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all cosponsored Sanders’s
legislation.
The bulk of the Sand-
ers bill would be paid for
by a 7.5% payroll tax on
employers and 4% from
workers’ paychecks. The
current system of Medi-
care and Medicaid would
be scrapped and replaced
with a significantly
more generous program.
Everyone in the United
States would be covered,
no opt in or out.
The big catch: You’d
lose your current em-
ployer plan. “The Medi-
care for All bills proposed
by Sanders ... would
effectively eliminate the
role of private health in-
surance providers,” Larry
Levitt, senior vice presi-
dent for health reform at
the nonpartisan Kaiser
Family Foundation, told
Fortune in an interview.
“The idea of eliminating
an industry and compa-
nies that are this large is
unprecedented.”
Under the plan, pri-
vate insurers would be
banned from competing
with government cover-
age, relegating them to
the role of selling supple-
mental insurance—table
scraps compared with
the $600 billion feast
that private insurance
is today.
Democratic politicians
are finding themselves
increasingly comfort-
able with that situation.
Harris told CNN’s Jake
Tapper, “Let’s eliminate
all of that,” referring to
the insurance industry
(she later softened her
stance). Gillibrand has
called it an “urgent goal.”
Wall Street is taking
that possibility seriously.
The S&P 500 Man-
aged Health Care Index,
comprising many health
insurance stocks, fell
10% between Feb. 26,
when House Democrats
introduced their own
Medicare for All legisla-
tion, and March 7. By
comparison, the index
was up nearly 15% in the
12 months preceding the
bill’s introduction.
It’s hard to overstate
the magnitude of such
an overhaul. United-
Health was ranked fifth
on the 2018 Fortune 500
list, grossing more than
$226 billion last year;
Anthem and Aetna (pre-merger with CVS) were
both in the top 50. Those
three companies alone
employed more than
364,000 people in 2017.
The prospect of all of
that simply vanishing
has the industry prepar-
ing for a fight. Last year
the nation’s largest hos-
pital, pharmaceutical,
insurance, and doctors’
lobbying groups formed
the Partnership for
America’s Health Care
Future (PAHCF), an
organization dedicated
to market-based health
care reforms—and push-
ing back on the specter
of Medicare for All.
“We want to build
upon the system that’s
working and fix what’s
wrong,” Lauren Craw-
ford Shaver, PAHCF’s
executive director, told
Fortune in an interview.
“In many of these Medi-
care for All proposals,
it’s very unclear what
they actually want to do.
They’re looking to start
all over. Why not pause
for a second and improve
what we have?” Shaver
points to polls showing
that Americans’ sup-
port of Medicare for All,
which is 71% if told it
would guarantee health
care as a right, falls to
37% when told it would
eliminate private health
insurance.
But insurers for the
most part haven’t offered
up a whole lot of sug-
gestions for fixing thecurrent private system
and feel little need to,
according to KFF’s
Levitt. “Right now, I’d
expect health insurers
to just trash the idea of
Medicare for All without
offering an alternative,”
he said.
That could be a
miscalculation. The cost
of private insurance has
been rising consistently,
and employers have in-
creasingly shifted costs
onto their workers—
while wages have largely
not kept pace.
Those financial reali-
ties and the frustrating,
jigsaw nature of U.S.
health care are fuel-
ing the enthusiasm for
Medicare for All.
The Sanders bill has
a zero probability of
passing before 2021.
But in a scenario where
Democrats win the
White House and total
control of Congress in
2020 (and nix the Sen-
ate filibuster), it’s not in
the realm of fantasy that
some form of Medicare
for All could pass.
Falling short, Demo-
cratic leaders would
still be likely to push
for expanded access to
Medicare (by lowering
the enrollment age to
55, for example).
If insurers can’t offer
a compelling alternative
to calm the swell, they
could soon find them-
selves fighting against an
industry-drowning tide.Kirsten GillibrandBernie sanderskamala harrisTHE Y ’RE ALL FOR
MEDICARE FOR ALL
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