Healthcare and the upcoming election

Kaiser Health News

Julie Rovner | 1/30/2020, 2:36 p.m.

Health has been a top issue in the presidential campaign during the past year: Not only do the Democratic candidates disagree with President Donald Trump, but they also disagree among themselves.

Voters have frequently complained that the debate has been confusing and hard to follow. Most of the attention so far has been focused on whether the U.S. should transition to a “Medicare for All” program that would guarantee coverage to all U.S. residents — and result in higher taxes for most people. But there is far more to the health debate than that.

The campaign is nearing some key moments — the caucuses in Iowa, the New Hampshire primary Feb. 11, voting in Nevada and South Carolina later in the month. By March 3, Super Tuesday, Democrats will have chosen a third of all delegates.

Here are six things to know as you tune in to the increasingly frenzied primary race:

Universal coverage, Medicare for All and single-payer are not all the same thing.

Universal coverage is any method of ensuring that all of a country’s residents have health insurance. Other countries do it in various ways: through public programs, private programs or a combination.

Single-payer is a system in which one entity, usually but not always a government, pays for needed health care services. Single-payer is NOT the same as socialized medicine. The latter generally refers to a system in which the government pays all the bills, owns the health facilities and employs the health professionals who work there. In a single-payer system, such as Medicare in the U.S., the bills are paid by the government but the delivery system remains mostly private.

Medicare for All is a proposal that was originally developed in the late 1980s. Building on the popularity of the Medicare program for senior citizens, the idea was originally to extend that program to the entire population. However, since Medicare’s benefits have fallen behind those of many private insurance plans, the later iterations of Medicare for All would create an entirely new, and very generous, program for all Americans.

Voters are more concerned about health care costs than health care coverage.

While Democrats fight over how best to cover more people with insurance, the majority of Americans already have coverage and are much more worried about the cost. A recent survey of voters in three states with early contests — Iowa, South Carolina and New Hampshire — found voters in all three ranked concerns about high out-of-pocket costs far ahead of concerns about insurance coverage itself.

It’s the prices.

There’s a good reason voters are so concerned about what they are being asked to pay for medical services. U.S. health spending is dramatically higher than that of other industrialized nations. In 2016 the U.S. spent 25% more per person than the next highest-spending country, Switzerland. Overall U.S. health spending is more than twice the average of other Western nations.

But that’s not because Americans use more health services than citizens of other developed nations do. We just pay more for the services we use. In other words, as the late health economist Uwe Reinhardt once famously quipped in the title of an academic article, “It’s the Prices, Stupid.” A later paper published last year (the original is from 2003) confirmed that is still the case.