- Aaron P. Bernstein/Reuters
- In the Democratic primary field so far, few issues have sparked as much verbal sparring among candidates as healthcare reform.
- Its crystallized one of the main divides among the 2020 candidates, who carry dueling visions of how to remake the American healthcare system.
- Keeping up with the plans being thrown around can be head-spinning at times, but here are seven key terms to help you cut through the jargon in the healthcare debate.
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In the Democratic primary field so far, few issues have sparked as much verbal sparring among candidates as healthcare reform.
Its crystallized one of the main divides among the presidential candidates, who carry dueling visions of how to remake the nation’s healthcare system.
Progressives candidates such as Sens. Elizabeth Warren and Bernie Sanders argue every American should be covered in a government-run healthcare system, popularly known as Medicare for All. It would also virtually eliminate private insurance in the United States, a major faultline cleaving the field.
Moderates, however, favor a more incremental approach, either shoring up the existing healthcare system or simply offering people the option to buy into a government-run insurance system known as the public option. Former Vice President Joe Biden and Mayor Pete Buttigieg support this route.
Keeping up with the plans being thrown around can be head-spinning at times, but here are seven key terms to help you cut through the jargon in the healthcare debate.
Medicare is a social insurance program designed to provide health insurance coverage for Americans that are 65 and older, as well as people with permanent disabilities or other diseases. This has been in place since 1965, and it covers 60 million Americans and accounts for 15% of total federal spending. Since its structured as an open-ended entitlement, Medicare has no real cap on how much it can spend.
The federal government sets the prices that doctors and hospitals get paid. And it helps cover the costs for prescription drugs, hospitalizations, and physician visits. Medicare also offers private plans for people who want additional benefits, but a limited set of health providers will accept it. More than a third of Medicare’s beneficiaries are covered by private insurers.
- Lucas Jackson/Reuters
‘Medicare for All’
“Medicare for All” is a term that envisions a system where all Americans receive health insurance through the Medicare system that’s already been established by the government.
This idea is extremely popular among progressives. Sen. Bernie Sanders made “Medicare for All” his signature issue during his 2016 presidential run, helping push the idea into the American political mainstream. Under the Sanders plan, the Medicare program would be expanded to cover all Americans and provide comprehensive benefits that include vision and dental.
It would also virtually eliminate private health insurance since the government-run insurance system would cover almost every aspect of healthcare, removing the need for private insurers. This part has generated a lot of controversy, especially among moderate Democrats who fear disrupting the way people receive their care will hurt them politically. But Sanders has argued his plan will control costs and drastically reduce spending that’s wasteful.
Much of the developed world has government-run health insurance systems. And “Medicare for All” has invited comparisons to the Canadian healthcare system.
Established in 1965, Medicaid is another social insurance program, but it provides healthcare coverage to low-income Americans. One in five Americans receive medical coverage from Medicaid, making it the largest single provider of healthcare in the nation. More than a third of American children are covered under Medicaid, and it also pays the costs for half of all births in the US.
States manage their own Medicaid programs within guidelines set by the federal government, and both share its costs. The Affordable Care Act engineered a Medicaid expansion to cover more Americans, and 37 states have done it so far.
A single-payer system is a broader term. It describes a government-run health insurance system that’s supported by taxes, with the federal government being the sole insurer. That’s the key characteristic underlying “Medicare for All.”
Viewed another way, it essentially means that the government assumes the responsibility for paying people’s health care costs, collecting the taxes needed to cover healthcare expenses.
This is seen as the middle-road approach to reforming the American healthcare system. Under the public option, people could buy into government-run healthcare if they wanted it. Theoretically, it would help consumers save costs because the government could use its power to negotiate on their behalf and lower rates, while also encouraging competition.
Candidates are proposing to use the public option in different ways. Some view it as the gateway to universal coverage, while others are content allowing people to buy into a government healthcare plan if they chose.
The public option was proposed as part of the Affordable Care Act, but Republicans and Democrats shot it down in the Senate back in 2009.
- White House photo/Pete Souza
Affordable Care Act
The Affordable Care Act, also popularly known as Obamacare, is former President Barack Obama’s signature healthcare law. Signed into law in 2010, it set up the individual insurance market exchanges where people could buy private health insurance plans with federal subsidies and it expanded Medicaid to cover more Americans.
Some of the law’s more popular provisions include children being allowed to stay on their parents’ plan until the age of 26 and it barred insurers from denying people coverage due to preexisting conditions. Twenty million Americans gained health insurance through the law.
Universal coverage is the lofty term often used to describe the broader goal of insuring everyone. When politicians say that healthcare is “a right,” think of it as an endorsement of universal coverage.