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Medicare for All Benefits Expand       05/21 06:07

   Generous benefits. No copays. No need for private policies. The "Medicare 
for All" plan advocated by leading 2020 Democrats appears more lavish than 
what's offered in other advanced countries, compounding the cost but also 
potentially broadening its popular appeal.

   WASHINGTON (AP) -- Generous benefits. No copays. No need for private 
policies. The "Medicare for All" plan advocated by leading 2020 Democrats 
appears more lavish than what's offered in other advanced countries, 
compounding the cost but also potentially broadening its popular appeal.

   While other countries do provide coverage for all, benefits vary. Canada's 
plan, often cited as a model, does not cover outpatient prescription drugs and 
many Canadians have private insurance for medications. Many countries don't 
cover long-term care.

   But the Medicare for All plan from Vermont Sen. Bernie Sanders would charge 
no copays or deductibles for medical care, allowing only limited cost-sharing 
for certain prescription drugs. Sanders would cover long-term care home and 
community-based services. Dental, vision and hearing coverage would be 
included. The House version of the legislation is along similar lines.

   "Medicare for All proposals would leapfrog other countries in terms of 
essentially eliminating private insurance and out-of-pocket costs, and 
providing very expansive benefits," said Larry Levitt, a health policy expert 
with the nonpartisan Kaiser Family Foundation. "It raises questions about how 
                                                                      tic the 
proposals are."

   Shifting the sprawling U.S. health care system to a government-run 
"single-payer" plan is one of the top issues in the 2020 Democratic 
presidential primary, but the candidates are divided. Some have endorsed 
Sanders' call, while others want to expand coverage within the current mix of 
private and government insurance. Independent studies estimate Medicare for All 
would dramatically increase government spending, from $25 trillion to $35 
trillion or more over 10 years. It stands no chance with Republicans 
controlling the White House and the Senate, but it is getting hearings in the 
Democratic-led House.

   Economist Sherry Glied, dean of New York University's Wagner school of 
public policy, says the offer of generous benefits may be needed to persuade 
Americans satisfied with employer coverage that they would be better off in a 
new government plan.

   "You are going to have to be very generous if you want this to be 
politically appealing to lots of people," said Glied, who was a senior health 
care adviser in the Obama administration.

   Glied says components like benefits, copayments and deductibles would all be 

   "People put out talking points and then they see what Congress is willing to 
swallow," said Glied. "Who knows where it would come out in the end."

   A second congressional hearing on Medicare for All is scheduled Wednesday 
before the House Budget Committee. Votes this year appear unlikely. The plan is 
a punching bag for Republicans trying to tag Democrats as "socialists."

   In a statement, Sanders' office said it's fair for the senator to compare 
Medicare for All to what other countries have because "all those other 
countries guarantee health care as a right," as his plan would.

   "Sen. Sanders believes providing comprehensive coverage through the 
government to all residents is the best way to do it," said the statement.

   If the legislation were to advance to votes, "we will hear out concerns from 
our colleagues and work with them to get this bill passed," the statement 
continued. "But we are very clear about what we want and what this country 
needs. Insurance company CEOs are going to pay well before the American people 

   Two recent reports have called attention to differences among countries that 
cover everyone and are often held up as models for Medicare for All.

   A report from the Congressional Budget Office will be the focus of 
Wednesday's House hearing. Another report, for the nonpartisan Commonwealth 
Fund, was written by Glied. Among its findings: Other countries don't 
necessarily take the same approach as Medicare for All, using a range of 
strategies to cover all their residents.

   "Currently, single-payer bills in the U.S. tend to share the same key goals: 
centralizing...the system, expanding the public benefits package and 
eliminating private health insurance entirely," the Commonwealth report said. 
"However, these three features are not the norm across countries that have 
achieved universal coverage for health care."

   The report found that one group of countries --- including Denmark, Britain 
and Germany --- provide comprehensive benefits. That includes, for example, 
mental health. They charge low copays. Those countries are the closest to 
Medicare for All.

   A larger group --- including Australia, France, Netherlands, Norway, 
Singapore, Sweden, Switzerland and Taiwan --- offer broad benefits but there 
may be gaps, and cost sharing is higher. Australia charges $60 for specialist 
visits. The Netherlands has a $465 deductible. Dental coverage may be limited.

   Finally, Canada has a narrow national benefits package. It doesn't cover 
outpatient prescriptions, long-term care, mental health, vision and dental. But 
there's no cost sharing for hospital and doctors' services. Canadians rely on 
private insurance and provincial governments to fill the gaps.


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