Several 2020 Democratic candidates support Medicare for All, but what would that proposal look like in action?

ARI SHAPIRO, HOST:

If there’s a single issue that’s defining the Democratic field of 2020 presidential candidates, it’s health care, Medicare for All, to be precise.

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KAMALA HARRIS: I believe the solution – and I’m – and I’m – actually feel very strongly about this – is that we need to have Medicare for All

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ELIZABETH WARREN: Medicare for All is all about…

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BETO O’ROURKE: The best way to get there is by having Medicare for All.

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BERNIE SANDERS: The strengths of a Medicare for All program…

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KIRSTEN GILLIBRAND: That’s why I am for Medicare for All.

SHAPIRO: When Vermont Senator Bernie Sanders unveiled his 2020 Medicare plan for all this week, several other Democratic presidential candidates stood alongside him.

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SANDERS: The American people want and we are going to deliver a Medicare for All single-payer system.

SHAPIRO: So what would that system look like? NPR’s health policy correspondent Alison Kodjak is here to talk us through that. Hi, Alison.

ALISON KODJAK, BYLINE: Hi, Ari.

SHAPIRO: Start with a bit of history. Where did the idea of Medicare for All begin?

KODJAK: So the idea of, like, a government-funded, universal health coverage goes way back to the Depression. Franklin Delano Roosevelt convened a committee on economic security in the midst of that economic crisis, and they advocated not only Social Security, but they wanted to include national health insurance in the system. That program failed because of opposition mostly from doctors.

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FRANKLIN D ROOSEVELT: We can never insure 100 percent of the population against 100 percent of the hazards and vicissitudes of life, but we have tried to frame a law which will give some measure of protection.

KODJAK: Thirty years later, Medicare was passed into law.

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UNIDENTIFIED REPORTER: President and Mrs. Johnson and Vice President Humphrey arrive for ceremonies that will make the Medicare bill a part of Social Security coverage.

KODJAK: It didn’t cover everybody either. It only covered retirees.

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UNIDENTIFIED REPORTER: The new bill expands the 30-year-old Social Security program to provide hospital care, nursing home care, home nursing service and outpatient treatment for those over 65.

KODJAK: So universal coverage, the idea of it, has been on the table for, in one form or another, ever since the 1930s.

SHAPIRO: So, in the present day, when we hear all these Democratic presidential candidates talk about Medicare for All, what does that proposal they’re talking about right now mean?

KODJAK: That proposal that came out this week, it would eliminate private health insurance altogether, have the government be the single payer for people’s health care. Everybody would get coverage. Hospitals, if they’re private now, would stay private. Doctors would remain in the private sector. But the government would be the sole payer of health care, and everybody would get insurance.

SHAPIRO: And what would that mean for patients, especially people like you and I who get coverage through our employer right now?

KODJAK: Well, we’d no longer get coverage through our employer. We’d get it through this government health insurance plan. The benefits might be much more generous than we have now. We wouldn’t have to pay part of the premium. There would be no copayments under this plan.

But that’s a big sticking point. How do you pay for that? It would have to be through tax increases of some sort because it would increase government spending. The one thing to keep in mind is that we already pay a huge amount for health care in this country, almost $4 trillion a year.

So you’re paying one way or another. Your private insurance is expensive. An average family plan provided through employers is about $20,000 dollars a year. And that often includes copayments and deductibles.

SHAPIRO: That’s a lot of money going to the insurance companies.

KODJAK: Sure is.

SHAPIRO: What happens to them under this plan?

KODJAK: Well, that’s the big question. Senator Sanders was asked about it earlier today on CBS.

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SANDERS: Under Medicare for All, we cover all basic health care needs. I suppose if you want to make yourself look a little bit more beautiful, you want to work on that nose, your ears, they can do that.

ED O’KEEFE: So basically Blue Cross Blue Shield would be reduced to nose jobs.

SANDERS: Something like that.

KODJAK: Yeah. So if that’s the case, the insurance industry, as it stands now, would shrink quite a lot. Today, about 540,000 people work in health insurance. Now, some of those people would probably get jobs with the government, but it would be a big disruption.

SHAPIRO: Yeah. And health care is about 18 percent of the U.S. GDP. So we’re talking about a huge shake-up for the economy. What are the implications of that drastic of a change to the system?

KODJAK: Yeah, it is a huge part of the economy. Most economists don’t really see that as a good thing, that we shouldn’t be spending that much on health insurance and health care in this country. So one goal of moving to a single-payer plan like this would be to make the system less expensive. There’d be no profit motive. There’d be fewer administrative costs. Perhaps we would pay doctors or hospitals less for procedures and care. And so if that succeeded, it might cut costs, which economists would applaud. But again, there would be losers, and it would be hugely disruptive to the economy.

SHAPIRO: You mentioned Senator Sanders. Which other 2020 candidates support this and which are not so sure?

KODJAK: Well, at his side in the announcement were Senators Kirsten Gillibrand, Senator Elizabeth Warren. Cory Booker has been behind it. So has Kamala Harris. Amy Klobuchar, who’s running, has said that she would rather see incremental progress on the Affordable Care Act, protect what we have now and make it better. And there are a lot of others who stand with her and say we should just stick with what we have and improve it.

SHAPIRO: NPR health policy correspondent Alison Kodjak, thank you.

KODJAK: Thanks, Ari.

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