WASHINGTON – The “Medicare for All” plan embraced by leading 2020 Democrats appears more lavish than what other advanced countries offer, compounding the cost but also potentially broadening its popular appeal.
The plan from Vermont Sen. Bernie Sanders would charge no copays or deductibles for medical care, allowing only limited cost-sharing for some prescription drugs. It would cover long-term care at home and in community settings. Dental, vision and hearing coverage would be included.
But while other countries do guarantee coverage for all, the benefits vary significantly. Canada, often cited as a model, does not cover outpatient prescriptions and many Canadians have private insurance for medications. Many countries don’t cover long-term care. Modest copays are common.
Economist Sherry Glied, dean of New York University’s Wagner school of public policy, says the offer of generous benefits may be needed to persuade Americans satisfied with employer coverage that they would be better off in a new government plan.
Two recent reports have called attention to significant differences among countries that cover everyone and are held up as models for Medicare for All.
A report from the Congressional Budget Office will be the focus of today’s House hearing. Another report, for the nonpartisan Commonwealth Fund, was written by Glied. Among its findings: Other countries don’t necessarily take the same approach as Medicare for All, using a range of strategies to cover all their residents.
“Currently, single-payer bills in the U.S. tend to share the same key goals: centralizing ... the system, expanding the public benefits package and eliminating private health insurance entirely,” the Commonwealth report said. “However, these three features are not the norm across countries that have achieved universal coverage for health care.” Many countries retain a role for private insurance, for example.
The report found that one group of countries – including Denmark, Britain and Germany – provide comprehensive benefits, including such services as mental health care. They charge low copays. Those countries are the closest to Medicare for All.
A larger group – including Australia, France, Netherlands, Norway, Singapore, Sweden, Switzerland and Taiwan – offer broad benefits but there may be gaps, and cost sharing is higher. Australia charges $60 for specialist visits. The Netherlands has a $465 deductible. Dental coverage may be limited.