Paying for a Doctor’s Visit Could Look Very Different in the Future

Universal healthcare, or Medicare For All, has been in the works for some time now. The first attempt at creating accessible health care came in 1915;… Trista - October 18, 2019

Universal healthcare, or Medicare For All, has been in the works for some time now. The first attempt at creating accessible health care came in 1915; however, the bill limited coverage to those who were impoverished, much like it is today. The next bill that tried making a change in medical coverage was something called the Wagner-Murray-Dingell Bill, which essentially called for compulsory national health insurance and a payroll tax. This bill eventually failed to pass after fourteen proposals!

It was President Truman who was the first person to propose a health insurance plan that covered all citizens, not just the extremely poor, as was the norm before him. However, Truman was attacked for trying to create socialized medicine, so his idea was not passed either. That leads us to where we are today: an eclectic mix of private insurance and government-funded insurance for the needy and the elderly.

With the next presidential election upon us, reforms to the medical system are an essential part of each candidate’s platform. Universal healthcare is on the agenda for multiple candidates; so let us take a look at what these candidates are proposing and how it will affect your coverage and benefits.


What Is Available Today With Medicare?

To understand how the new plan would be beneficial, let us look at what Medicare currently covers. To date, the program has two parts: Part A and Part B. Part A covers hospital care, and Part B covers doctors’ visits, outpatient care, and some medical equipment. Patients also have the option of signing up for Part D, which covers prescription drugs, but this plan does cost extra. Currently, Medicare does not cover long-term care, dental, vision, hearing exams, or hearing aids.

Medicare also has other costs associated with it. While there is no monthly premium for Part A, Part B does carry one, the amount of which depends on the person’s income. There are also deductibles and co-payments for all three parts of Medicaid. Under Parts A and B, there is no cap on out-of-pocket expenses. This is precisely why Medigap exists; it is used to cover the cost of co-pays and other gaps in coverage. However, you do have to pay for this extra coverage.


The Current Health Insurance System

How exactly do people purchase insurance, as of right now? Most workers will buy into health insurance plans offered by their employers.

Others use federal government programs, such as Medicaid, Medicare, and the Veterans Health Administration. Anyone who does not qualify for one of these programs or who does not have insurance through an employer must find coverage on the private market or simply go without.


What Is the New Plan?

A common misconception is that there is only one proposal for Medicare For All on the table; wrong! Quite a few bills are being written up, including one by Senator Bernie Sanders and Representative Pramila Jayapal. Although the bills are being written by different people, they still hold some similarities to each other. Despite this, they all have the same goal: to expand on our existing coverage.

How might the bills aim to achieve this? These bills are composed of a myriad of moving parts that work together to assist the public in obtaining coverage for many medical procedures. Let us take a look at some of these commonalities between these healthcare bills.


Comprehensive Benefits

This may seem self-explanatory, but it is still important to note. According to the new Medicare For All, everyone would be covered for any necessary health services with no additional deductibles or co-pays. This greatly expands on what is available today: most patients have to pay, even if it is a small amount, every time they go to see a doctor of any kind for any reason.

Medicare For All would necessarily pay for all visits, tests, and procedures according to a set schedule of prices; this is quite similar to how the Medicare system of today is structured. Elective procedures such as plastic surgery would still need to be covered by private insurance.


Tax Financed Healthcare

No wishful thinking here; if we want this system to work, we are going to have to pay for it somehow. But how exactly will Medicare For All be funded? By more taxes, of course! But who will be taxed, and where will the money go? Essentially, the plan is to set up an agency similar to Social Security, where the money is sent and used specifically for healthcare costs. This agency would be named the American Health Security Trust Fund. The American Health Security Trust Fund would receive money from multiple tax revenues, credits, and subsidies.

What exactly will these tax revenues look like? That is the million-dollar question. While nothing is set in stone yet, proposals so far are a new healthcare income tax, an employer payroll tax, a surcharge on high-income individuals, and a tax on securities transactions. Although this may seem like a lot of extra money being taken out of the public’s pocket, research shows this system will actually save money!


Out With the Old, In With the New

Another common misconception surrounding Medicare For All is that the federal government would entirely run healthcare. That is simply not true. Although everyone is enrolled in the system, healthcare providers and facilities would continue to operate as independent private practitioners. However, under this new system, Medicare For All would pay these private practices for the services they provide.

Another significant advancement with this new system is that insurance would no longer be contingent upon employment. Gone are the days of sticking with a job just because you need health insurance. Medicare For All simply creates more freedom for the patient.


Lifetime Enrollment

As stated previously, all citizens would be enrolled in the program. What could make this perk even better? Once you are enrolled in Medicare For All, you cannot be denied coverage. This is simply breathtaking when you look at how hard it is for individuals to receive coverage for pre-existing conditions.

That is not the only way to lose coverage these days. If an individual starts to make too much money, their government-funded health insurance can be taken away, regardless if the individual can find an affordable alternative.


No Premiums

Again, we covered some of the basics of this already. While there are no deductibles, co-pays, or premiums based on a per-visit basis, there are fees to be paid for the new insurance system to work. The premiums you would be paying to your insurance now go into that entity we talked about earlier, the Health Security Trust Fund. This fund is the driving force behind Medicare For All; without it, the system will fail.

This system should sound familiar to you: it is exactly how Social Security works in that you pay money throughout your working life, so you have something for retirement. Here, you are paying into a health fund so that your medical expenses are paid for.


Healthcare Providers

What is the fate of those who provide medical services after this plan is adopted? After four years, private insurance companies will no longer be able to sell their programs that offer similar coverage to Medicare For All. They will only be allowed to provide coverage for those procedures not covered by the new plan, things such as cosmetic surgery. The good news is that some existing federal programs will remain intact.

On a special note here, according to Sanders’ plan, private contracting between healthcare providers who do not participate in the program is permitted, and also allows for private insurance to cover these costs. Under another approach, named Medicare for America, all residents would be covered under the program unless they specifically opted out of a qualified employer plan. Under this plan, private insurance would still be allowed as long as it is a qualified health plan, but private insurance would be eliminated for purchase through the individual market. Depending on which bill is adopted will determine the fate of private insurance.


Will Medicare For All Pass?

The simple answer is quite possible. The fact is that this plan looks good on paper, but the people are still wary. It is simply too good to be true. Universal coverage has been a goal in this country since the inception of government-funded health insurance. For it to finally be in the works and for it to look possible is merely unbelievable to most people.

And although the people are all for Medicare for All on paper, when they look at increased taxes, the tides turn once again. The more we visualize Medicare for All like Social Security, the better it will be to accept the new fees required for the new healthcare plan to work.


How Does Medicare for All Work?

The simple explanation here is that the system would change from a multi-payer system to a single-payer system, the single-payer being the federal government. And again, the federal government would receive this money through a fund that we as taxpayers pay in to.

Although this will largely eliminate private and employer-sponsored insurance, Medicare itself will not disappear entirely. This program would also be expanded to include everyone and would consist of long-term care that is not covered as of right now.


Quality of Care

Another factor that hinders the public from outright approval of Medicare For All is the fear of having health care controlled by the federal government. This reminds us of a socialist society, where everyone is treated equally, so the quality of items produced is average at best. But this cannot and will not happen with the new system.

Medicare For All allows the patient the complete freedom of choosing their provider, which essentially places all of the burdens on the individual. If you feel that you are receiving sub-par services from your provider, that is entirely your fault; do the research before choosing your healthcare system.


Out-of-Pocket Costs

There is a difference here between who is proposing the Medicare For All bill. Jayapal prohibits all cost-sharing while Sanders allows for up to $200 a year for prescription drugs (this does not apply to families way below the poverty line).

Medicare for America proposes no out-of-pocket costs for individuals in the lower income tax brackets but would require higher-income tax bracket individuals to pay anywhere from $3,500 (individual) to $5,000 (family) a year for medical costs.


Financing for Healthcare

I know we have talked about this before, but there are some interesting thoughts and facts to bring up. Though one proposal states that taxes will be financing universal health care (Sanders), Jayapal’s bill plans on taking money that would have gone to pay for Medicare, Medicaid, and other federal programs that fund health services towards Medicare For All.

While it may seem a little outrageous to be taking more taxes to pay for health services, it may actually be costing you less. Remember, you will no longer be paying any premiums, co-pays, or deductibles.


Providers for Medicare For All

Again we have already touched a bit on this, but more information is relevant here. The good news is that Medicare For All will be building off the former system in so much that providers who already accept Medicare will most likely continue to provide care under the new bill.

Another important fact here is that the bill also includes a private pay option where providers and individuals can make their own arrangements to pay for health services; however, this would fall outside of the Medicare For All program and would need the individual to follow specific requirements before making this arrangement.


Transition to Medicare For All

Changing over to an entirely new system overnight is not going to happen realistically. So how do we plan on getting everyone covered promptly? One of the proposed methods is to implement the new system by age group.

But what about the supplemental insurance to the now existing Medicare, Medicare Advantage? If this is kept in place, open enrollment will be necessary, and individuals will have a choice between five plans. Adjustments in providers will also need to take place because if Medicare For All is passed, Medicare will be responsible for covering everyone, not just those 65 and older.


Bernie Sanders’ Health Plan

One of the proponents of Medicare For All, Sanders has proposed one of the most comprehensive healthcare packages to date. The benefits of his plan include hospital visits, primary care, medical devices, lab services, maternity care, prescription drugs, vision, and dental care. In this list of benefits, prescription drugs are the only out-of-pocket cost to the consumer.

Sanders recently amended his bill to include long-term care to his list of benefits. This means that patients with disabilities would be covered for care at home or in community settings.


Pramila Jayapal’s Ideas for Health

Although similar to Sanders in what she wants to be included in the bill, she does set out some specifics that are worth mentioning. Those who qualify for the program would transition over 2 years; the transition would start with those under the age of 19 and over the age of 55, who would move into the program one year after the bill becomes law; everyone else would be enrolled in the program within the next year.

Jayapal’s bill will also be covering abortion services; she also differs from Sanders in that she will not have consumers pay any out-of-pocket costs for prescription drugs.


A Health Plan By Debbie Stabenow

Although she may not back Medicare For All, Debbie Stabenow is determined to expand Medicare to cover more individuals.

Her plan effectively named Medicare at 50, allows consumers an option to buy into Medicare at the age of 50. This program would create lower premiums because Medicare pays out less to doctors than private insurance.


Medicare for America

This legislation was put together by two individuals: Rosa DeLauro and Jan Schakowsky. In essence, their bill would create a comprehensive, government-run insurance program that would phase out the existing federal programs as well as private insurance. You may be asking yourself, well, how is this different than the other plans mentioned previously?

Large employers will still be allowed to offer private coverage, which would give employees the added benefit of being able to choose between private insurance or go with the possibly cheaper government-funded option. Also, private insurance companies can continue to provide Medicare Advantage plans, not only to the elderly, either; non-seniors can take advantage of these plans as well.

Possible downfalls? Premiums and out-of-pocket expenses go up depending on the income of the household being considered. Medicare for America also aims to give more control to the government when it comes to health care; it plans to do this by establishing a loose upper limit on doctor and hospital charges while permitting the government to negotiate drug and medical device prices.


Choose Medicare Act

Proposed by Jeff Merkley and Chris Murphy, this bill would create a whole new part of existing Medicare. Dubbed Part E, it would meet all of the requirements for a gold-level plan under the Affordable Care Act.

Then, this plan would be sold on the ACA healthcare exchanges and would be eligible for subsidies. This bill would still allow employers to offer their employees health coverage rather than private insurance.


Medicare-X Choice

This legislation was drafted by Michael Bennett and Brian Higgins. Essentially, this plan would allow access to Medicare to patients of any age through the Obamacare marketplace.

The main difference in this plan is that the enactment of this system would not be nationwide. In fact, it would only benefit very few people. It would first offer Medicare options in areas with few hospitals and doctors, or in areas where there were limited options in coverage.


State Public Option Act

This bill was created by Brian Schatz and Ray Lujan. This option takes a whole new spin on things: it would give consumers the opportunity to buy into Medicaid, not Medicare.

What exactly is covered under each plan would inevitably vary from state to state; however, no program can offer less than what has already been established by the Affordable Care Act.


Choice Act

Introduced by Schakowsky and Whitehouse, this bill would create an entirely new public health insurance option that would be offered on health care exchanges.

Each health insurance option would include different levels, such as gold, silver, and bronze, and all plans would have subsidies. Small employers will have the opportunity of providing their own health insurance coverage, but large employers will not have this option.


Kamala Harris’ Health Plan

Harris differs significantly from what we have seen before; although she still proposes a government-run system, she does not want to eliminate private insurance; however, they will be operating under a tightly regulated system. This system would ensure lower costs and extensive benefits. Basically, her plan would expand on the costs and benefits already adhered to by Medicare Advantage. Additionally, it would lengthen the transition time from the old system to the new from four years to ten years. To help ease the transition phase, the plan would automatically enroll newborns and uninsured persons, while also allowing for any of those interested in the option of buying into Medicare right away to do so immediately.

Harris also supports creating a higher capital gains tax, which would impose taxes on households making $100,000 or more. This tax would be exempt from those households making less than $100,000. She also wants to impose a higher income threshold for middle-class families that live in high-cost areas. To make up for this loss in revenue, Harris wants to add an additional tax on Wall Street stock, bond and derivatives transactions. The fees would be 0.2 percent, 0.1 percent, and 0.002 percent, respectively.

There are some similarities to other proposed plans too. The end goal is to make sure that every citizen has insurance coverage; however, Harris does require a co-payment with her plan. Despite this, costs will remain low; her annual cap for co-payments is set at $200.


Pete Buttigieg’s Healthcare Ideas

His overall plan looks like this: expand coverage, lower costs, and offer Medicare for all who want it. How does he plan on accomplishing this? By introducing a public option and more subsidies for private insurance. In a nutshell, Buttigieg would allow for employer-sponsored and individual private insurance to remain intact while leaving the option open for consumers to join a government health program.

What exactly would the government program look like? Buttigieg wants to create an optional government insurance program that would automatically enroll uninsured persons while also allowing employer-sponsored insurance holders to join. The first to be enrolled will be those who qualify for Medicaid expansion but who live in states that refused to expand eligibility under Obamacare. The government plan would cover the same benefits as private plans sold under Obamacare.

Buttigieg also wants to expand federal subsidies for private insurance that is purchased through Obamacare marketplaces; the grants would be more generous and would even lift the eligibility cap that currently cuts off many middle-class families from receiving federal assistance.


Joe Biden’s Healthcare Plan

His plan is unlike anything we have seen before. Biden wants to build a public option to Obamacare. His plan also calls for smaller tax increases as compared to other policies discussed previously, which means that participants in his program would be responsible for co-pays, premiums, and deductibles.

Biden claims he will also tackle drug prices by allowing the government to negotiate prices and permitting people to buy FDA-approved drugs from overseas. Biden’s plan would also retain private insurance.


John Delaney’s Idea for Healthcare

Delaney brings a unique proposal to the table. He wants to enroll every person under 65 into a public program that covers necessary medical services while leaving Medicare for those over 65 the same as it is today.

Delaney would still allow for supplemental insurance to be purchased. He plans on paying for this public program by maintaining the shared state-federal payments for Medicaid and by eliminating tax breaks for employer health benefits.


Britain: The National Health Service

Now let’s take a look at how Medicare For All compares to other healthcare systems around the globe. First up, Britain. Here, the government not only provides health insurance, but also pays for it. It is like Medicare For All in that it allows for medical care for all, regardless of income.

However, Britain’s plan is funded through a payroll tax, which would differ from most of the plans previously discussed. Another similarity: patients in both America and Britain do not pay out-of-pocket when visiting a doctor (only if Medicare For All passes). People in Britain do pay for prescriptions, but it is capped at less than twenty dollars. This health system is not without its flaws; there are often long waiting periods for treatment. Citizens also have the option to buy private insurance, but this is often pricey.


Canada’s Healthcare System

This country has the system most like Medicare For All. This system is set up with government-run health insurance that covers everyone, but most of the care is provided by private doctors and hospitals. As with both Britain and Medicare For All, patients pay nothing at the time services are rendered.

The difference between Medicare For All and Canada’s system is that the latter does not provide an extensive amount of coverage. Many people have to purchase private health insurance to cover vision, dental and prescriptions. Like Britain, Canadians sometimes have to wait a significant amount of time to receive specialized care.


Healthcare In Switzerland

Switzerland is often discussed for its health care system, among other laws and policies. So, what makes this country so talked about and unique?

In Switzerland, all insurance is private, but they sell most of their plans on a nonprofit basis. All programs have a premium that is dependent upon the choice of doctor, the deductible, and how easy it is to see the specialist. In some cases, subsidies are based on income.


France’s Healthcare

Health insurance is provided by a small selection of nonprofit health insurance companies. These companies are funded by tax dollars. Most of the health care expenses are being paid by public insurance. Most individuals must purchase private insurance to be covered entirely.

Private insurance is provided either through an employer or a voucher. In this country, the government is responsible for setting prices for health services and drugs and can even control the number of new doctors and equipment available in hospitals.


Germany’s Healthcare

Germany has two types of health insurance: a national public system and a private system. The national system charges a monthly premium based on income, which is paid in part by employees and employers.

Private insurance works just like it does here; most people get it as an add-on to another insurance. The government also sets limits here: specifically on how much doctors can earn and how much they can charge for their services.


What Does That Mean For Your Health Insurance Currently?

How will this affect the health insurance world as we know it? Good news for those who are currently uninsured: you would be covered (rather quickly), although you would have to pay for your services through taxes. If your income is low enough, there would be no cost to you at all. If you are insured through your work, you would no longer have to pay for health insurance through your employer, but you would still be responsible for a premium based on income.

For those who are already on Medicare, the new Medicare For All would simply expand your coverage to include dental, vision, hearing aids, some long-term care costs, and all prescription drug costs over $200 annually. You would no longer have premiums or co-pays for care, but you would pay taxes if you are still working. If you are on the Medicare Advantage plan, you would have to drop it and switch to the government-based program.

In the case you are currently on Medicaid, your choice of doctors and hospitals will increase, and your out-of-pocket costs would remain low. The bad part here is if you are still working, you could potentially pay more in taxes.

If you are self-insured, you would now pay for your health insurance through taxes. Your out-of-pocket costs could go either way; either somewhat higher or significantly lower. It is also possible you could gain a broader range of doctors and hospitals. Veteran care will not change at all under Medicare For All for at least the next ten years. Individuals would use the same healthcare system and would pay nothing out of pocket.