
WASHINGTON — Generous benefits. No copays. No need for private policies. The “Medicare for All” plan advocated by leading 2020 Democrats appears more lavish than what’s offered in other advanced countries, compounding the cost but also potentially broadening its popular appeal.
While other countries do provide coverage for all, benefits vary. Canada’s plan, often cited as a model, does not cover outpatient prescription drugs and many Canadians have private insurance for medications. Many countries don’t cover long-term care.
But the Medicare for All plan from Vermont Sen. Bernie Sanders would charge no copays or deductibles for medical care, allowing only limited costsharing for certain prescription drugs. Sanders would cover long-term care home and communitybased services. Dental, vision and hearing coverage would be included. The House version of the legislation is along similar lines.
“Medicare for All proposals would leapfrog other countries in terms of essentially eliminating private insurance and out-ofpocket costs, and providing very expansive benefits,” said Larry Levitt, a health policy expert with the nonpartisan Kaiser Family Foundation. “It raises questions about how realistic the proposals are.”
Shifting the U.S. health care system to a government-run “single-payer” plan is one of the top issues in the 2020 Democratic presidential primary, but the candidates are divided. Some have endorsed Sanders’ call, while others want to expand coverage within the current mix of private and government insurance. Independent studies estimate Medicare for All would increase government spending — from $25 trillion to $35 trillion or more over 10 years. It stands no chance with Republicans controlling the White House and the Senate, but it is getting hearings in the Democratic-led House.
Economist Sherry Glied, dean of New York University’s Wagner School of Public Policy, says the offer of generous benefits may be needed to persuade Americans satisfied with employer coverage that they would be better off in a new government plan.
“You are going to have to be very generous if you want this to be politically appealing to lots of people,” said Glied, who was a senior health care adviser in the Obama administration.
Glied says components like benefits, co-payments and deductibles would all be negotiable.
A second congressional hearing on Medicare for All is scheduled Wednesday before the House Budget Committee. The plan is a punching bag for Republicans trying to tag Democrats as “socialists.”
A report from the Congressional Budget Office will be the focus of Wednesday’s House hearing. Another report, for the nonpartisan Commonwealth Fund, was written by Glied. Among its findings: Other countries don’t necessarily take the same approach as Medicare for All, using a range of strategies to cover all their residents.
The report found that one group of countries — including Denmark, Britain and Germany — provide comprehensive benefits. That includes, for example, mental health. They charge low copays. Those countries are the closest to Medicare for All.
A larger group — including Australia, France, Netherlands, Norway, Singapore, Sweden, Switzerland and Taiwan — offer broad benefits but there may be gaps, and cost sharing is higher. Australia charges $60 for specialist visits. The Netherlands has a $465 deductible. Dental coverage may be limited.
Canada has a narrow national benefits package. It doesn’t cover outpatient prescriptions, long-term care, mental health, vision and dental. But there’s no cost sharing for hospital and doctors’ services. Canadians rely on private insurance and provincial governments to fill gaps.