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Sen. Bernie Sanders (I-Vt.) has introduced substantive single-payer legislation in the U.S. Senate. The Medicare For All Act (S.1129), which was filed April 10, 2019, would establish a universal single-payer health program to ensure care for all residents of the United States.

full legislative text:
https://www.congress.gov...

PERI economic analysis:
https://www.peri.umass.edu...

options for financing single payer:
https://www.sanders.senate.gov...

PNHP press release:
https://pnhp.org/news...

Overview of the bill

Based on our analysis, we find the Medicare For All Act of 2019 to be a significant step forward in the fight for single payer. Taken together with Rep. Pramila Jayapal's Medicare for All Act ( H.R. 1384), it would transform the U.S. health care system, making health care a human right.

How can the bill be improved?

Based on decades of careful analysis and research, PNHP recommends several improvements to the Medicare for All Act that would save even more money and improve patient care:

Fund hospitals through global budgets, with separate funding for capital projects: A "global budget" is a lump sum paid to hospitals and similar institutions to cover operating expenses, eliminating wasteful per-patient billing. Global budgets could not be used for capital projects like expansion or modernization (which would be funded separately), advertising, profit, or bonuses. Global budgeting minimizes hospitals' incentives to avoid (or seek out) particular patients or services, inflate volumes, or upcode. Funding capital projects separately, in turn, allows us to ensure that new hospitals and facilities are built where they are needed-not simply where profits are highest. They also allow us to control long term cost growth.

End "value-based" payment systems and other pay-for-performance schemes: This bill continues current flawed Medicare payment methods, including alternative payment models (such as Accountable Care Organizations) established under the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Studies show these payment programs fail to improve quality or reduce costs, while penalizing hospitals and doctors that care for the poorest and sickest patients. PNHP recommends that Sen. Sanders end all value-based payment and pay-for-performance programs, as outlined in Section 903 of Rep. Pramila Jayapal's single-payer bill, H.R. 1384.

Establish a national long-term care program: This bill includes home- and community-based long-term services and supports, a laudable improvement from the 2017 bill. However, institutional long-term care coverage for seniors and people with disabilities will continue to be covered under state-based Medicaid plans, complete with a maintenance of effort provision. PNHP recommends that Sen. Sanders include institutional long-term care in the national Medicare program, as it is in Rep. Pramila Jayapal's single-payer bill, H.R. 1384.

Ban investor-owned health facilities: For-profit health care facilities and agencies provide lower-quality care at higher costs than nonprofits, resulting in worse outcomes and higher costs compared to not-for-profit providers. Medicare for All should provide a path for the orderly conversion of investor-owned, for-profit health-care providers to not-for-profit status.

Fully cover all medications, without copayment: Sen. Sanders' bill excludes cost-sharing for health care services. However, it does require small patient copays (up to $200 annually) on certain non-preventive prescription drugs. Research shows that copays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.

Building momentum for single payer

See below for a list of current Medicare For All Act co-sponsors. It is important to build as much support for single payer as possible, and you can help!

1. If your senators have already co-sponsored the Medicare For All Act, call and email to thank them. Also, ask them to help improve the bill by covering institutional long-term care, establishing global budgets for hospitals, ending pay-for-performance schemes, banning investor-owned health facilities, and fully eliminating copayments.

2. If your senators have not cosponsored the Medicare For All Act, call and email to encourage them to co-sponsor. If you believe one or both of your senators may be skeptical, visit pnhp.org/gop to brush up on the conservative case for single payer.

To find your senators by state, click here. If you have trouble locating contact information for your senators, you can always call the U.S. Capitol switchboard at (202) 224-3121.
Current co-sponsors:
Introductory Press Conference

Sen. Sanders was joined by several co-sponsors, leaders from National Nurses United and the American Medical Student Association, and other health justice advocates to introduce the bill on April 10, 2019. PNHP live-tweeted the press conference (be sure to follow us @PNHP).

Media Coverage

Bernie Sanders puts focus on healthcare with Medicare for All bill
By John Whitesides
Reuters, April 10, 2019
U.S. Senator Bernie Sanders unveiled the latest version of his ambitious "Medicare-for-All" plan on Wednesday, moving the healthcare debate among Democratic presidential contenders to center stage in the 2020 race. Continue reading...

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Understanding the Medicare For All Act of 2019 - PNHP

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Sen. Bernie Sanders (I-Vt.) has introduced substantive single-payer legislation in the U.S. Senate. The Medicare For All Act (S.1129), which was filed April 10, 2019, would establish a universal single-payer health program to ensure care for all residents of the United States. full legislative text: https://www.congress.gov... PERI economic analysis: https://www.peri.umass.edu...

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The United States should require all of its citizens to vote. Doing so will push back against voter suppression and tear down barriers to participation because the best way to protect the right to vote is to underscore that it is also a civic duty.

This is the message of a report issued this week by the Universal Voting Working Group, a joint initiative by the Brookings Institution and the Ash Center for Democratic Governance and Innovation at Harvard's Kennedy School. Its opening words:

"Imagine an American democracy remade by its citizens in the very image of its promise, a society where the election system is designed to allow citizens to perform their most basic civic duty with ease. Imagine that all could vote without obstruction or suppression. Imagine Americans who now solemnly accept their responsibilities to sit on juries and to defend our country in a time of war taking their obligations to the work of self-government just as seriously."

We argue that the United States should require citizens to participate in elections as Australia and two dozen other nations do. As it is with jury service, so it is with voting: Asserting a civic duty is the best way to guarantee the right this duty entails. Our report, " Lift Every Voice: The Urgency of Universal Civic Duty Voting," aims to build on the achievements of the civil rights, voting rights and democracy movements by continuing to push for a series of reforms to ease access to the ballot box and make voting simpler and easier.

Our working group was under no illusions that mandatory participation in elections would be adopted quickly or easily in the United States. Between now and November 2020, there is much that needs to be done simply to ensure that voters will be able to cast ballots safely. For the medium term, we urge that the first steps toward universal civic duty voting might begin with local or state experiments of the sort that have, in our nation's past, pushed good ideas to the national stage.

But we also hope to shake up the nation's voting debate to lay out an expansive vision of what our democracy could and should look like, and to show that this idea, which has only rarely entered the American debate, is exceedingly practical. Australia has had mandatory participation on the books for nearly a century, and it has worked.

Over the course of 18 months, our working group studied systems of universal voting, met with civil rights, voting rights and democracy advocates, immigrant rights groups, state legislative organizations, election officials at all levels, and many others to refine our ideas and create a detailed policy proposal.

Our intervention reflects a sense of alarm and moral urgency, but also a spirit of hope and patriotism. That we consider 50% turnout in midterm elections a historical achievement (as was the case in 2018) should be a warning. The disparities in turnout between different groups, detailed in our report, are equally worrying. Boosting turnout, we insist, is a matter of justice and representation. This mandate also takes seriously the Declaration of Independence's insistence that political legitimacy depends on the "consent of the governed." Our turnout levels, at 60 percent on the high end in presidential elections and 40 percent in the typical case in midterm elections, means that elected leaders earn their legitimacy from a small group of individuals even in landslide elections. This suggests that many voters are withholding their consent from our government, passively in some cases and actively by the most alienated voters.

Civic duty voting shifts elections from an "opt-in" to an "opt-out" system. It does not force voters to elect any one candidate and therefore, we believe, it survives constitutional muster. In addition to allowing for a wide variety of exceptions to the voting mandate, the policy laid out in the report also encourages None of the Above options to be added to the ballot. Any civic duty voting policy should allow for religious and conscientious objection to voting.

Casting a ballot in countries with civic duty voting is often easier than it is in the United States. Registering to vote is a straightforward and accessible process, if not automatic; requesting a ballot or finding your polling place typically does not require calls to your local supervisor of elections or constantly checking online resources to ensure that your polling location has not changed; and voting in person does not mean standing in line for hours.

Many opponents of compulsory participation worry about imposing penalties on non-voters. We are careful to insist that fines for non-voting not be more than $20, that neither civil nor criminal penalties would be imposed for not paying the fine, that the amount would not compound over time, and that it would be set aside for those willing to meet a modest community service requirement. Included in the proposal is a conscientious objector provision for those who have religious or moral qualms about voting, and provide a wide range of legitimate reasons voters could give to escape any penalties. In Australia, only 13 percent of non-voters ever have to pay the penalty. Our emphasis is not on imposing sanctions but on sending a strong message that voting is a legitimate expectation of citizenship in a nation dedicated to democratic self-rule.

At a time when our nation is in the midst of a new struggle to end entrenched racial injustice, we see universal voting as a way to amplify long-suppressed voices. The John Lewis, whose loss we mourn and whose life we celebrate, risked his life again and again on behalf of voting rights and full participation. "Voting access is the key to equality in our democracy, Lewis declared. "The size of your wallet, the number on your Zip Code shouldn't matter. The action of government affects every American so every citizen should have an equal voice."

Our proposal is rooted in the obligation of all citizens to our democracy and represents an effort to make our system more equal and more participatory. We hope it can serve as a spur for a new and more vibrant democracy.

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Amber Herrle and E.J. Dionne urge the U.S. to adopt mandatory voting. They stress that penalties for non-voting should be minimal and that religious or conscientious exemptions should be granted, but that voting is a core civic duty and that fair representation is necessary for a just democracy.

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The United States should require every eligible American to vote - or at least participate - in general elections.

As states and municipalities strive to make the 2020 elections full and fair amid political controversy and the limitations imposed by the pandemic, it should be remembered that even in normal times, our elections have two crucial shortcomings: low voter participation and an electorate that does not reflect the nation's increasingly diverse population.

The solution to both problems is straightforward: Make voting a universal civic duty. Mandatory voting is already in place in 26 countries, including Argentina, Australia, Belgium, Ecuador, Greece, Singapore, Switzerland and Uruguay.

In Australia, participation in elections has been mandatory since 1924. The government, political parties and civic groups all work to educate citizens about their responsibilities and to make voting fully accessible to all. Election day, which falls on a weekend, is treated like a community celebration. Although participation is mandatory, choosing a candidate is not: Voters can cast a blank ballot or provide a "valid and sufficient reason" to abstain. After each national and state election, those who did not participate are sent a letter asking why. If no reason is supplied after two attempts, the nonparticipants are fined the equivalent of about $15.

The system is widely popular in Australia and functions well in other countries too. Yet there has been virtually no discussion of this potentially game-changing policy in the United States. We are now seeking to change that.

For two years, 27 scholars and advocates, including the two of us, have studied mandatory voting. Our conclusion is that adopting universal civic-duty voting in the U.S. would have major benefits for American democracy.

It would dramatically increase participation in elections. In Australia, Belgium and Uruguay, participation rates have remained near 90% for the last two decades. In the 2018 midterms, the U.S. achieved a much-touted record turnout, but still only an anemic 53.4% of eligible voters cast their ballots; in 2014, the figure was 42%.

Mandatory participation would also diminish the demographic skew at the ballot box. Voting rates now vary dramatically by income, education, age and race. Although African Americans vote in higher proportions than whites when income is factored in, communities of color, especially African Americans, have faced a variety of voter suppression policies and tactics.

One reason jury service is mandatory is to assure that jurors will reflect the population as a whole, and that, as a result, they will render fairer judgments. The same logic applies to voting. Near universal participation among America's racially and ethnically diverse voting-eligible population will yield more equitable and responsive representation.

The adoption of universal civic-duty voting could also help shift our election laws away from policies that, intentionally or not, keep some groups from the polls. It would encourage same-day registration, ending felony disenfranchisement, pre-registering 16- and 17-year-olds, paid leave to vote, and expanded early and mail-in voting. Schools would have a strong incentive for robust civic education to prepare 18-year-olds to vote. Civic organizations could invest more in public education about voting, and spend less on driving voter turnout.

It's even possible that political campaigns would change for the better. If everyone is voting, then everyone is listening, and candidates and parties will need to make efforts to attract broad support, rather than focusing solely on rallying their base supporters and discouraging turnout on the part of their opponents.

There will be resistance to the idea of civic-duty voting. Libertarians will object to another government mandate, and challenge the idea's constitutionality. Among advocates for low- income and historically marginalized communities, imposing even a small fine may raise alarms. And some may worry that a voting requirement would encourage ineligible voters to participate.

We took all these objections very seriously.

We believe the proposal is constitutional, since a blank ballot, a vote for "none of the above" or acceptance of a conscientious objection to voting will assure all voters of their ability to "speak" as they wish. Our current system has effective safeguards in place that, coupled with public education, can ensure against inadvertent violations by ineligible voters.

As for enforcement, states and municipalities can offer community service as an alternative to paying a fine, or they could employ incentives as opposed to penalties to minimize potential adverse effects of whatever enforcement mechanism, however slight, is in place.

This election year, the United States finds itself questioning old assumptions and seeking new ideas to further its goals of justice and equality. For those of us who have fought for decades against voting restrictions and for the right of communities of color to have their voices fully heard, universal voting is a powerful innovation. In this moment of reckoning and change, it could be a giant step toward a truly inclusive democracy.
Miles Rapoport, formerly Connecticut's secretary of the state, is a fellow at the Ash Center for Democratic Governance and Innovation at the Harvard Kennedy School. Janai S. Nelson is associate director-counsel of the NAACP Legal Defense and Educational Fund.

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Op-Ed: One fix could change U.S. politics, government and elections for the better: Make voting mandatory

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The United States should require every eligible American to vote - or at least participate - in general elections. As states and municipalities strive to make the 2020 elections full and fair amid political controversy and the limitations imposed by the pandemic, it should be remembered that even in normal times, our elections have two crucial shortcomings: low voter participation and an electorate that does not reflect the nation's increasingly diverse population.

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As we head into South Carolina's primary and gear up for Super Tuesday, the 2020 candidates are looking to stand out to voters. But perhaps no policy proposal has marked this election more than Sen. Bernie Sanders's push for Medicare for All.

While the Democratic candidates agree on expanding health coverage, they're divided on how to insure everyone, whether to insure everyone, and, of course, how to pay for it all.

So how are they similar? How are they different? And how does that compare to President Trump?

Rachana Pradhan, correspondent for Kaiser Health News; Noam Levey, national healthcare reporter for The LA Times; and Dan Diamond, health reporter for Politico and host of the "Pulse Check" podcast helped us break down where each candidate stood on health care.

Like what you hear? Find more of our programs online.

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"The 150 million Americans who do have insurance increasingly can't afford to go to the doctor because they have $2,000 deductibles," says health care reporter Noam Levey.Want to support 1A? Give to your local public radio station and subscribe to this podcast. Have questions? Find us on Twitter @1A.

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Listen to Today, Explained episodes free, on demand. News comes at you fast. Join us at the end of your day to understand it. Today, Explained is your all killer, no filler, Monday to Friday news explainer hosted by Sean Rameswaram and featuring the finest reporters from the Vox Media Podcast Network and beyond.