After decades in the political wilderness, “Medicare for all”and single-payer health care are suddenly popular. The words appearin political advertisements and are cheered at campaignrallies—even in deep-red states. They are promoted by a growingnumber of high-profile Democratic candidates, like AlexandriaOcasio-Cortez in New York and Rep. Beto O'Rourke in Texas.

Republicans are concerned enough that this month PresidentDonald Trump wrote a scathing op-ed essay thatportrayed “Medicare for all” as a threat to older people and toAmerican freedom.

It is not that. But it is also unclear what, exactly, theseproposals mean to many of the people who say they support theconcept.

Related: Obama comes out in favor of Medicare forAll

As a renegade candidate for the 2016 Democratic nomination forpresident, Sen. Bernie Sanders opened the door to such drasticreform. Now, with Republicans showing littleaptitude for fixing an expensive, dysfunctional healthcare system,more voters, doctors, and politicians are walking through Sanders'door.

More than 120 members of Congress have signed on asco-sponsors of a bill called the Expanded and Improved Medicare forAll Act, upfrom 62 in 2016. And at least 70 have joined Capitol Hill's newMedicare for All Caucus.

But some worry the terms “Medicare for all” and “single payer”are at risk of becoming empty campaign slogans. In preciseterms, Medicare-for-all means bringing all Americans under thegovernment's insurance program now reserved for people 65 and over,while single-payer healthcare would have the government payeveryone's medical bills. But few politicians are speakingprecisely.

Celinda Lake, a Democratic pollster, says, “People read into'Medicare-for-all' what they want to read into it.”

For every candidate with a clear proposal in mind, another usesthe phrases as a proxy for voter frustration. The risk, somecritics say, is that “Medicare for all” could become a Democraticversion of the Republican “repeal and replace” slogan—a vote-getterthat does not translate to political action because there isneither agreement about what it means nor a viable plan.

“If you're on the left, you have to have something on healthcareto say at town halls,” says David Blumenthal, president of theCommonwealth Fund. “So you say this and move on. That's part of themotivation.”

Dr. Carol Paris, the president of advocacy group Physicians fora National Health Program, says she has fielded a number of callsfrom candidates asking for tutorials on Medicare-for-all.

“I'm heartened, but not persuaded” that all the high-profiletalk will result in any action, she says. She worries about whatshe calls “faux 'Medicare-for-all' plans” that don't live up to themantra.

Polling highlights healthcare as a top voter concern, andpressure is building for politicians to take meaningful action thatcould redress the pain caused by personal healthcare costs thatcontinue to rise faster than inflation.

Maybe that action would be negotiating lower drug prices orfixing flaws in the insurance system that allow for surprisemedical bills and high out-of-pocket costs. Republican candidatesmostly continue to bad-mouth “Obamacare” as the root of allproblems in American healthcare (of course, it's not), and somestill push to repeal it. They tend to offer only vague assurancesthat, for example, they will guarantee that people withpre-existing conditions can find affordable insurance—proposalsthat do not withstand expert scrutiny.

But more and more voters seem to think the country needs moreradical change.

In polling this year, 51percent of Americans and 74 percent of Democrats saidthey support a single-payer plan. Surveyssuggest growing enthusiasm among doctors, too, withmore than half in favor.

Yet experts suggest voter support may not withstand warnings oftax increases or changes to employer-sponsored insurance.A 2017poll from the Kaiser Family Foundation found thatsupport for Medicare-for-all dropped when respondents were toldthat their taxes might increase or that the government might get“too much control over healthcare”—a common Republican talkingpoint. (Kaiser Health News is an editorially independentprogram of the foundation.)

Despite initial enthusiasm, Vermont'sgovernor let a state single-payer plan die in part becauseit was calculated that it would requirean 11.5percent payroll tax on businesses and a state incometax of up to 9.5 percent.

The broader goal—affordable, universal healthcare—could beachieved by a range of strategies. For models, we can look tonations that have generally achieved better health outcomes, forless money, than the United States.

Canada and Britain come particularly close to true single-payer.Their governments pay medical bills with money raised through taxesand have monopolistic negotiating power over prices. But afterthat, the systems differ.

In Canada, which is Sanders' inspiration, the governmentprovides health insurance for most medical needs, with noout-of-pocket costs. People can, and often do, buy a second,private plan for any unmet health needs, such as prescriptiondrugs.

Britain goes a step further. Its government owns hospitals andemploys many specialists via the National Health Service. A smallprivate system exists, catering mainly to wealthier people seekingfaster access to elective procedures.

Other countries achieve universal healthcare (or nearly so), butwithout single-payer. France and Germany have kept an insurancesystem intact but heavily regulate healthcare, including by settingthe prices for medical procedures and drugs, and requiring allcitizens to purchase coverage.

These more incremental options have not captured the Americanimagination to the same extent as Medicare-for-all. But adoptingsuch a system would require the biggest shift, with significantimplications for taxes, patient choice, doctors' salaries,and hospital revenue.

Enthusiastic politicians sometimes gloss over thoseconsequences. For example, Liz Watson, a Democrat running inIndiana's 9th Congressional District, suggested the impact ondoctors' income was not much of a concern because they would see a“huge recovery” on expenses since they would no longer need tonavigate the bureaucracy of insurance paperwork. But analystsacross the board agree single-payer would cut revenue fordoctors—many say by about 12 percent, on average.

And many voters seem confused by thefundamentals. Inpolling by the Kaiser Family Foundation, about half ofAmericans said they believe they would be able to keep theircurrent insurance under a single-payer plan, which is not thecase.

Optimism without specifics carries risk, as President BarackObama learned after promising that people wouldn't lose theirdoctors under the Affordable Care Act. That promise haunted theObama administration—it was singled out as PolitiFact's“Lie of the Year” in 2013 and is still mocked bymembers of the Trump White House.

There's also the thorny issue of how Medicare-for-all wouldaffect the thousands of jobs at private insurers. “We have aninsurance industry in Omaha, and people say, 'I worry about thosejobs,'” said Kara Eastman, a Democrat running on Medicare-for-allin Nebraska's 2nd Congressional District. She suggested peoplecould be retrained, saying there would have to be “repurposing ofpositions.”

Critics of Medicare-for-all, on the other hand, tend toexaggerate the costs of single-payer: “Denmark's top tax bracket isnearly 60 percent!” (True, although that's largely not because ofhealthcare.) “Doctors' incomes will drop 40 percent!” (True,specialists in private practice would probably see pay cuts, butprimary care doctors could well see an increase.)

Canadians generally pay higher taxes than Americansdo—specifically, a goods and services tax, and higher taxes on thewealthy. In Germany, working people pay 7.5 percent of income as acontribution toward comprehensive insurance.

But many Americans pay far more than that when you countpremiums, deductibles, co-payments, and out-of-network charges.Estimates of the tax increases required to supporta Medicare-for-all or single-payer system are allover the map, depending on how the plan is structured, the pricespaid to providers and drugmakers, and the generosity ofbenefits.

As a politician famouslynoted, “Nobody knew healthcare could be socomplicated.”

Some candidates do have clear proposals in mind. Ocasio-Cortez,for example, running for the House from New York's 14th District,is firm: a single, government-run health plan that covers everyone,with no co-payments or deductibles, and perhaps allows Americans tobuy supplemental private coverage. It's the Canadian approach,textbook single-payer.

But many who back Medicare-for-all are vague or opento incremental approaches, like a “publicoption” that maintains the current insurance structurewhile allowing people to buy into Medicare.

O'Rourke casts Medicare-for-all as a starting point fordiscussion. But he says that what matters most is “high-quality,guaranteed universal healthcare.” Getting there, he adds, “willinevitably require some compromise”—like a public option. Notably,he has not signed on as a co-sponsor of the Medicare-for-all billbecause that plan does not allow for-profit providers toparticipate.

Jared Golden, a Democratic House candidate from Maine's 2ndDistrict, says in his campaign materials that he favors “somethinglike Medicare for all,” but he clarified that, at least initially,he would argue to lower the Medicare eligibility age, a change thatwonks often call “Medicare for more.”

And the Wisconsin Democrat Randy Bryce, who is running toreplace Speaker Paul Ryan in the House, says he would support apublic option or lowering the eligibility age for Medicare. “Idon't want to say that there's only one way to go about it,” Brycesays.

But many other candidates—both for Congress and forgovernorships—who are talking “Medicare for all” on the campaigntrail either did not acknowledge or declined multiple requests tobe interviewed on the subject. They include Andrew Gillum, who isrunning for governor in Florida; Gina Ortiz Jones of Texas' 23rdDistrict; the California candidate for governor Gavin Newsom;Massachusetts 7th District candidate Ayanna Pressley; andPennsylvania 1st District candidate Scott Wallace.

Lake, the pollster, suggests that policy details simply aren'tas relevant in a midterm year and that for now we shouldn't expecta candidate's support for Medicare-for-all to be anything more thana way to signal his or her values. But she suggests that willchange in the run-up to 2020, adding, “When we head into thepresidential election, people will probably be pickier and wantmore details.”

That gives politicians and voters a few years to decide whatthey mean and what they want when they say they supportMedicare-for-all or single-payer healthcare. For now, it's hard toread too much into promises.

Paris, who lives in Nashville, says she was surprised andexcited to hear that her representative, Jim Cooper, a Blue DogDemocrat, had signed up as a co-sponsor of the Medicare for allbill.

“I told him, 'I'm dumbfounded,'” she recalled.

His answer? “Don't get too excited.”

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

From: BenefitsPro