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Policy Issue Analysis: Bernie Sanders’ Medicare for All

Policy Issue Analysis Assignment: Bernie Sanders’ Medicare for All Essay

 

The issue of health care insurance is one that has dominated the political landscape, particularly by Democratic Presidential candidates over the last few years. The plan by Bernie Sanders is motivated by the present dysfunctional policy where private insurance companies are profiting from Medicaid Programs while the citizens of the United States continue to suffer as they are required in most cases to buy prohibitively priced medications out of their pockets. According to the Sanders’ proposal, he wants to overhaul the United States’ insurance into a single-payer system, wherein the government will be singularly compelled to offer insurance coverage to every American irrespective of their socio-economic status (Krieg & Luhby, 2019). Of importance to note from this proposal is the elimination of private insurance companies from the program, which Sanders hopes will make treatment affordable and a fundamental right for all Americans. Indeed, the prosecution of this matter at the national stage in the run-up to the 2020 presidential election is an indictment of the existing insurance plan for Americans and the general absence of a comprehensive plan that protects them from the greed of greedy pharmaceutical companies and equally money-oriented health care settings.

The present policy issue analysis regarding Bernie Sanders proposed Medicaid for All will be conducted by Garhett Gulmer. I am a 25 year old who currently works in a telemetry unit on Boise. Upon the completion of my masters as a Family Nurse Practitioner, I intend to return to rural medicine in order to help the needy using the skills that I will l have acquired. I have at a personal capacity studies the single-payer systems as instituted by the Canada and the U.K. Thus, from the points that I have gathered, I strongly feel that whereas the health care system needs to be fixed, the single-payer system does not seem to be the solution. Principally, the wait times associated with it in the aforementioned countries makes it a questionable option particularly with regards to the quality of care and its impact on the cardinal responsibility of nursing, which is to offer quality care to hurting patients.

Definition of the Policy

The Medicare for All Bill, while going to significantly impact the health care industry, has some issues to need to be addressed before it can be rolled out. The social effect of the proposed single-payer system is something that cannot be overlooked. According to conservative news outlets, allowing the government to undertake the responsibility of providing insurance to its citizens is tantamount to becoming a socialist state. In such a state, the wealthy individuals in the society will be tasked to pay for the health care costs of the less wealthy in the society, which contradicts the tenets of capitalism that the country is founded upon. Thus, while all agree that the health care industry needs to be overhauled, the manner in which to do so without upsetting the social tenets of the country remain contentious.

According to analysis regarding the bill, Senator Sanders and his team have not provided the cost of the entire exercise while conservative groups have stipulated that it could run into trillions of shillings. As such, the American tax-payers are going to contribute more money towards the program. According to the proposed documents, a 4-% income based premium payments alongside 7.5% income based premium by employers beyond the first $29 000 for a four-people family and exempting the first $2 million in payroll respectively will support the bill (Pramuk, 2019). In addition, a progressive federal income tax, taxing the extremely wealthy as well as eliminating a tax loophole that allows self-employed individuals to evade paying taxes on certain items by establishing certain cooperation will also form part of the funding proposals. That so many of the proposed funding modalities are being proposed means that legislations will have to be undertaken with the sole aim of determining the ones that will indeed be used and the ones that will be considered as government overreach. Indeed, picking the items on the list that could eventually become laws will create a great battle between conservatives and liberals concerning the extent to which the government can use its powers to tax wealthy individuals and the role that private insurers will play in the entire plan.

Moreover, ethical considerations regarding the bill have also been raised by its opponents. Whereas the intentions of the same cannot be questioned, the ethical principles of human dignity and equity it espouses cannot be left unchallenged. The bill would ensure that all individuals in the United States, including the 40 million uninsured ones, have a cover it is enacted into law (Cancryn, 2019). Even then, what is the role of the government in the provision of this and would it not be appropriate to allow those who can afford to pay for their private insurances to do the same instead of forcing them to be covered by the Medicare for All? The above question thus raises the ethics of government forcing people into its programs yet they have the ability to pay for the care themselves. Further, the question of the difference between the government’s determination of the terms and conditions of the insurance scheme and the private sectors determination of the same also arises. Therefore, whereas the policy would address some of the pressing ethical concerns currently derailing the Affordable Care Act, it still has its own ethical challenges that require examination.

The Medicare for All bill as proposed by Senator Sanders has also raised some serious political angles to consider. Whereas a majority of Democrats support the institution of a single-payer system in the United States, the radical nature of the bill proposed by Sanders has led to some of them considering an alternative bill. In addition to the Democrats, Republicans are vehemently opposed to the control of the insurance market by the government as they consider that government overreach (Singleton, 2019). Further, members from both sides of the political divide consider the proposal expensive to fund, which would put a strain on the federal government budget. In other words, the place of market economics in the present proposal has caused sharp political divisions that may impair the actualization of Medicare for All.

The Medicare for All, just like the Medicare and Medicaid as well as the Affordable Care Act, does not seem to consider conscience as an integral part of care. In a manner similar to the above policies, the primary question that influences them entail credibility and affordability. In the arguments presented by the Medicare for All proponents and even some of the above policy supporters, the government control everything that happens in the market place (Pramuk, 2019) and thus the opinion or feelings of Christians is secondary. Nevertheless, Christians have felt that their faith cannot be secondary to anything else as to them, conscience is very important. Therefore, Medicare for All does not espouse the Christian belief of what care should entail and as such falls short of satisfying the Christian angle of the matter.

Moreover, there are historical, cultural and environmental matters that the Medicare for All has not considered. In the United States, it would be difficult to sell a policy option that resembles socialism because of the historical confrontation between the West and the former USSR and countries that practice socialism. The non-conformism of the two will ensure that the bill as presented by Sanders does not pass the house chambers (Krieg & Luhby, 2019). In addition, the prevalent culture in the United States also abhors the tendency to get freebies without working for them. This makes it difficult for the policy to be acceptable to a majority of United States citizenry particularly the moderate Democrats and conservatives. Lastly, the prevalent environment that has been permeated by political antagonism will act as a substantial barrier for the bill to become into a law. All these jeopardize the operationalization of the Medicare for All Bill as envisioned by Sanders.

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Issue/ Policy Options

The Bernie Sanders Medicare for All policy has been described as ambitious by both its proponents and opponents. According to the

Policy Issue Analysis Assignment Bernie Sanders’ Medicare for All Essay

Policy Issue Analysis Assignment Bernie Sanders’ Medicare for All Essay

proposals contained in the bill, he is looking to establish a government care system that will offer insurance for all Americans. The bill has proposed legislation that would establish not only a single payer system but also protect the long-term care for individuals suffering with various disabilities. According to Cancryn (2019), the bill as proposed by Sanders has several far-reaching effects with its capacity to cover preventative and primary care, dental and vision, prescription drugs, substance abuse and mental health management, prescription drugs, and long-term, maternity and newborn care, through a government supported plan.  In addition, the bill seeks give Americans the liberty to visit a doctor of their choice minus copays or deductibles. However, perhaps the most fundamental and contentious provision of the bill would be its capacity to eliminate the private insurance market from the United States due to what the proponents of the bill call greed. All these areas currently experiencing problems owing to the existing arrangement between the federal government and private insurance companies.

Given the nature of the insurance industry, there needs to be options that would replace the Medicare for All Bill. Instead of the single-payer system that Senator Sanders is proposing in his Medicare for All Bill, the United States should consider creating a universal health care system wherein all the hospitals are government-owned (Moore, 2018). The government’s mandate would extend to running the said hospitals in order to cut costs paid to private investors. Indeed, if the motivation of the bill was to reduce costs, then adopting the universal health coverage would the best way to handle the matter. By this method, the huge administrative costs currently being witnessed will be reduced. Alternatively, the political class should consider introducing a plan that upgrades the Affordable Care Act. According to this plan, the ACA would be left in place while out-of-pocket costs, deductibles, and premiums would be capped. In addition, automatic enrollment would be guaranteed for everyone irrespective of whether they meet some of the present thresholds (Rubin, 2019). In this arrangement, the out-of-pocket expenditure would receive capping even if they came from employer provided plans, Medicare or Medicaid. In order to pay for all these, the plan proposes the elimination of pay-for-free services and raising taxes on the wealthy.

Moreover, the current insurance imbroglio would also be eliminated through another viable plan that entails upgrading the Medicare plan to cover everybody. In this plan, the current Medicare would be enhanced through limiting out of pocket expenditure, offering hearing aids and dental care coverage, and also institute integrated drug benefits. This updated Medicare could then be allowed to become available to all Americans irrespective of their insurance status, health status, age, and even income (Rubin, 2019). Further, the plan may also consider cutting costs founded on income, maintain employer provided coverage and part of it be paid through tax increments.

If the current policy of Affordable Care Act continues to exist and the market is not changed, 40 million Americans will continue to suffer from effects of not having insurance cover. Moreover, most Americans will continue to benefit the big pharmaceutical industry since patients will continue to fund their prescription medications out of their own packets. In most cases, the costs for such medicines are so high that Americans end up dying because of the same. Moreover, the current health care system has seen costs continuing to outpace inflation in terms of costs even when the Affordable Care Act was introduced in 2010. Over the last 12 years, the prices of drugs have continued to rise by an average rate of 12% annually, which puts consumers at a disadvantage (White, 2018). The Federal Center for Medicaid and Medicare Services revealed that the entire health care services were circa $3.5 trillion in the year 2017, which translates to about 18% of the country’s gross domestic product. The above figures far outstrip any other in the world. The CMS further approximate that increment in costs will occur at 5.5% annually, which would translate to $5.7 trillion by the year 2026.

An inaction on the current state of the health care industry will lead to increased mortality rates. That 40 million Americans do not have the capacity to get insurance has led to a fall in life expectancy. According to statistics, 26% of American citizens having 18-64 years experienced issues paying their medical bills. Out of these population, 2% of them had been declared bankrupt. Moreover, the quality of care will also reduce if the status quo is maintained. Leaving the health care industry to private insurance players results in demotivated employees including nurses as investments are not made to improve the working conditions.

Evaluation of Options

            The primary objective of the policy option is to ensure that all United States citizens are insured and that the insurance covers taken by them are affordable. This would bring sanity to the healthcare industry by removing some restrictions such as disability support that currently exist in the present policy. In order to meet these objectives, the policy option elected must control the issue of out-of-pocket expenditure. The same should extend to premiums and other deductibles in order to make health care affordable. In cognizance of the above criteria, the following evaluation table will be used to determine the best option:

Policy Alternatives Score Card

           
Criteria Universal Health Care ACA Upgrade Plan Medicare Upgrade Plan #4 #5
Effectiveness ++strongly positive + positive +  positive    
Protection of rights ++ strongly positive ++ strongly positive ++ strongly positive    
Costs -negative +positive +positive    
Administrative feasibility +positive ++ strongly positive ++ strongly positive    
Political Feasibility –strongly negative -positive +positive    
Fairness ++ strongly positive +positive +positive    
Evidence-Based Practice –strongly negative +positive +positive    
Environmental Effects -negative +positive +positive    

 

The Final Policy Problem Statement: The existing insurance market is biased towards the private insurance players with unregulated costs making it expensive for a majority of Americans. As a consequence, most Americans do not have insurance services while those who have them may not afford certain services due to disqualification by the existing policies. However, there is need to introduce a policy that regulates the out of pocket payments, deductions, and one that addresses the issue of drug prices.

Recommended Solution

            The list provided in the alternative policies entail three solutions that may be utilized to address the issue of insurance coverage in the United States. Among the three alternatives, the Medicare Upgrade Plan looks the most likely to offer solutions to the issues that are affecting the health care insurance sector in the United States. The principles of the plan has borrowed heavily from the Medicare for All Plan with regards to limiting the out-of-pocket payments and allowing everybody to become insured irrespective of their age and levels of income. It would be argued that Sander’s main objective is to have everybody insured in the United States while keeping the costs as low as possible. To this end, the Medicare for All succeeds in doing just that and as such it would be a good solution to the problem that has formed the backbone of the present analysis.

Moreover, in addition to addressing the glaring gaps in the insurance industry, a policy needs to receive backing from both the liberals and conservatives of the country. Whereas one could argue that the Universal Health Coverage option is the most ideal, it is far too radical even for moderate Democrats. As such, it would be easier to adopt the Medicare Upgrade Plan. Whereas the plan works to regulate the prices of medicine and ensure that none of the beneficiaries pay exorbitant out of pocket fees, it sustains the private insurers in the market. The fact that private insurers have a role to play in the market makes the plan appealing to both Republicans and moderate Democrats that do not support the radical proposal by Medicare for All to eliminate private insurers from the market altogether.

            Lastly, the adoption of the Medicaid Upgrade Program is preferred as it protects consumer rights. Given the greed that has permeated the insurance industry, it becomes important to create a policy that would protect consumers against insurance companies. By ensuring that the medication costs are integrated and that out of pocket ones are limited, the consumers of the health care plan will be sufficiently exploited against exploitation. In addition, the administrative feasibility of the plan is strongly positive, implying that the program will not burden the federal government with exorbitant costs. Therefore, Medicare Upgrade Plan should be used instead of the more radical Medicare for All.

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