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The complete guide to understanding Bernie Sanders’s Medicare for All

Health care is, once again, at the center of the US political debate. After the Republican party tried and failed twice to repeal and replace Obamacare, and as reports of yet another conservative proposal circulate, attention turns to someone else—Bernie Sanders, who today (Sept. 13) is presenting his much-anticipated Medicare for All bill (paywall).

A bill that builds on Democratic congressman John Conyers’s expanded and improved proposal, introduced in the House on Feb. 10, Sanders’s bill has gained support among Democrats, and is poised to be the boldest proposal the party has put forward since Donald Trump’s election. Quartz spoke with a Sanders aide to understand what the bill is all about.

How does Medicare for All work?

Essentially, the proposal aligns the US with the rest of the developed world, providing universal health coverage. Similar to the current Medicare coverage for those over 65 years old and for people with disabilities, all would automatically be insured, in a system financed by a tax-funded government trust fund. Unlike Medicare, which now provides four-tier coverage with different levels of deductibles and co-pays, this bill would simplify things: Enrollment would be automatic, with coverage the same for everyone, and typically without any co-pays.

How is this different from Obamacare?

Drastically. Obamacare works as a system to make private health-care insurance affordable. Medicare for All replaces private insurers with a public insurance system. If the bill passed, the current, fragmented system of insurance providers would be gone. Employers and individuals wouldn’t have to choose and buy health insurance. They would automatically be enrolled in the nationwide plan.

What does Medicare for All cover?

Pretty much everything. According to the bill’s summary, it would include “hospital services, including emergency services and inpatient drugs; ambulatory patient services; primary and preventive services, including disease management; prescription drugs, medical devices, and biological products; mental health and substance abuse treatment services, including inpatient care; laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn care; pediatrics; oral health, vision, and audiology; rehabilitative and habilitative services and devices.”

Would anyone remain uninsured?

Virtually no one would be uncovered.

Is this the same as a single-payer option?

It basically is. The bill provides for a four-year transition period to allow people, including those currently enrolled in Medicare, Medicaid, and other federal insurance programs (for instance, the Veteran Affairs plan) to switch to the unified system. After that, all health coverage would be paid for through the public trust fund.

How is this different from a public option?

A so-called public option would allow people to buy into Medicare as one of the options available for insurance coverage. Medicare for All makes that the default option—no opting out, though of course people would be able to buy supplemental private insurance if they wished.

Is this socialized health coverage?

Yes, it is.

But isn’t Medicare for senior citizens?

The name of the bill, Medicare for All, is a bit of a marketing choice. Medicare is the health-coverage program with the highest level of satisfaction among enrollees, and it’s something most Americans recognize. The majority of citizens have direct experience with a senior or someone covered by it, and are likely aware of its advantages. According to the Kaiser Family Foundation, support for universal health coverage is dramatically different depending on the label given to it. While 53% Americans are very positive about the idea of Medicare for All, only 21% are very positive if the same program is labeled “single-payer option.”

What about abortion?

The bill covers comprehensive reproductive care, including abortion services. Making abortion a part of the bill, “was not an afterthought,” the Sanders aide said, and the proposal tries to address all of the limitations that might try to stop its inclusion. The bills specifically deals with the Hyde amendment, which blocks federal funds from being spent to pay for abortion services, stating explicitly that “RESTRICTIONS SHALL NOT APPLY. Any other provision of law in effect on the date of enactment of this Act restricting the use of Federal funds for any reproductive health service shall not apply.” Further, the bill would forbid—both at a federal and state level—discriminating against an eligible provider on the grounds that it provides abortions. The bill is intended to send signal that abortion is a core right for the Democratic party to defend.

Where’s the money coming from?

A look at other countries’ health systems leaves little doubt that providing overage through a single-payer model is cheaper and more effective, and would end up saving Americans money. But the program will need money to start, and it’s not yet clear how the government would get that funding. Sanders is expected to present viable financing options later today.

Who’s supporting the bill?

The bill is sponsored by Bernie Sanders, with 15 co-sponsors, all Democrats: Elizabeth Warren (Massachusetts), Ed Markey (Massachusetts), Kirsten Gillibrand (New York), Corey Booker (New Jersey), Kamala Harris (California), Sheldon Whitehouse (Rhode Island), Brian Schatz (Hawaii), Mazie Hirono (Hawaii), Tammy Baldwin (Wisconsin), Richard Blumenthal (Connecticut), Al Franken (Minnesota), Martin Heinrich (New Mexico), Jeanne Shaheen (New Hampshire), Patrick Leahy (Vermont), Jeffrey Merkley (Oregon). The broad support could make universal health-care the mainstream Democratic option for coverage.

But is this going anywhere?

Not in the short term. And an immediate fight is not what Sanders and his allies want, either. According to Adam Green, the co-founder of Progressive Campaign Change Committee, a grassroots organization that worked with Sanders in developing the bill, this is a first step to building viable support behind the idea of a universal health care, with the hope of gaining enough momentum to be able to turn it into law the next time Democrats have the majority. They are thinking along the lines of what happened when the Family and Medical Leave Act was approved under the Clinton administration— after consensus for it had been built under George H. W. Bush’s presidency.

Though the proposal—and the widespread support it’s gaining—has raised criticism for being too bold, and getting the party tangled up in another big health-care reform, Green says going bold is the right path. With Republicans in power in both houses of Congress and the White House, Democrats have an opportunity to pursue and build support for big ideas. In fact, his group hopes to make it an electoral issue, and capitalize on the Republican party’s inability to provide an alternative to Obamacare. “Republicans might have done Medicare for All the biggest favor by showing they have no way to improve the current system,” Green says.

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