As the health care debate heats up, it’s time to be clear about what Medicare for All is and what it is not. Medicare for All does not mean giving people the option to “buy in” to Medicare under our current health insurance system — what might be called Medicare for Some.

Members of Congress who support bringing everyone in America under one federally-administered health insurance program are proposing Medicare for All. Members of Congress who support opening up Medicare to people as an additional insurance option are proposing a Medicare buy-in, or, in plain English, Medicare for Some. Predictably, some Members of Congress support both.

Medicare for All is the bill, endorsed by nearly all the prospective Democratic 2020 candidates, still waiting to be brought before our lawmakers for a vote. It is an improved and expanded version of Medicare, the federal insurance plan for people over 65 and people with disabilities that covers care from most doctors and hospitals anywhere in the country.

As proposed, Medicare for All eliminates all of Medicare’s premiums, deductibles and coinsurance, adds new vision, hearing and dental benefits to Medicare, and offers better home- and community-based care.

Medicare for Some comes in many versions. But the concept would allow people to keep their commercial coverage or switch to Medicare. All versions of Medicare for Some keep the premiums, deductibles and coinsurance payments required under commercial insurance and the current Medicare program. Some versions maintain Medicare Advantage plans, a form of commercial insurance, in the Medicare program. One version opens Medicare to people 50 and older.

No version of Medicare for Some guarantees affordable care for all Americans.

While Medicare for Some appeals to our instinctive craving for more “choices,” it does not address the unsustainable cost increases that keep our commercial health care system from being as fair and effective as Medicare itself, or the health care systems in place in other developed countries.



Only Medicare for All will bring down national health spending and guarantee health care as a human right for every American.It does so by eliminating the profits, administrative waste and inefficiencies of commercial health insurance and using the collective bargaining leverage of all Americans to negotiate fair rates for doctors, hospitals and prescription drugs.

Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system. At the same time, Medicare for All — and only Medicare for All — will provide all Americans their choice of doctors and hospitals anywhere in the United States; we will no longer have to figure out whether services or providers are “in-network” or “out of network.” And only Medicare for All does away with nearly all out-of-pocket health care costs for individuals.

Photo: Molly Adams | Flickr

It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. And that does mean sacrifice.

Yes, you will have to give up the luxury of having a restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up the joy of paying premiums, deductibles and coinsurance. You no longer will be able to spend a lovely afternoon haggling with your insurer about authorizing your care and paying claims.

And you will lose the immense privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs.

What will Medicare for All give you in return? Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend — irrespective of where you work. And you will never risk losing your health insurance again.



No health insurance system is perfect. But commercial insurance has created unsustainable health care costs for the nation, with irrational and excessive doctor, hospital and prescription drug costs.

Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system.

As a nation, we pay twice what other countries pay for health care, for medical outcomes that are below average. As individuals, too many Americans lack access to the care they need, cannot afford rising deductibles and copayments, and are one medical crisis away from bankruptcy. And let’s face it: does anyone really enjoy dealing with Aetna, Anthem, Humana or UnitedHealth?

Now that the facts are straight, the challenge is to overcome the misinformation campaign mounted by those who benefit from the current system. In that debate, the 70 percent of Americans who currently support Medicare for All have on their side the one (and only) point that really matters: Medicare for All is the only winning policy solution to our collective health care crisis.