CNBC: 70% of Americans now support Medicare-for-all—here's how single-payer could affect you

CNBC

Yoni Blumberg@YoniBlum 

 1:05 PM ET Tue, 28 Aug 2018

The vast majority of Americans, 70 percent, now support Medicare-for-all, otherwise known as single-payer health care, according to a new Reuters survey. That includes 85 percent of Democrats and 52 percent of Republicans. Only 20 percent of Americans say they outright oppose the idea.

"Medicare is a very popular program, so the idea of expanding it to everyone is popular as well," Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, tells CNBC Make It. "The advantage of Medicare-for-all, which is much closer to how the rest of the world provides health care to their residents, is that you can achieve universal coverage at a lower cost."

The problem with health care in the US

For at least a decade, most Americans have been dissatisfied with the country's largely for-profit health-care system, according to Gallup. In a poll last year, 71 percent of respondents said the system is "in a state of crisis" or "has major problems."

Health care in the U.S. is criticized primarily for its inefficiency, inaccessibility and ever-rising costs. The average annual deductible for employer-sponsored health care plans, which make up most of the plans in the U.S., was $1,505 in 2017, compared to $303 in 2006, according to the KFF.

Last year workers paid on average $5,714 toward their cost of coverage by way of monthly premiums, a 3 percent increase from the year before.

 

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Although the quality of care tends to be high, care doesn't reach everyone. Americans forego treatment because of the cost more often than residents in 11 other high-income countries, according to a report published in the Journal of the American Medical Association.

A 2017 Bankrate survey found that one out of four Americans said they or someone in their family skipped necessary medical care because they couldn't afford it. Millions wait each year until they get a tax refund to access medical care they had been putting off, the JPMorgan Chase Institute found.

Passing on treatment when an issue arises is bad enough. But affordability is important because simply going to the doctor for a physical on a regular basis can save your life. That's according to MacArthur Foundation "genius" Atul Gawande, who was recently selected to lead the joint health care venture formed by Amazon, J.P. Morgan and Berkshire Hathaway to tackle rising health-care costs.

"Incremental care — regular, ongoing care as opposed to heroic, emergency care," he writes in The New Yorker, "is the greatest source of value in modern medicine."

“You do not want to give Jeff Bezos a seven-year head start.”

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What Medicare-for-all would change

Reuters defines Medicare-for-all as "a publicly financed, privately delivered system with all Americans enrolled and all medically necessary services covered." In theory, it would solve some of the main issues of America's current system.

Sen. Bernie Sanders proposed his Medicare-for-all bill in September of 2017. It aims to gradually reduce the uninsured rate, which currently sits around 12 percent, until it reaches 0 percent, by enrolling everyone in a nationwide public insurance plan. Under his proposal there'd be no more deductibles or co-payments. Although there's no opting out, people would have the option to buy supplemental care through private insurers.

The bill has little chance of passing with a Republican majority in Congress, as Sanders has conceded. Right now it's just setting up Democrats for potential legislation in the future and bringing attention to drawbacks of the current American system, he says, such as exorbitant spending and high drug prices.

 

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A single-payer system simplifies who is responsible for covering costs. That gets rid of some of the issues that stem from the complexity of the current American system, like balance billing.

In a recent incident reported by NPR that's since gone viral on social media, Drew Calver, a 44-year-old teacher and triathlete in Austin, Texas, had a heart attack. He was rushed to an out-of-network hospital and had stents implanted.

A network is a list of hospitals, doctors and other medical providers who are covered by a person's health plan. Out-of-network providers are either not covered at all, or are covered at a much lower rate, leaving the patient responsible for much or all of the resultant bill. Almost 18 percent of hospital admissions end up with some out-of-network claim, often because someone goes to an in-network hospital but ends up getting care from an out-of-network physician. Among those who can't afford the ensuing costs, most say they didn't realize they were receiving care outside their insurance network.

Calver went home after four days. Though he asked from his hospital bed and was assured that his insurance would be accepted, his portion of the bill came to almost $110,000. That's "nearly twice his annual pay," NPR notes.

"Under a pure Medicare-for-all plan, those issues would go away," Levitt says.

What it might cost

Although support for Medicare-for-all is growing, the proposal also receives plenty of criticism. "The arguments we've found that resonate are that it would give the government too much control over the health-care system, that people would have to give up their current insurance plans, and that it would increase taxes," Levitt says.

When Sanders first introduced his bill, he argued that most Americans would find any tax hikes offset by savings on household health-care costs. In other words, what you would save by not forking over premiums, co-pays when you go to the doctor or deductibles when you visit the emergency room would outweigh any additional amount you pay in taxes. That point is central to the debate over the viability of universal health care.

"The average of what people would pay when you take into account taxes, premiums and out-of-pocket costs would go down," says Levitt. "Generally, lower-income people would end up paying less for health care. But higher-income people would pay a whole lot more. It depends a lot on which taxes end up getting increased in order to pay for the new plan."

Critics argue that the financial burden on the federal government would be staggering. A much-discussed report released last month by the Mercatus Center at George Mason University suggested that Sanders' proposal would lead to a $32.6 trillion increase in federal spending over a 10-year period. The Urban Institute came up with a similar estimate in 2016.

However, Canada has successfully implemented a single-payer system even though Canadians pay about the same amount in taxes as Americans. The performance of Canada's system ranked ninth in a 2017 study by the Commonwealth Fund comparing 11 high-income countries, while the American health-care system ranked last.

 

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Proponents of single-payer health care point out that the Mercatus report suggests that national health expenditures could decline by about $2 trillion over the same 10-year period. National health expenditures refers to all health spending, including that of the federal government, private employees and state Medicaid programs, while federal health expenditures refers only to spending from the federal government.

"Lower spending is driven by lower provider payment rates, drug savings, and administrative cost savings," Yevgeniy Feyman of the Manhattan Institute told Vox. "It's not clear to what extent those savings are politically feasible, and socially beneficial."

At current levels, administrative and pharmaceutical costs are significantly higher in the U.S. than they are in other high-income countries, and doctors earn significantly more. The Mercatus report suggests that, under Medicare-for-all, doctors would be paid about 10 percent less.

Sanders has still not released a financing plan, so much of the impact of his bill on consumers and the health care industry as whole is still unclear. Still, not only is the system favored by the American public but, as Vox points out, "in the Democratic wing of the Senate, every major potential presidential candidate has endorsed it."

In response to the Reuters survey, Sanders tweeted, "The momentum is with us."

Dan Geiger