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Defining "Medicare for all"

Democrats unveiling a Medicare for All platform.
Democrats discuss Medicare for All legislation on Capitol Hill last year. Photo: Jim Watson/AFP/Getty Images

Let’s jump into the debate Democrats are going to be having for at least the next two years: What, exactly, constitutes “Medicare for All”?

Why it matters: Supporting some version of “Medicare for All” has become a litmus test for a lot of Democratic primaries in 2018, and will surely be one in 2020.

What they’re saying: Tim Higginbotham and Chris Middleman, organizers with the Democratic Socialists of America’s Medicare for All campaign, pushed back against the squishier definitions of the term in a Vox op-ed on Friday.

  • “We need a true single-payer system, not a patchwork … effectively abolishing the private health insurance industry altogether.”
  • That single program should cover everyone, should provide services like mental and dental health, and should be free at the point of service (no co-pays or deductibles), they said.

The other side: Try writing, for example, a health policy newsletter that treats “Medicare for All” and “single-payer” as synonyms, and you’ll hear from the Democrats who support a less sweeping program, like an optional Medicare buy-in.

  • Medicare, they accurately note, relies heavily on private insurance. Why should “Medicare for All” have to mean pure single-payer when that’s not what Medicare is today?

My thought bubble: Hardly anyone is actually talking about a literal expansion of the existing Medicare program, whether voluntary or compulsory.

  • Medicare today doesn't meet the definition DSA has laid out. Neither does Canada's single-payer system, for that matter. Medicare also doesn't cover things like maternity care, which more center-left proposals would change.
  • If this ever gets resolved, it will be during the 2020 primary at the earliest — not in 2018, when a raft of Democratic candidates across the center-left spectrum truly are benefitting from the term’s vague popularity.
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