Shared from the 6/10/2019 Houston Chronicle eEdition

The various meanings of ‘Medicare for All’

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New York Times file photo

Nurses hold signs supporting Medicare for All proposals at a rally on Capitol Hill.

Most Americans agree that something needs to be done to improve access, efficiency, and benefits and control costs of health care. But little consensus exists on what that might be.

Passed in 1965, Medicare now covers about 60 million Americans and has broad public and political support. Once considered an outlier position, polls show that a majority of Americans (and many health professionals) support the concept of an expanded Medicare for All system. Because of the term’s popularity, some politicians have embraced it, but often without providing sufficient details. Further, Medicare for All has not been well defined, much less well understood by the public, health care providers and politicians.

Often it is difficult to clearly define something that on first glance may seem readily evident, such asa dozen eggs. A dozen eggs can be small, medium, large, extra-large or jumbo. Eggs can be white or brown, free range or not. Differentiating eggs can be worked out fairly easily, but efforts concerning health care reform are more complex. Understanding various approaches to health care is akin to defining what is meant by “meat loaf” or “seafood chowder.” Search the internet for recipes, and you may find no two identical recipes (although each blogger would maintain that theirs is the best).

Similar challenges emerge when well-intentioned politicians and public interest groups discuss “Medicare for All.” The term means different things to different people. Some embrace the words. Others deride them.

There are a wide variety of legislative proposals. Two of them would create a universal Medicare for All, a publicly financed single-payer health plan.

Three proposals — The Choice Act, The Medicare-X Choice Act, and The Choose Medicare Act — would create a new public plan option based on our current Medicare program. Sometimes euphemistically referred to as Medicare for Some, these use more incremental approaches. They would be offered to individuals and some or all employers through the Affordable Care Act (ACA) marketplace to supplement private sources of coverage and public programs.

Two additional proposals would create a Medicare buy-in option for older individuals not eligible for the current Medicare program. One would allow people between ages 50 to 64 to buy into Medicare. The other would be a Medicare public option to buy into a public plan modeled after Medicare. Finally, one proposal would create a Medicaid buy-in option that states can elect to offer to individuals through the ACA marketplace.

As Gerald Anderson, professor of Public Health at Johns Hopkins notes, “Voters have become casualties as candidates toss around these catchphrases — sometimes vaguely and inaccurately. The sound bites often come across as ‘quick answers’ without a lot of detail.”

With presidential candidates embracing “Medicare for All,” it is imperative that voters become informed about the details. A recent Kaiser Family Foundation poll showed that 56 percent of Americans support the idea of anew federal health care program. That support quickly evaporated, however, when trade-offs such as higher taxes or loss of private insurance options were included.

Key elements to evaluate the merits of any proposal are knowing who is covered, what benefits are/aren’t included, cost, how funded and who pays. Further, what will be the roles of government and the private sector in managing and controlling costs?

Like meatloaf or seafood chowder, someone else’s favorite Medicare for All recipe might not be to your liking at all.

Iammarino is a professor emeritus of health sciences at Rice University. O’Rourke is a professor emeritus of community health at the University of Illinois.

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