What is Medicare for all?

• In a single-payer system only one entity, generally the state or federal government, pays for everyone’s medical care. 
• As in traditional Medicare, the single payer for Improved-Medicare-For-All is the federal government, but a more comprehensive range of services will be provided for all individuals from birth to death. 
• The goal is universal, accessible, affordable, comprehensive, quality health care.

• The US spends a larger fraction of its economy on health care than any other comparable industrialized country, but we are not as healthy. Our life expectancy is shorter and our maternal and fetal mortality are poor.  We pay more and get less than similar nations.
• Medical debt is the leading cause of personal bankruptcy in the US, and treatments are not affordable for some. 
• We have millions of uninsured and underinsured residents, and some have insurance that many physicians won’t accept. We place last among developed nations:

Commonwealth Fund on Health Care 2021

All of the prices are higher.

• Prescription drugs cost up to 400% more than the same drug in other countries.

• In other countries drug prices are negotiated by the government, but not in the US (outside of the VA).

• Insurance companies in the US are almost all for-profit. Money is taken out of the health care system and goes to marketing, lobbying, salaries, and shareholders of the company. 

• Administrative costs in the US are much higher, due to the plethora of insurance companies and policies.  In the US roughly 20% of our health care dollar pays for administrative services. Medicare pays 2%.

• “Socialized medicine” refers to a system like the one in the United Kingdom, where the government owns the hospitals and physician practices. 

• In a single payer system, hospitals and practices remain privately owned but are reimbursed by only one payer–the government. 

Single payer provides universal access to health care and simplified billing. Low administrative overhead means more of the health care dollar goes to health care.

•  Physicians would be relieved from the burdens of authorizations, denials of payments, denials of medications, multiple formularies, byzantine billing systems, collections, contracting with multiple insurers, and scrambling to find care for the uninsured. 
• This benefits practices of all sizes, giving physicians more options.
•  Physician fee schedules would be negotiated with the government. 

• Expanding MediCal and ACA or decreasing the age for Medicare eligibility (the “public option”) have all been suggested, but there is no reduction of administrative waste from multiple coverage and claims programs, and no savings– just added taxpayer cost. 
• It doesn’t relieve the physicians’ administrative burdens.
• These stopgaps are not universal, nor comprehensive, and many “cardholders” still cannot access care.

• Single payer achieves savings by removing the middlemen, simplifying administration,  and negotiating drug prices. 
• Taxes levied on larger businesses, as well as a progressive tax on personal incomes will be less than what most people and businesses have been paying for premiums, deductibles, copays, and drug costs. Our current system unfairly burdens the middle class. 
• Those with very high incomes may pay slightly more. For a more complete discussion: Single Payer Saves Californians $117 billion a year

No. Patients will no longer be limited to “referral panels.” They will have freedom of choice of providers, hospitals, and laboratories. 

• Physicians would most likely be paid as they are now–fee for service, salary, or possibly capitation. Payment methods may be set by each medical group. 
• Budgets for hospitals will be set each year. The hospital budget might be a global budget, covering all activities related to the hospital (including their employed providers). A hospital’s current administrative cost is 25% of its budget and single payer would minimize this expense.

• Those monies are critical for the single payer system to flourish. The State can apply for waivers that allow the Medicare, Medicaid, and other Federal funds that would have been spent in California to be applied to the State single-payer system.  
• If a Federal system is implemented, these Federal funds would flow into it.

• The change would be to the insurance arm and to hospital financing. The hospitals, either individually or as a group, would negotiate an annual budget. 
• The Permanente Medical Group could continue in its current form and contract with the hospital group, as it does now. 
• Patients could continue seeing their Kaiser doctors, but would also have the choice of seeing doctors outside the Kaiser system.