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'Everybody In, Nobody Out': What We Know So Far About the Medicare for All Act of 2019


Yes, I have rejected in very firm language several recent demands for me to sign a BS petition endorsing the bill that had not even made public yet. It appears that the version that will be introduced is now available for inspection and discussion, and this extended article from a source other than NPR (much less CNN) is the best news we have had on this issue since Sanders’ bill over a year ago. I have not read the entire article, but it looks as if the Jayapal-Sanders bill will be better than HR676 in several areas, not least the transition. The notion that we could “repeal and replace” 18 percent of the US economy with several hundred thousand innocent working stiffs was one of my chief complaints. Two years is pushing it, but probably the most pragmatic plan.


That is simply not true. This proposal and all other serious ones make it quite clear that the “improved and expanded” MFA beurocracy will pay providers directly out of tax revenues collected for the purpose, earmarked in perpetuity for that sole purpose as with Social Security itself. If you have specific documented information to the contrary please provide it.


Did you even READ the section, What About Investor-Owned Facilities?, specifically the last sentence of it? I for one would prefer a system owned and operated by Us the People as represented by the horrendously corrupt federal government. But that is simply not going to happen and has never been a significant part of the discussion in this country. It is the financial sector (how care is paid for) that is the great bulk of the problem, and plenty of other countries enjoy excellent health care at reasonable cost with such mixed systems.


I completely agree with everything you’ve said. I too have been more than a bit harsh towards Rep. Jayapal, but it’s hard not to. Her office could have at least let everyone know that nothing would be shared to the public, and for these reasons… That would have gone a long way toward ramping down the rhetoric and hysteria.

I noticed too that provision about every resident “would be eligible for coverage”, and think that must be resolved. I don’t think people need to walk in with zero identification, but regardless of your status in the United States, you should be covered if you get sick, break a leg or get into some other medical trouble. And like many other countries, there should be no bill at the point of service or appearing in the mail days or weeks later like today’s healthcare insurance providers do regularly!


I wish the article had discussed if Jayapal’s bill separates operating and capital budgets as part of global budgeting process. This is crucial in planning and future distribution of medical resources in the new system . It also drives out some of the motivation that lead non-profits to act like for profits.


Interesting point. Is this discussed in either of the previous bills?


So you’re saying that every country that covers medical care for its residents, is fascist?

That’s absurdism, right?


Waiting for more about insurance industry vs government as the single payer of bills.

Details vague on that now - Day and Dudzic talk about “transition benefits for any healthcare and insurance industry workers displaced by the transition” and “extend[ing] a single-payer plan to about half the population” during the transition.

What about other half of population? Do they stay on private insurance and, if so, do they pay taxes into the govt monies for single payer?

Also mention “transition periods to try to catch people who may lose their insurance if private insurance plans go under or refuse to write coverage after passage of the single-payer bill, which is likely.”

“If” insurance goes under? “Which is likely?” Meaning? Believe HR676 allocated retraining/money for massive insurance industry downsizing that positively would happen.

No point second guessing if it’s going public soon…


Bernie and Jayapal would not do that to the American health care consumer. Take your bullshit elsewhere.


The insurance companies should have no role in a properly designed Medicare for All system.


You’re overthinking. The article states clearly–at least to me–that the insurance industry (currently the payer of perhaps 25 percent of all medical bills) will cease to exist over the course of a two-year transition period (or possibly 3-4 years). At the end of that period, all medical bills would be paid by the federal government, which currently pays about 65 percent through Medicare, Medicaid, the VA, and several smaller programs, with individual households paying the rest through deductibles and co-pays.

That’s the short story. State governments pay a share of Medicaid. But in the big picture, We the People will continue to pay ALL of the costs, as we always have, just not sops for the “investors” (stockholders) who “own” the insurance industry.

The fine details of the structure of the transition are yet to be worked out. That will occur as the bill is debated in Congress, with the usual suspects trying to kill it at every step of the way. Presumably the “half the population” who would fall under the new single-payer system at the midpoint of a two-year transition would consist of a portion of the under-65 population, plus the currently uninsured and those who would lose their private insurance as that industry is shut down.

The reference to “transition benefits for any healthcare and insurance industry workers displaced by the transition” means just what it says. Unlike what happens to workers when an investor-owned company (corporation) shuts down (cf. Toys Were Us), the plan is that the workers displaced in this case would receive severance pay, unemployment benefits, and retraining/relocation assistance.

This is a monster of an operation, changing radically the financial structure of 18 percent of the US economy. A loose army of very knowledgeable people have been working on it for 30 years, having gained much of their knowledge from the experience of the many countries which have already made this transition.


All good points. But who cares? Why answer questions? Opponents surely won’t ask them.


It often has nothing to do with legal issues, but everything to do with producing an actual, serious bill. Just like any project (think about your work), it’s doomed to failure if if too many cooks are in the kitchen. That’s why there’s an organized committee review process in Congress where legislators—the people we elect to write laws—review introduced legislation. Third parties can have plenty of input during this process if a legislator turns to them for guidance, and third parties can include you, especially after a bill is posted.

Oh, and note how this article calls HR 676 a “messaging” bill. That’s key. Bills with zero financing (like California’s recent single payer bill) and drafted absent significant components are what make up the bulk of non-enacted legislation. They are also called “showboat” measures. They are so a politician can say they did something, or are for something, especially during elections. In the past, when I’ve pointed that out, I’ve been called a sellout who can’t see corporate control of our politics, etc. Hopefully this article will dispel with that idea now. A lot of legislation is written in state-after-state with no real intention of it becoming law. That doesn’t mean such legislation can’t play an important role in getting ideas into circulation though, which HR 676 did.


Regarding the issue of disallowing for-profit entities to deliver health care services within the Improved and Expanded Medicare for all system, …

I have never been clear on exactly how that gets prevented in real life. There are lots of situations where nonprofit entities run hospitals but subcontract out some specific operations to for-profit companies. For example they might hire a private sector company with expertise in cyber security to program and maintain their electronic records systems.

I have heard that Catholic Hospitals often subcontract essentially all hospital administrative functions to for-profit companies and that fact is key to why Joe Kennedy III has failed to endorse HR676 in past sessions of Congress.


Truly lucid and helpful, economagic!


Everything I work on is on a server available to read by everyone on the project and we share across projects to maximize reuse. We don’t share with the general public but a world where literally everything is open including business communication and documents is even beyond my pie in the sky one where the government is much more open. I’d love it if we had that kind of open and cooperative world but I don’t dream quite that big.

Anyway we’ve covered this ground before and I’m mostly on the same page as you wrt moving forward with a unified bill (something I’ve been wanting since Bernie’s bill came out). Hopefully this new bill will be on the public site soon and we’ll have many interesting things to discuss.


Thanks – glad you could use it!


Well said. Absolutism, aka black/white or either/or thinking, aka Manichean thinking, aka binary thinking, is a bar to understanding and is at odds with reality.


I have a good friend that works in an administrative capacity at a public hospital. Many services are actually contracted out, including to physician groups, just as they are for janitorial services. We’ve touched on this before, but a dirty little secret is physician groups often benefit from elusive pricing strategies, and often charge bill rates apart from hospital admission. In a sense, they are like a sought-after hair stylist, that overcharges clients, that a salon owner nevertheless contracts a chair to in the hopes of bringing in and keeping business. It really is an issue that demands attention, but the pushback, as when pricing disclosure was proposed in ACA negotiations, will be fierce.


i had exactly the same thoughts and hesitation about this promotion of the still-not unveiled proposal.