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Nearly one-third of the Senate Democratic conference is making a statement Wednesday, endorsing the notion that every American should have not just access to health care but actual health care. Sen. Bernie Sanders (I-VT), with the cosponsorship of at least 15 Democrats, introduces his Medicare for All bill Wednesday.
The bill would revolutionize America's health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans younger than 18 would immediately obtain "universal Medicare cards," while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
Private insurers would remain, with fewer customers, to pay for elective treatments such as cosmetic surgery—a system similar to that in Australia, which President Trump has praised for having a "much better" insurance regimen than the United States.
But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country's universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.
The bill doesn't have a lot of specifics, particularly about how it's paid for and what it will cost. It will be paid for by taxes, of course, but the mix of who pays and how much has to be worked out. That's okay, because this is by no means the Medicare for All bill that's going to become law and it's not intended to be. This is the starting point for discussions and where healthcare reform goes from the Affordable Care Act.
As Sanders himself recognizes, this will be a political fight not just with Republicans, but with the healthcare industry—particularly the insurance and pharmaceutical industries. "We understand that the opposition to this legislation will be incredible," Sanders told HuffPost. "We fully anticipate that, and they have unlimited sums of money." So this effort is going to be aimed at energizing the grassroots.
In that sense, it's well-timed, with a population that has been steeped in the idea of healthcare reform for nearly a decade now and is primed for the discussion. In fact, a Kaiser Family Foundation survey from June found that there is now majority support in the country for the idea of a single-payer system—53 percent in fact, the highest level of support KFF has found since it began asking this question in 1998. When it's called "Medicare for All," it gets 57 percent support.
It's time to start building on that support. When we start talking about the taxes involved, that support will of course shrink but that's where having the political and policy discussions this bill will spark comes in. It's going to be a process of educating and informing and debating. That starts today.