Thread by @charles_gaba

@jkarsh @gracels "Single Payer" refers to any healthcare system in which a single entity--presumably the federal government--pays for most (or all, in the case of "pure" single payer) healthcare expenses.

@jkarsh @gracels In the United States, we have a hodge-podge of healthcare coverage systems, including three which are often considered "single payer": Medicare, Medicaid/CHIP and the Veteran's Administration. However, there are differences even there. 2/

@jkarsh @gracels With (current) Medicare, the government only pays for perhaps 80% of the cost, which means there's still some level of premiums, deductibles and co-pays. Also, (current) Medicare isn't comprehensive--it only covers perhaps 80% of most enrollees' medical/healthcare services. 3/

@jkarsh @gracels Most (current) Medicare enrollees also purchase supplemental *private* insurance, called "MediGap", to cover the other ~20% of services. Alternately, about 1/3 of Medicare enrollees enroll in "Medicare Advantage", which is *administered* by private insurance companies. 4/

@jkarsh @gracels While Medicare's government funding is all federal, *Medicaid* is paid for via a combination of federal/state funding. It's mostly for lower income people, and it tends to be a lot more comprehensive than Medicare as well as (usually) having no premiums & nominal co-pays/etc. 5/

@jkarsh @gracels Here's the "psychedelic donut" of U.S. healthcare coverage as of 2017. As you can see, a hodge-podge: Large employer coverage, small employer coverage, the VA/TriCare, Medicare, Medicaid, CHIP, the individual market (ACA), miscellaneous and of course the totally uninsured. 6/

@jkarsh @gracels Every one of these different types of coverage has different levels of comprehensiveness, different levels of cost sharing (premiums/deductibles/co-pays), different levels of networks (which doctors/hospitals you can use), etc etc. It's confusing as hell. 7/

@jkarsh @gracels What *Bernie* is proposing with his "Medicare for All" bill is to almost completely replace ALL of this with a vastly *expanded* version of Medicare which would convert nearly this entire donut into a single orange donut. 8/

@jkarsh @gracels Bernie's "pure" single payer "Medicare for All" bill would theoretically cover 100% of the population w/100% comprehensive coverage usable with 100% of doctors and hospitals, with 100% of the cost being paid for by the federal government, leaving $0 cost sharing for enrollees. 9/

@jkarsh @gracels The *only* exceptions to Bernie's M4All vision would be the VA and the Indian Health Service, which combined cover something like 15 million people, I think. Those would be left as is...but they're still paid for via federal dollars anyway. 10/

@jkarsh @gracels The *name* "Medicare for All", that's a bit of a misnomer. For one thing, over 1/3 of current Medicare enrollees choose Medicare Advantage, which would be eliminated by his bill. For another, in terms of *comprehensiveness* *Medicaid* is a closer match to what he describes. 11/

@jkarsh @gracels Last summer, Bernie got very upset w/@KamalHarris for calling *her* universal coverage plan "Medicare for All" since it would keep Medicare Advantage...but as I explained in this op-ed, her plan is actually *closer* to a bill called M4All from 2006: 12/

washingtonpost.com/opinions/2019/…

@jkarsh @gracels @kamalharris Bernie calling it "Medicare for All" confused people re what the bill would do. A *LOT* of people think that the "Medicare" part refers to CURRENT Medicare, which includes premiums/deductibles/co-pays (which it wouldn't) and that it wouldn't cover everything (which it would). 13/

@jkarsh @gracels @kamalharris At the same time, a LOT of people don't understand that the "...for All" part would mean exactly that: It would be MANDATORY for 100% of the U.S. population once fully ramped up, with no exceptions (other than the VA & IHS), whether you wanted it or not. 14/

@jkarsh @gracels @kamalharris Plenty of polls have found that a substantial portion of those who *say* they "support" "Medicare for All" are under the assumption that it actually means "...for all Who Want It", assuming that they have the *option* of keeping private major medical coverage if they prefer. 15/

@jkarsh @gracels @kamalharris There's also other bills out there with "Medicare" in the titles as well. @SenStabenow's "Medicare 50+" bill would make *current* Medicare an *optional* buy-in for those age 50-64. "Medicare X" and "Choose Medicare" would add an expanded Medicare as a Public Option. 16/

@jkarsh @gracels @kamalharris @SenStabenow There's also "Medicare for America", which is my personal favorite long-term universal coverage plan...but again, each of these, as well as Bernie's "Medicare for All" bill, change the definition of what "Medicare" means to some degree or another, causing even more confusion. 17/

@jkarsh @gracels @kamalharris @SenStabenow ANYWAY, the point is that the bigger and more disruptive the bill, the more people it impacts, the more jobs it impacts, the more businesses it impacts, the more complicated it becomes to implement, and the more controversial it becomes. /END