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Prepared by the Lowcountry Indivisible Healthcare Issues Team. August 2019




Part A – Medicare for All, vs. Universal Access / Universal Coverage

Part B – Essential Elements of Healthcare Policy

Part C – Essential Elements of Health Plan Coverage



Medicare for All is a popular term being used by many Democratic presidential candidates and leaders.  The LCI Healthcare Issues Team believes a more practical and achievable goal is Universal Access, Universal Coverage. Medicare for All is really just a brand for what is known as “single payer”. The only industrialized nations that actually have a single payer model are Great Britain and Canada. All other developed countries, excluding the US, have achieved Universal Access, Universal Coverage using some well regulated combination of private, nonprofit insurers and government programs. Every one of their citizens is guaranteed access to high quality, affordable health care.


The LCI Healthcare Issues Team believes that not only is Medicare for  All not safely achievable in any short time frame, it could also dramatically destabilize the opportunity for major Democratic wins in 2020 (i.e. goodbye Blue Wave).


Our reasons for this are several:  

  1. Many citizens, Democrats as well as Republicans, do not want to forfeit their employer sponsored coverage for the unknown. They will resist such change with votes against Democratic candidates. In addition, the loss of employer based funding streams into the health marketplace would dramatically increase the national deficit.

  2. A more gradual change, as described in the next section, can avoid dramatic employee layoffs in the healthcare sector and insurance sector. Such layoffs would likely spur a recession equal to the one created in 2008 when banking and Wall Street were allowed to blindly take enormous risks seeking greater profits for stockholders.   

  3. A gradual transition would be based on citizens and corporations growing more comfortable with a system that includes an expanded role for government. As comfort grows, they will, over time, opt for the transition to a government regulated, Universal Access, Universal Coverage approach.


The LCI Healthcare Issues Team firmly believes in Universal Access, Universal Coverage; in other words, assuring that every person in America has adequate health insurance coverage. It could begin by Congress establishing, by statute, that healthcare is a right and not just a privilege for those who can afford it. Other bipartisan legislative steps would include:

  1. Strengthen the Affordable Care Act, ACA (ObamaCare) by repairing the damage done to it by the Trump Administration and improving the parts that could perform better after initial experience. Establish Medicare as an option on the Marketplace.

  2. Allow employers and employees to continue employer sponsored insurance so long as it meets the ACA minimum standards.

  3. Strengthen Medicare, Veterans Administration health program and expand Medicaid in all states.

  4. Enroll individuals not covered by these programs to buy into Medicare or Medicaid at reasonable or subsidized rates.


With all Americans covered and getting access to needed primary, specialty and preventive care, health care parameters such as life expectancy, maternal / infant mortality and chronic disease morbidity would be expected to improve dramatically to become on a par with other developed countries with universal care. Also, the devastating impacts of not having access due to a lack of insurance would disappear. As more and more citizens get care through one of the government programs in #3 and #4 above, employers will eventually see the wisdom of getting out of the health care benefits role they took on as a default position in the 1950s. Their alternative would be subsidizing employees as they enroll in a Medicare Choice program.  Employers would benefit by eliminating the unwelcome burden of being in charge of health plan design, contract administration and employee grievances relative to onerous insurer regulations. Consequently, Universal Access, Universal Coverage becomes a much simpler transition, but one that takes time.


In addition, traditional insurance companies would retain some business lines relative to Medicare Advantage, specialty boutique plans (such as cosmetic surgery) and continuing  the role many of them play today as a claims administration subcontractor to the federal government.





As the federal government takes on more responsibility for healthcare as a right for all Americans, the following policies should be part of any presidential candidate platform:

  • Guaranteed coverage for pre-existing conditions

  • Limits on cost sharing by enrollees

  • Low income individuals and families should get subsidies to assure that they have as high a quality of care as do the wealthy

  • Employee populations, when under adequate employer sponsored coverage, should have the right to retain that coverage so long as it exists.

  • Affordable access to needed medications guaranteed by either legislation or government regulation.


The following health plan elements must be included in any health plan, regardless of it being employer or government sponsored. (Note, items with an asterisk are currently required under the ACA).    

Relative to all populations regardless of age or gender:

  • Inpatient and outpatient physician care *

  • Inpatient and outpatient hospital care *

  • Emergency services *

  • Laboratory services *

  • Rehabilitation and rehabilitation devices*

  • Preventive care, including annual primary care physician exams and immunizations*

  • Prescription drug coverage*

  • Broad, open networks of providers

  • Mental health and substance abuse treatment*

  • Home health care


Relative to plan elements focused on women:

  • Maternal and childbirth care*

  • Mammography*

  • Preventive gynecological exams*

  • Birth control coverage*

  • Breast feeding and lactation support*

  • Family planning services*


Relative to plan elements focused on children:

  • Well child physician visits*

  • Dental services *

  • Vision services*

  • Pediatric specialty care, including neonatal intensive care


Health Plans that go beyond essentials may be preferred if they offer:

  • Adult vision services

  • Adult dental services

  • Long term care coverage

  • Transportation services for the disabled or frail elderly

  • Community based social services designed to support individuals with physical or mental challenges or an inability to independently sustain activities of daily life

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