by Nancy Spannaus
Sept. 14—With great fanfare and a showing of Senate support that surprised many, Sen. Bernie Sanders introduced his Medicare-for-All bill of 2017 into the U.S. Senate on Sept. 13. Seventeen senators joined him as original cosponsors, and dozens of constituency organizations have voiced their support.
In campaigning for the legislation on the hustings, Sen. Sanders has appealed to FDR’s Economic Bill of Rights, which identified the right to health care as a basic right of all Americans. His draft legislation (S. 1804) boldly asserts that commitment: “Every individual who is a resident of the United States is entitled to benefits for health care services under this Act,” it states in Title I. The bill then proceeds to outline a process of transition for bringing all sections of the U.S. population under coverage of the Medicare, single-payer system over a period of four years.
However, there is one major exception. That is the more than 8 million people (according to a CDC study in 2015) who are recipients of long-term care. They will continue to be treated by the separate, but unequal Medicaid system for the foreseeable future. That is a major difference between Sanders’ bill and that of his political colleague, Rep. John Conyers, who has 117 cosponsors for his Medicare-for-All bill in the House. (H.R. 676)
Sanders’ 96 page bill has significant similarities to the Conyers bill, in additional to the commitment to universal coverage. It outlaws deductibles and co-payments and premiums for those in the expanded Medicare system. It mandates negotiations with the pharmaceutical and medical equipment providers to set prices. It expands coverage to dental and eye care. It establishes a national health care budget, with a universal Medicare Trust Fund, which budget will not only pay for health services to providers, but also include necessary capital expenditures, medical education, and a fund for aiding those insurance workers who are displaced by the new, simpler system. [For our review of the Conyers’ bill, click here.]
There are, however, significant differences, besides the non-coverage of recipients of long-term care. These include the four year phase-in period (as compared to a little more than a year in the Conyers’ bill); no restrictions on inclusion of for-profit providers; and maintenance of the same network of institutions setting standards as was established by Obamacare (Conyers’ bill called for new, more inclusive institutions).
To be a little more specific on the first difference, the expanded coverage would come in tiers of individuals who can buy into Medicare through the Obamacare exchanges. This involves lowering the eligibility age in stages from 65 to 55, then 45, then 35, then everyone. Much of the bill is devoted to detailed discussion of how to regulate the payments to be made under this buy-in plan.
But the most important difference is that Sanders’ bill omits the issue of funding. Instead, his office has produced a white paper outlining various options for covering the increased costs, and he reports that he will be introducing a separate bill dealing with that issue in the future. The various options identified include an income-based tax premium on employers, an income-based tax premium on households, savings from the repeal of the health insurance employer-exemption, and various kinds of taxes on the wealthy. [See Sanders’ website for a copy of the paper.]
In fact, the nation can’t afford a delay. Measures must be taken now to protect and rebuild the economy (Glass-Steagall and a national credit institution), while simultaneously dealing with the health emergency which is reflected in the opioid crisis and increasing death rate among significant sections of Americans. Only the whole program is “practical” under current conditions.