Medi- wait what? A ridiculously brief guide to the health insurance proposals in the 2020 race
With a seemingly endless supply of healthcare solutions coming out of the democratic field, it is a struggle to catch up with all the nuanced differences. Lucky for you, the next couple paragraphs will clarify the various ideas, from Medicare for all and Medicare for America to the Affordable Care Act (dubbed "Obamacare" by Mitch McConnell) and the system we had before it.
Before the ACA was passed into law, health insurance was fully private and largely unregulated. Insurers hand-picked customers that they thought would pay more in premiums than cost in claims, and as a result, people with preexisting conditions were charged very high rates or rejected outright by insurers, but it was a very prosperous industry and invested a lot in other sectors of the economy, allowing the US to lead the world in medicine.
When President Obama got into office, he signed the Affordable Care Act into law. This did a number of things. First, it prohibited insurers from denying coverage to people with preexisting conditions. To keep insurance profitable with this, an individual mandate and employer mandate were added, forcing even the healthiest young people to get insurance, balancing out the overall risk of the pool. "Obamacare" also created a website, which took a long time to get going and cost Democrats control of congress in 2010, to ensure compliance with other ACA requirements. This resulted in 20 million more Americans having coverage, but costs for healthy people increased, many people were undercovered by their insurance, many people lost access to their doctors, and some employers reduced wages to pay for employees' health insurance benefit. These downsides were made more severe when funding for the program was cut and then eliminated by the Republican-controlled congress.
The ACA's mixed results were taken by Republicans as a sign of government incompetence harming the economy, and by Democrats as a good start that needs to be more comprehensive. Republicans now support repealing the ACA and reinstituting something like the old system, and most Democrats support either Medicare for All (Sanders, Warren, now Harris) or a public option (Biden, Buttigieg, O'Rourke).
Medicare for All gives the government health insurance that the elderly have now to all Americans, and candidates who endorse it would add more services and shrink deductibles and co-pays of the expanded Medicare. Doctors and hospitals would be private, but the rates they are paid would be set by the government. Positives include the freedom to see any doctor, 40 million more people having insurance and tens of millions of under-insured people gaining more comprehensive care, and all the economic benefits of having more insured people. Negatives include the loss of a large investor in other sectors (HMO companies), higher national deficits, and/or higher taxation of the wealthiest Americans (per the plans of presidential candidates) which could prompt the wealthy to move more capital offshore.
The public option offers Medicare, as is, to everyone who is willing to pay a modest, affordable premium. Sounds like a happy medium, right? In fact, there are many valid concerns with it. First, not everyone will know how to or be able to enroll for various reasons, especially if they have inconsistent incomes that could lead to missed payments. Second, economists agree that the slow decay of the healthcare industry as more and more companies stop providing health insurance will cause a rapid sell-off that could take us into a recession, unlike medicare-for-all, which would lead to the swift closure of HMOs. Third, unlike with Medicare-for-All, a public option would leave medicare with very weak negotiating power on drug prices and hospital charges and thus would lead to desperate HMOs egregiously overcharging taxpayers for their services.
The purpose of this article was to inform the public on all the plans without any angle or advertisement. I Know that these summaries leave a lot out, so feel free to post any questions/comments/concerns down below and I'll do my best to get back to you.