Can you imagine having health insurance that would cover your family across generations? Or a plan where you wouldn’t have to struggle to pay your medical bills? These are the principles behind an idea that finally seems to be gaining political momentum, and which promises to be one of the key policy issues in the 2020 presidential campaign: Medicare for All.
According to the Physicians for a National Health Program (PNHP), a group of doctors who support single-payer insurance (Medicare for All), this is a system where a single public agency organizes the financing for medical care, yet the provision of the care will remain private. 
Under a single-payer system, everyone who lives in the United States (it is not yet known what will happen with undocumented immigrants) will have free coverage for all health care. This would include everything from preventative care, doctor visits and vaccinations, to hospitalizations, mental and reproductive healthcare, dental and vision care, as well as medical supplies and prescription medication.
The program would be financed by combining public sources, which currently include very large contributions to programs such as Medicare and Medicaid, and new modest taxes based on the ability to pay.
According to the PNHP, the country would save over $500 billion dollars on administrative costs and processes by replacing the current system, which is based on insurance companies making a profit, with a simplified and non-profit single-payer health system.
Premiums would disappear and 95% of all households would save money. Patients would no longer face financial barriers for receiving medical care (such as copays and deductibles) and get back the freedom to choose their doctors and hospitals, while also allowing physicians maintain autonomy over patient care.
Opponents of Medicare for All say that a system monopolized by the government would be inefficient. And that a single-payer system would limit the care options we currently have in the US.
Another drawback would be the impact this would have on the enormous labor force currently working in private insurance: around 540,000 jobs, according to the Department of Labor.
In 2016, $10,348 was spent on each person in the United States, which is double that of any other industrialized country. Despite this, our performance in the United States regarding health care is poor.
In countries with a single-payer system, like Canada, Spain, France and Italy, every citizen is covered. In the United States, there are still 28 million people without health insurance.
How is This Different from Obamacare?
The Affordable Care Act (ACA) was established in 2010 with the goal of expanding health care coverage for millions of Americans.
How?
Using a health care market in which insurance companies offer affordable health care plans. There are also markets where the government offers tax credits to help pay premiums, guaranteeing that patients will not be discriminated against for having a medical condition.
Another one of ACA’s strategies was to recommend that states expand Medicare programs to include people who did not qualify before due to their income being just above eligibility levels.
This expanded health care dramatically. According to the Kaiser Family Foundation, around 20 million people have obtained coverage since 2010, in large part due to the expansion of Medicare.
However, Obamacare is still a multiple-payer system, which is what makes it different from Medicare for All. Although the government has a strong presence on many levels, especially in helping consumers with credits for paying monthly premiums, it continues to be a system that is based on private care and administration.
Yet, despite all its benefits, the system has been unable to bridge the coverage gap to allow everyone access to medical care. There are still 28 million people in the US without health insurance.
History of Medicare
Medicare was established by law in 1965 as part of a plan to provide universal coverage for seniors over 65. The program was signed by the president at the time, Lyndon B. Johnson, and helped to improve medical care for seniors, thereby extending their lives.
The program originally had two parts, Medicare A, which included hospital insurance, and Medicare B, which covered medical care.
In order to be eligible for Medicare you must have worked in the United States and contributed to Medicare for at least 10 years.
Some experts, like Linda Fried, dean of the Columbia University Mailman School of Public Health, believe that a good option to improve the program would be to lower the eligibility age for Medicare to cover people 50 and older. This would solve a large part of the problem by providing medical care to people who are at a time when they are beginning to spend more on healthcare.
In 2017, Vermont senator Bernie Sanders introduced the bill known as Medicare for All. The project didn’t become law, but Sanders started a debate that will surely last into 2020.
And, in fact, there are states that are planning to make it a reality in the near future. For example, the controversial governor of California, Gavin Newsom, made it a campaign challenge. He has already experimented with a mini version of universal health care when he was mayor of San Francisco.
But many things have changed since 1965. Medicine for all is no longer associated with socialism and unions, like the powerful California nurses’ union, which supports the single-payer system. There has also been a change of heart among medical care providers. There is a new generation of doctors who, in contrast to the generation before them, support a universal system, and who make primary care and preventative medicine a priority in their work.
