Long-term care added to ‘Medi­care for All’



Sen. Bernie Sanders launched a re­vamped “Medi­care for All” plan on Wed­nes­day, high­light­ing a di­vide among Democrats over one of their bedrock 2020 cam­paign is­sues – the fu­ture of health care in America.

As be­fore, the Demo­cratic pres­i­den­tial can­di­date’s sig­na­ture pro­posal would re­place job-based and in­di­vid­ual pri­vate health insurance with a gov­ern­ment-run plan that guar­an­tees cov­er­age for all with no pre­mi­ums, de­ductibles and only min­i­mal co­pays for cer­tain ser­vices.

In this lat­est ver­sion, Sanders added cov­er­age for long-term care.

Some Demo­cratic 2020 hope­fuls point to their sup­port of Medi­care for All to prove their pro­gres­sive bona fides. But other Democrats say it’s not po­lit­i­cally or eco­nom­i­cally fea­si­ble be­cause of the large tax in­creases re­quired, pre­fer­ring in­stead to sta­bi­lize the Af­ford­able Care Act and use it to ex­pand cov­er­age.

House Speaker Nancy Pelosi has sounded skep­ti­cal about Sanders’ plan.

Repub­li­cans, mean­while, cite Medi­care for All as Ex­hibit A in their own 2020 nar­ra­tive de­pict­ing a rad­i­cal­ized Demo­cratic Party steer­ing to­ward “so­cial­ism.”

Sev­eral in­de­pen­dent stud­ies of Medi­care for All have es­ti­mated that it would dra­mat­i­cally in­crease gov­ern­ment spend­ing on health care, in the range of about $25 tril­lion to $35 tril­lion or more over a 10-year pe­riod. But a re­cent es­ti­mate from the Po­lit­i­cal Econ­omy Research In­sti­tute at the Uni­ver­sity of Mas­sachusetts in Amherst sug­gests that the cost could be much lower.

Sanders and his sup­port­ers say it’s a mat­ter of prin­ci­ple.

“Health care is a human right, not a priv­i­lege,” de­clared the Ver­mont In­de­pen­dent, who is again seek­ing the Demo­cratic nomination for pres­i­dent, as he un­veiled his bill at a Capi­tol Hill event crowded with nurses and ad­vo­cates for patients.

Four of Sanders’ fel­low senators and ri­vals for the Demo­cratic nomination have signed onto the up­dated sin­gle-payer health care pro­posal. In ad­di­tion to Gil­li­brand, they are Sens. Cory Booker of New Jersey, Ka­mala Har­ris of Cal­i­for­nia and El­iz­a­beth War­ren of Mas­sachusetts.

The lat­est edi­tion of Medi­care for All adds cov­er­age for long-term care in home and com­mu­nity set­tings, on top of its ba­sic prom­ise of com­pre­hen­sive health cov­er­age, in­clud­ing den­tal and vi­son. Brand name pre­scrip­tion drugs would be sub­ject to co­pays to­tal­ing no more than $200 an­nu­ally.

“It is not a rad­i­cal idea to say that in the United States, ev­ery Amer­i­can who goes to a doc­tor should be able to af­ford the pre­scrip­tion drug he or she needs,” Sanders said. As with previous ver­sions of the plan, he did not in­clude de­tails on how to pay for it, of­fer­ing in­stead some general op­tions.

Cap­i­tal­iz­ing on Sanders’ un­veil­ing, Sen. John Bar­rasso, R-Wyo., fired off a let­ter to the Con­gres­sional Bud­get Office re­quest­ing a de­tailed cost es­ti­mate of Medi­care for All bills in the House and Se­nate.

“The Amer­i­can peo­ple de­serve a com­plete and thor­ough vet­ting of this pro­posal,” Bar­rasso wrote to the non­par­ti­san num­ber crunch­ers.

Some Democrats seem to be try­ing to change the con­ver­sa­tion inside the party to build con­sen­sus around “cov­er­age for all” as dis­tinct from the Sanders plan. They aim to reach that goal through var­i­ous in­cre­men­tal steps, while pre­serv­ing the tra­di­tional U.S. mix of pub­lic and pri­vate insurance.

In­deed, a Demo­cratic co-spon­sor of an ear­lier ver­sion of Sanders’ bill was among those hav­ing sec­ond thoughts. Sen. Jeanne Sha­heen of New Hamp­shire did not re-up this time, say­ing in a state­ment “there are faster ways to reach universal cov­er­age by build­ing on the progress we’ve made through the Af­ford­able Care Act.”

Demo­cratic pres­i­den­tial can­di­dates who don’t back the Sanders plan are fo­cused on safe­guard­ing pop­u­lar pro­vi­sions of the Obama-era ACA, such as the one that pro­tects cov­er­age of pre-ex­ist­ing con­di­tions.

“Of course, our No. 1 goal should be to make sure we keep in place those pro­tec­tions so peo­ple don’t get kicked off their insurance,” Sen. Amy Klobuchar, a Min­nesota Demo­crat who isn’t signed onto Sanders’ bill, said Tues­day. “Then we also have to see the Af­ford­able Care Act as a be­gin­ning and not an end.”


Sen. Kirsten Gil­li­brand, D-N.Y., flanked by Sen. Bernie Sanders, I-Vt., left, and Sen. Jeff Merkley, D-Ore., speaks dur­ing a news con­fer­ence Wed­nes­day on Sanders’ re­vised “Medi­care for All” leg­is­la­tion.

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