What does Universal Healthcare mean?

By Stan Cohen

Guest Column

Most advocates of some kind of health care coverage reform support the following basic concepts:

• Access to affordable health care is a basic need. Like police and fire services it should be available to all, not just the privileged.

• Health care in America is too expensive today and something must change.

In 2016, even with Obamacare, there were about 28 million Americans without health insurance. There appears to be a consensus that the current system needs to be transformed, but any health care system comes with trade-offs. Trade-offs mean that there would be some winners and some losers.

The terms “universal health care” and “single payer system” are used and misused with a variety of definitions, depending upon who is using them.

Here is what is generally understood by the various labels:

• Medicare for All: All Americans would be covered by Medicare (see footnote for an explanation of the Medicare program);

• Medicare for All who wish to join: Everyone would be eligible to participate, some would have to “buy-in” in order to have coverage;

• Medicare for More: The current Medicare age limit (65) would be reduced so that more citizens would have access to Medicare. Eligibility for Medicaid would also be expanded;

• Universal health care: Can mean a government-administered plan or private sector plans, or a mix of both. However administered, everyone is covered. There are no less than 32 countries with some form of universal health coverage today. Of those, 17 offer single-payer systems. Some countries operate a two-tier system in which the government provides basic health care with secondary coverage available for those who can afford elective, private care. Examples: Germany and Sweden;

• Single-payer system: Can mean a government-administered plan or a private sector plan with one payer. Medicare and the Veterans Health Administration are examples of single-payer systems. Canada’s “Medicare” is another example. “Single payer” is a sub-set of universal health care and is one of several ways to get to universal health care.

• A public option: A government-run system that is available in addition to private plans;

• Socialized Medicine: In a socialized medicine system, the government not only pays for healthcare but operates the hospitals and employs the medical staff. In the United States, the Veterans Health Administration (VA) is an example of socialized medicine.

Each of the above models may or may not include one or more of the following outcomes or caveats:

• Outlaw private insurance where it competes with the public plan;

• Preserve Medicare Advantage plans;

• Preserve “supplemental” coverage by private insurers where it does not compete with the public plan;

• Eliminate (or reduce) co-pays, deductibles and other cost sharing;

• Cost sharing by the consumer, with some plans eliminating cost sharing for those below a poverty threshold;

• Cover drugs;

• The plan would be funded by all based on their ability to pay (i.e. taxes);

• Expanded coverage could include dental, vision, hearing, fitness, etc.;

• Phase-in over a period of years;

• Lower (or eliminate) premiums, with consequent increase in taxes;

• The Affordable Care Act (Obamacare) becomes obsolete;

• Employer-sponsored health insurance becomes obsolete;

• Providers (M.D.s, nurses, hospitals, clinics, etc.) certified and controlled by the single-payer entity.

Medicare is a five-plus decades-old federal program that provides health insurance for Americans 65 and older and for other groups of people with disabilities. Medicare is not socialized medicine.

Medicaid is a federal program of health coverage for low income citizens. Medicaid is sometimes referred to as a single-payer system, but it is jointly funded by the federal government and each state government. The funding comes from two sources rather than one.

Traditional Medicare pays doctors and hospitals according to set prices determined by the government, and most medical providers in the United States accept them. It’s also possible to enroll in private Medicare plans that can offer additional benefits, though with a more limited set of health providers. These “Medicare Advantage” plans have annual out-of-pocket limits. Traditional Medicare’s out-of-pocket spending has no limits. Consequently, many beneficiaries also buy private supplemental insurance to limit those costs.

Private insurers handle Medicare drug coverage. Beneficiaries pay premiums, deductibles and co-payments.

Stan Cohen is a resident of Bridgton.

Please follow and like us: