Medicare for All: Special Considerations for Future Healthcare Reform

August 20, 2019

In recent years, the phrase Medicare for all has been thrown around in a variety of contexts. Unfortunately, much of the disagreement around this federal healthcare reform concept is based on the fact that the people coming to the table to discuss the matter have different definitions for the term.

Additionally, while several important players are chiming in on the discussion around Medicare for all, still other important stakeholders are being left out – thereby limiting the progress that can be made from the very start.

Now is the time to come together in a united discussion, based on building uniform understanding, common rhetoric, and real evidence-based progress, if we are ever to have the desired impact of improved healthcare programs and accessibility to care.

Defining Medicare for All

“Medicare for all” means different things depending on who you talk to. Unfortunately, the variety of definitions people use to describe this notion contributes to a great deal of disagreement.

Healthcare reform is a heated, loaded concept. To begin a successful discussion of Medicare for all, we need to make sure we are talking about the same framework for implementation.

For instance, some people see Medicare for all as another way to describe universal healthcare for the nation. Others use the phrase to describe a single-payer health system, which could be a federally run or mandated program. Still others say “Medicare for all” and mean that they would like to see the age at which someone is eligible to receive Medicare lowered.

When we are discussing the concept of Medicare for all, we must first spend a moment to make sure we are all discussing the same implementation framework, because what we really want to get to the bottom of is how to provide improved care for as many people as we can while driving down the costs for everyone involved.

Medicare & Medicaid

While we are on the topic of Medicare, it is prudent to discuss Medicaid, as well. Medicaid is another issue entirely, but the two go hand in hand.

Medicare is a federal health insurance program that guarantees coverage to individuals 65 years and older (with some exceptions). Medicaid, on the other hand, is a federally funded assistance program for individuals of any age, determined as being in need based on qualifying factors such as physical or mental handicaps.

As we dive into the discussion of Medicare for all, it is important to keep the model of Medicaid in mind. Not only is the program already covering a massive portion of the population, but it may also provide insight into how a Medicare for all program could work in practice.

However, any lessons to be learned from Medicaid must be acknowledged quickly. Most proposed Medicare for all plans would effectively eliminate the Medicaid program on a national level, since Medicare for all would eliminate any state-specific differences in coverage, including Medicaid.

Medicare for all would fundamentally change the roles and responsibilities between state-level health and federal-level healthcare.

Lawmakers have proposed a few versions of the Medicare for all plan that would maintain the long-term care portion of Medicaid; however, all acute Medicaid services would be eliminated and rolled up under a universal Medicare plan.

Not only would Medicaid’s elimination have a direct impact on the role of states in the healthcare system, but it would also eliminate the possibility of testing healthcare delivery reform, as well as payment methodology reform, within the established system.

With more than 73 million people receiving coverage from Medicaid, more consideration needs to be given to the fact that these in-need individuals would experience drastic shifts in their care that could cause gaps in service.

The loss of Medicaid is a massive consideration that must be factored into any plans for healthcare reform to ensure we’re caring for those most in need of support.

Infrequently Discussed Considerations

As the debate around Medicare for all develops, one thing that is frequently not talked about is the fact that such a program would need to be constructed alongside private healthcare.

Even if a lack of need for private health insurance is a goal 10, 20, or 50 years down the road, we must first discuss what a widespread Medicare program would look like in partnership with private health insurance companies today.

For instance, 48.9 million people throughout America have full-scale medical coverage through United Healthcare. Building a single payer system, for example, in this country, without consulting some of these large players, is going to cause massive legal issues as well as difficulties with coverage continuity and employment.

The largest health insurance providers in the nation – United, along with Anthem, Aetna, Cigna, and Humana – private health insurance companies (as well as the people they employ) are major stakeholders who need to be incorporated into discussions about Medicare for all, as well as being factored into any future plans for implementation.

Learning From the Existing System

There are two starkly different programs that we can examine to learn a great deal about what is possible and what could work (or fail) if we pursue a Medicare for all model.

The first is state Medicaid programs. Many state-run assistance programs have provided coverage to individuals from birth to death. By categorizing those cases specifically and looking at how those programs have (or have not) functioned, we can gain a great deal of insight into how a true Medicare for all program can be built for maximum efficacy.

Looking at specific state cases – such as Arizona’s Medicaid program, which has gone through numerous and frequent changes compared to less volatile programs in Colorado and New York – allows us to take a look at quasi-beta test examples of Medicare for all.

The second model we should consider is in an entirely different industry of public service: the Department of Motor Vehicles (DMV). The DMV is available to all and is entirely funded by the government. In thinking about the DMV, the experience of visiting a DMV location and interacting with the system, we must ask ourselves:

• Would this be what Medicare for all looks like?
• Would long lines, long wait times, and short appointments become the experience for healthcare with Medicare for all?
• Which states have fluidly functioning DMVs and what are they doing differently in states where visiting the DMV is notoriously agonizing?

While the concept of Medicare for all seems revolutionary, there are in fact many models of similar programs that we can learn a great deal from to devise a successful system.

Focus on the Goal

The topic of how to provide effective, high-quality healthcare at a reasonable cost should not be one that is politicized, but it is. Conversations around the subject are difficult due to political tensions, but we cannot allow ourselves to get lost in the rhetoric.

Rather, we must come together to clearly define definitions and terms, examine models that provide valuable insights, and begin discussing what is best for all of the stakeholders involved – from the patients who need care to the individuals who work to make the whole system function, including administrators, nurses, physicians, and insurance companies.

Despite the numerous debates surrounding Medicare for all, there is one common goal we all share: to improve healthcare for everyone involved while driving down costs.

The states often serve as the testing ground in federal healthcare initiatives; this is where we will see the most change. Federal change is slow, calculated, and all-encompassing.

If we desire movement in the direction of improved, more accessible, and more affordable healthcare, we must begin these conversations, unified on a specific definition, and implement strategies at the state level.

Healthcare will never be a “one size fits all” system. However, I do believe we can create a system that works for us all.

We need to continue talking. We need to include all the players at the table. We need to vet out ideas in practice at small-scale levels. We need to examine the data and extrapolate intelligently.

Above all, we need to work well together.