Senator Sanders bill (AFAIK) proposes to convert the United States healthcare industry into a single payer system with the government being the single payer. It proposes to eliminate private medical insurance and the private health insurance industry. While I think that healthcare is a right, I think this proposal is wrong for the United States at this point in time. For one thing, it will result in a massive disruption in the healthcare industry which is currently set up for a mix of private and public insurance plans. For another, it will add confusion to the healthcare delivery system. And finally, it will never pass with the current generation of representatives in Congress. Here's a more modest proposal that will, I think, accomplish most of what Medicare for All wants, but is doable in my lifetime (and I'm 66).
I think that what should be done is that Medicare should be offered to everyone as one of the alternatives for insurance through the Affordable Care Act's state and federal exchanges. This will be the "public option" that was originally in the ACA, but was removed at the last minute in order to get the votes to pass the bill back in 2010. I also think that the Congress should re-instate the requirement that everyone have health insurance and also reinstate the penalty for not having health insurance (although this will not be really burdensome as you'll see later). This accomplishes a few important things:
(1) it makes sure everyone has insurance,
(2) it retains the private health insurance industry because people on Medicare will still want to buy Medigap and Part D (drugs) insurance. In conjunction with the mandatory insurance requirement, this should be a very lucrative market for insurance companies.
(3) it makes use of an already very efficient and competent insurance provider - the federal government, so no new bureaucracy will be needed (although I'm sure that with potentially millions of new enrollees, the Medicare employment numbers will rise).
There will, of course, be issues to overcome. (By the way, I've not researched all of these; I just think they are likely because of common sense and my own experiences with the health insurance industry and Medicare. So take all this with a grain of salt.) First, I think it's likely that the 1.45% Medicare payroll tax will need to be increased, probably to somewhere between 3% and 5% (probably more). However, since many people will not now have to pay higher premiums for private health insurance and their deductibles will almost certainly be lower so that may not increase their overall spending. A Medicare for All public option will also have to figure out how to fold Medicare Part A premiums into the payroll tax, and there will have to be provisions to cover children (who obviously won't be paying the payroll tax). Probably the biggest issue will be what happens to all the taxpayers who get health insurance through their employers. The federal government could make a deal with employers to make Medicare the default option for their employees with the employers picking up some of the Medicare payroll tax. The Medicare payroll tax could also be reconfigured to be paid on a sliding scale based on a person's income. Just like one's income tax, the Medicare tax would adjust based on income.
There are obviously any number of things that I'm not thinking of here. But providing Medicare as a public option for the ACA seems like a first, logical step to getting us to 100% health care coverage.
