The Democratic Debate on Healthcare: Universal Healthcare or Medicare For All?
In the past 2 debates we have seen 20 candidates in two days speak of tedious topics like immigration, healthcare, criminal reform and many others, with each candidate taking a stance on each topic. One of the most prominent topics spoken in these last two debates was healthcare with candidates taking one of three stances, Universal Healthcare, Medicare For All, or something in the middle. We have candidates like Bernie Sanders and Elizabeth Warren that are in favor of Medicare For All. We also have other candidates like Vice President Joe Biden who wants to give healthcare to all but wants to do that by building on Obamacare, instead of replacing it, which is what a plan like Medicare For All or Universal Healthcare plans would do. So, the question is, what are the differences between Universal Healthcare and Medicare For All, or are they the same?
According to the World Health Organization, or WHO, Universal Healthcare is healthcare for all individuals and communities without causing financial hardship (What is UHC, 2019). This is the type of healthcare we see in countries like England, Canada, and Australia, with some of these countries considered the healthiest country of the world according to Bloomberg’s Healthiest Country Index The aim is to provide access to healthcare while not causing a financial burden, but because money isn’t endless there are different ways a country goes forth implementing this. According to The Commonwealth Fund they are three ways of going about implementing universal healthcare, a regulated system of health plans, a single public plan (also known as Medicare For All) or complete private coverage.
In a regulated system of health plans a marketplace is created where patients who cannot get insurance through their employer or do not have an employer have access to insurance through private health insurance carriers. This is the type of system we see with the Affordable Care Act, or the ACA, also known as Obamacare. Countries like The Netherlands and Switzerland also enforce universal healthcare in this manner. The differences between the ACA and countries like The Netherlands and Switzerland are subtle, for example, the Swiss require purchase of separate insurance plan for children. The Dutch, on the other hand, like the U.S, do include children in health insurance plans. In this type of universal healthcare system, co pays do exist for certain medical treatments and specialties. The Dutch, like the U.S have no copays for preventative services, and the Dutch also don’t have copays for primary care services. The Swiss have a copay for all medical services.
The downside to this type of universal healthcare is that many remain uninsured for a few reasons, cost being the most common reason in the U.S, as this type of universal healthcare requires the patient to pay a monthly premium. And while the U.S, like the other two countries, require people to have insurance or they pay a fine, the fine is a much lower cost, than the monthly premium, and is only a one-time payment. With this being said, many Americans that are low income would rather pay a $97 fine a year, and have no healthcare, instead of paying $118 a month and have healthcare.
Another way to implement universal healthcare is the single payer system. This system is also the healthcare system we have heard candidates like Bernie Sanders call Medicare for All or free universal healthcare. In this system the federal or local government takes full responsibility of almost all medical costs of the people. We see this type of universal healthcare in places like England, Sweden and Canada and has been considered on the most cost-efficient systems. There are certain medical services that patients still pay for. In Canada patients still pay a portion of drug costs and in Sweden and England there is still a co-pay but the cap is low, ranging around the $200 range. The bill being proposed by the U.S is proposing no co-pays for any medical services, this includes dental, vision and long-term care. This is yet to be one by any country.
This healthcare plan, the single payer system, is strongly advocated by presidential candidates Bernie Sanders and Elizabeth Warren. They agree with healthcare being a human right and support the idea of everyone having free healthcare. This would not only give healthcare access to the million of U.S citizens that do not have healthcare, but it would also save a lot of lives of patients who have died because of lack of healthcare. Disadvantages of this free universal healthcare include long waits for doctor appointments, raised taxes for certain populations, physician burnout. With no cost to medical services, there is an opportunity for increased consults, without an increase in the number of doctors. This can cause decreased mental health of medical professionals leading to bad medical care.
The third type of universal healthcare is not necessarily a type of healthcare but instead a supplemental to the previously mentioned plans. This is known as the private coverage. Private coverage or healthcare insurance, unlike Public, is paid for completely by the person, and does not include subsidies. While in the first type of universal health care (regulated system of health plans) the person still pays a monthly cost for insurance, they receive subsidies, that is they pay less than they would pay for private insurance. These subsidies are based on size of family and income. Countries like the U.S and Canada provide the option of private insurance. Many Canadians opt in getting private insurance to assist them with paying for prescription drugs that the National Canadian government does not cover.
Sanders, Booker, Tulsi, and Warren completely agree with universal healthcare by means of Medicare for All while other candidates like Castro, Buttigieg, O’Rouke, and Biden agree with Universal Healthcare by means of Medicare for All, but want to also keep the Private Coverage so that those that are content with their private plan through their employers can keep it. Harris has previously agreed with Universal Healthcare via Medicare for All.
Healthcare policy is difficult, we have various definitions for various topics like different definitions for Universal Healthcare and Medicare For All. We have different definitions for reform, healthcare, health status and many other words. The public needs to focus on metrics like lives saved, cost of prescription drugs, wait times for doctor appointments, co-pays, number of people insured, in order to determine which type of universal healthcare will be most helpful for them and the U.S, and candidates need to focus on explaining these metrics to the people of the U.S so they can be able to make an informed decision before voting for a candidate, just like they make informed decisions before a medical procedure.