Pramila Jayapal (D-WA) is implementing the most comprehensive health insurance plan to date, which envisions a rapid transition to a public health plan offering a solid set of benefits.
Co-Chair of the Progressive Caucus released a proposal on Wednesday to move the United States to a single payer health care system, in which a single government-run health plan offers insurance coverage to all Americans .
"We are hearing a complete transformation of our health care system and a system in which no private insurance company provides these basic benefits," Jayapal told reporters on Tuesday. "We mean universal care, everyone inside, nobody outside."
Jayapal's bill envisions a future in which all Americans get health insurance and pay nothing out of pocket when they see a doctor or hospital. His plan, the Medicare for All Act of 2019, describes a more generous set of benefits than what is currently offered by other single payer countries, such as England. or Canada. The benefits of Jayapal's bill are even more generous than those included in Senator Bernie Sanders (I-VT) Medicare for all.
Representative Pramila Jayapal (D-WA) and Progressive Congress caucus co-chair, Republican Mark Pocan (D-WI), second from right, spoke to reporters during a Q & A session December 11, 2018.Kainaz Amaria / Vox
But where Jayapal's plan contains a lot of details about what's covered, it's not about a crucial question: how will the government pay for the new health care program?
The new proposal comes at a time when Democrats are merging around a Medicare platform for all. Leading candidates in the Democratic primary as Sens. Kamala Harris (D-CA), Cory Booker (D-NJ) and Elizabeth Warren (D-MA) all co-sponsored Sanders' single-payer bill in the Senate. .
The health care industry has already begun to prepare for a major health care battle if a Democrat wins in 2020, recently. launch a new coalition hospitals, insurers and drug manufacturers to oppose the Medicare-for-all program. Jayapal said she's already getting the promise from House Speaker Nancy Pelosi to hold the first-ever House of Commons health care hearings later this year.
"We will push it as hard as we can and as fast as we can," Jayapal says. "Nibbled enough on the edges. We really need to transform the system.
Jayapal's Medicare for All plan includes a very generous benefit package and a quick transition to government-managed health care.
Jayapal's single payer proposal would create a universal Medicare program covering all US residents in a single government-run health plan.
This would prevent employers from offering separate plans that would compete with this new option managed by the government. It would remove Medicare and Medicaid, moving their enrollees to the new universal plan. This would, however, allow two existing health systems to continue to function as they currently do: the Veterans Affairs health system and the Indian health services.
Those who qualify for the new universal health insurance plan would join this program within two years. It would start with people under the age of 19 and over 55 who would join the program one year after it came into force – and all the others one year later.
It should be noted that this is actually a more rapid transition than Senator Sanders is considering in her proposal, which would give the United States four years to resist a government-run plan.
However, everyone will eventually end up in the same plane, which includes a set of particularly robust benefits. It would cover hospital visits, primary care, medical devices, laboratory services, maternity care and prescription drugs, as well as vision and dental benefits. Jayapal's bill would cover abortion services, as well as the New version from Sanders' plan.
Jayapal's plan also includes coverage for long-term care services for nursing services. The current Medicare program does not include this benefit, nor does the Sanders single payer plan in the Senate. This would make the health system that she considers more generous than that proposed by Sanders, but also more expensive.
The plan is also much more generous than the single payer plans managed by the US counterparts. The Canadian health care system, for example, does not cover vision care, dental care, prescription drugs, rehabilitation services, or home health services. Instead of, two-thirds Canadians take out private insurance to cover these benefits. The Netherlands similar benefits (dental and vision care are also excluded), as well as Australia.
Javier Zarracina / Vox
In addition, the Jayapal Plan does not require consumers to pay for health care expenses other than prescription drugs. This means that there will be no charge when you go to the doctor, nor any cost sharing when you go to the emergency room. All of these services would be fully covered by the universal health plan.
This also does not comply with single-payer international systems, which often require payment for most services. Taiwan's one-time payer system imposes fees on patients when they visit the doctor or hospital (although it provides an exemption for low-income patients). In Australia, doctors pay 15% of the cost of their visit to a specialist doctor.
The Sanders plan is more generous than the plans currently being received by Americans at work. Most plans sponsored by the employer last year, the deductible was over $ 1,000. It's more generous than the current Medicare program, which covers Americans over 65 and seniors pay 20 percent their visit to the doctor even after they have reached their franchises.
Medicare, employer coverage and other countries' schemes show that almost all the insurance plans we are accustomed to cover a reduced benefit package, with an additional expense for citizens. Private insurance usually appears to fill these gaps – or to allow citizens to gain faster access to services covered by the government plan (for example, to move to the forefront of non-emergency surgery).
The reason our peer countries have followed this path is clear: it's cheaper to run a health plan with fewer benefits. The plans proposed by Jayapal and Sanders have no similar features among the existing single payer systems. By covering a more comprehensive set of benefits and asking for cost-sharing without registration, it is likely that the government will cost much more than programs adopted by other countries.
The big question that Jayapal does not answer: how do you pay for it?
The Jayapal plan describes in detail the type of coverage that a universal plan should offer. But he does not do any work to explain how to pay for a package of benefits as generous.
Jayapal says that it is a problem that will be addressed in the future. "Most bills do not have that when they are introduced, it comes later in the process," she said about a financing plan. "I actually think the question is not about how we pay for it, but about ensuring that every American gets the health care they deserve and that they have the right to." .
Jayapal mentioned a wealth tax or the repeal of Republican tax cuts as possible options for paying the system.
The funding of the health system envisioned by Jayapal is a daunting challenge. About half of the countries trying to implement single payer systems fail. This is the estimate of William Hsiao, a health economist at Harvard, who has worked with a dozen governments over the past two decades. Whether in Taiwan, Cyprus or Vermont, the process is about the same: meeting lawmakers, developing a plan, drafting legislation. Only half of these bills become law. The part where it collapses is inevitably the moment when the country has to pay for it.
Senators Cory Booker (D-NJ), Bernie Sanders (I-VT) and Kirsten Gillibrand (D-NY) spoke to reporters at an event introducing Senator Sanders' Medicare for All Act on September 13 2017. Alex Wong / Getty Images
That's what happened when Sanders Vermont attempted to create a single payer plan in 2014. Like Jayapal, local lawmakers have defined a clear vision of the type of health plan they wish to extend to all Vermont residents. Their plan was doubtless less ambitious; it was necessary to co-pay when the patients went to the doctor.
But the dream of a single Vermont payer collapsed when the state realized how much more taxes it would need to pay for its new system. Vermont dropped the government plan after finding that it would have to raise payroll taxes by 11.5% and income taxes by 9%.
It's true, in Vermont and the United States, that increasing taxes does not necessarily mean that overall health spending is rising. It is quite possible that health spending will decrease as taxes increase, Americans no longer spend billions on premiums for employer-provided coverage.
Single payer systems are changing pays for health care, often transferring more of the burden onto richer individuals to create a more progressive system. The proposed 9% Vermont income tax, for example, would cost a $ 100,000 worker much more than a $ 30,000 employee.
But who pays how much is a key question to which this Jayapal bill does not respond. Until this version is passed, we can not know if the health care system envisioned by the Vermont senator could become reality.
Representative Pramila Jayapal (D-WA) is interviewed following a vote on Capitol Hill, June 25, 2018.Zach Gibson / Getty Images
Dylan Scott contributed to the writing of this article.