‘Medicare for All’: Is It Popular? And Is It the Same as Britain’s System?

https://www.nytimes.com/2017/09/14/us/politics/medicare-for-all.html

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As leading Democrats embrace Senator Bernie Sanders’s proposal to vastly expand Medicare to cover all Americans, Republicans are fighting back with familiar critiques of such a single-payer system.

Mr. Sanders argued for his “Medicare for all” legislation in an Op-Ed published in The New York Times on Wednesday, while his Republican colleagues dismissed the idea in a news conference. Here’s an assessment of their claims.

Mr. Sanders claimed that “the majority of the American people” want Medicare for all, citing an April poll by The Economist/YouGov in which 60 percent of Americans agreed that Medicare should be expanded to cover everyone. But this appears to be the high end of support.

A Quinnipiac poll in August reported that 51 percent of respondents said that replacing the current health care system with a Medicare-for-all model was a good idea. “Medicare for all” generally polls more favorably than “single payer.” In a June poll from the Kaiser Family Foundation, 57 percent of respondents supported Medicare for all, while 53 percent favored a single-payer approach.

Other polls about single-payer health care found lower levels of support: 44 percent from Morning Consult/Politico, 44 percent from Rasmussen and 33 percent from the Pew Research Center.

Pollsters at AP/NORC did not ask about a specific model in an August survey, but 60 percent of respondents said it was the federal government’s responsibility to provide health care for everyone.

Mr. Sanders extolled the virtues of the Canadian health care system, while Senator John Barrasso, Republican of Wyoming, criticized Mr. Sanders’s plan by outlining what he called the faults of the British system. Neither comparison is perfect.

Canada has a decentralized national health insurance program, which provides universal coverage and reimburses private health care providers. While Mr. Sanders’s model would provide comprehensive services including mental health, dental and vision care, provinces and territories in Canada administer their own programs, so benefits vary and are usually not as generous. Ontario, Quebec and British Columbia — the three provinces where three-quarters of Canadians live — provide only emergency optometry and dental care, with some exceptions for children and the elderly.

The British system differs from Mr. Sanders’s plan in structure. The National Health Service owns and runs hospitals, which British citizens can visit usually free of charge, and has contracts with doctors. Under Mr. Sanders’s plan, every American would receive insurance through Medicare, but the government would not run hospitals.

One of the most common critiques of the British system revolves around long waiting times. In 2011, patients in N.H.S. emergency rooms in England waited a little over two hours on average from attendance to departure, as Mr. Barrasso noted. Median wait times are about 20 minutes longer this year, and the percentage of people who receive care in under four hours has been declining.

But in the United States, the median emergency wait time was comparable in 2011, the most recent year for which data is available from the Centers for Disease Control and Prevention. The figure was about two hours: 30 minutes waiting to see a doctor, and slightly longer than 90 minutes for treatment.

Mr. Barrasso also argued that the success rate for breast and prostate cancer treatments was “so much better in the United States” than in Britain. The five-year survival rates for breast and prostate cancer were 88.6 percent and 97.2 percent in the United States, and 81.1 percent and 83.2 percent in Britain. But in the United States, survival rates can decrease if the patient is uninsured.

Mr. Sanders’s two claims about the high costs of the American health system in his Op-Ed are largely accurate.

The Organization for Economic Cooperation and Development estimates that the United States spent $9,890 per person on health care in 2015. That’s about twice as much as the four countries with universal health care systems that Mr. Sanders listed: Canada ($4,640), France ($4,600), Germany ($5,550) and Britain ($4,190).

The United States also spends the most on prescription and over-the-counter drugs per person than any other O.E.C.D. member country. The federal government is legally barred from negotiating drug prices for Medicare, although Medicaid and the Veterans Health Administration can and do obtain discounts.

By contrast, Japan, Canada, Australia and virtually all European countries regulate drug prices, according to the Pew Charitable Trust. For example, they limit a drug’s price to what other countries pay for it, set a benchmark price based on the cost of similar products, or directly negotiate with the pharmaceutical companies.