Preparations have begun and plansare being drawn for the 2020 presidential campaign. As candidatesmake their way to your backyard to discuss their agenda, you cancount on health care reform being high on the list of policy topicsdiscussed.

Both proposals, Medicare for All (M4A) and Medicare at 50(buy-in plans), are sure to make their way into campaign speechesacross the country. With much debate, voters are likely to backcandidates that take a strong stance on the topic — one way oranother.

With boundless political partisanship on the topic, there is onemajor aspect to discuss with all politics set aside: What will theproposals mean to the U.S. health care system as a whole?

Medicare for All

Having a single-payer system has been proposed multiple times inthe U.S., all with little chance of being passed. However, thecurrent Medicare for All proposal is led by presidential candidate,Bernie Sanders, along with 14 co-sponsors in the Senate — the mostmomentum a proposal of its kind has had up to this point. The billaims to:

• Form a single-payer, government-run plan that would cover U.S.citizens and non-citizens alike for services like:
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  • Primary and preventive care
  • Prescription drugs
  • Dental and vision care
  • Mental health and substance abusetreatment
  • Maternity care
  • Long-term care and more
• Eliminate all copays and deductibles for doctor visits andhospital stays
• End private insurance as a whole, making it illegal for aprivate company to offer coverage for anything covered underM4A

Amidst conflicting statistics on the proposal's popularity amongAmericans, the Kaiser Family Foundation found that 55 percent ofU.S. voters believe that "Medicare for All" would allow an optionfor those without insurance to receive coverage, but do not view itas a complete elimination of private insurance.

Impact on hospitals

There is no question that when it comes to payments, doctors andhospitals get paid out significantly less by original Medicare thanby private insurance companies. The American Hospital Associationfound that in 2016, Medicare covered an average of 0.87 of everydollar spent on care, while private insurance companies cover 145percent of the hospitals' costs.

As many hospitals already find their financial situations to beless than satisfactory, the addition of more patients being coveredby a Medicare program could only further the strain. The risk runshigher for hospitals in rural areas, where fewer patients andservices make it difficult to keep the balance sheet in check. Ifthese hospitals are forced to balance the hardship of being ruralalong with partially covered bills as a standard, some opponentsfear that it could lead to hospital closures in some areas.

Impact on doctors

If passed, Medicare for All would mean that doctors wouldparticipate in an agreement with Medicare where they would bereimbursed for claims. The good news is that many doctors alreadyaccept Medicare in an agreement like this. However, they typicallycount on a mix of payments from private insurance, patientout-of-pocket and Medicare combined.

Moving to a single-payer system would mean lower pay as astandard. There are some concerns that this will create difficultyin sustaining a practice for many doctors.

Moreover, a single-payer system could add to an existingshortage of physicians. The Association of American Medical Colleges recentlypublished data that predicts by 2032, our country will have ashortage of 122,000 physicians. This data is based on the healthcare system as it currently stands.

Impact on patients

Patients in the United States will experience, arguably, themost dramatic change to health care as they know it. The best datawe can go off when it comes to patient care on a single-payer planis that of other countries operating in a similar system.

Remember that with this proposal, we are talking about acomplete elimination of private insurance. According to a 2017survey from the CDC, there was 136.6 millionAmericans on a private health insurance plan. (Note, this numberdid not include the millions aged 65 and older who rely on privateMedicare Advantage and Medicare Supplementalplans). This would mean hundreds of millions of people would beforced out of their private coverage.

When it comes to patient care, we can look to single-payerCanada, where the data shows that patients wait an average of 20weeks from the time they are referred to a specialist to the timethey are able to see the specialist. For major tests like MRIs, theCanadians wait an average of 10 weeks before being seen.

In 2018, the Fraser Institute said in a report conclusion onwait times:

"Research has repeatedly indicated that wait times formedically necessary treatment are not benign inconveniences. Waittimes can, and do, have serious consequences such as increasedpain, suffering, and mental anguish. In certain instances, they canalso result in poorer medical outcomes — transforming potentiallyreversible illnesses or injuries into chronic, irreversibleconditions, or even permanent disabilities."

As an American married to a Canadian citizen, I've alsopersonally watched one of my in-laws wait years (with significantpain) for an MRI. When she finally had the exam performed, thetumor on her spine was so significant in size that she wasscheduled for surgery immediately. Fortunately, the tumor turnedout to be benign and she is now able to walk without pain. However,I've never gotten over wondering how differently this story wouldhave ended if a malignant tumor had been left to grow inside herbody all that time.

So, there is certainly cause for concern that a single-payersystem in the U.S. might cause further physician shortages andlonger patient wait times. The answers will depend upon the payavailable to providers and their staff, how the general publictreats "free" health care, and how the Medicare infrastructurewould be able to adapt to include an entire nation ofbeneficiaries.

The outlying nuances and lingering questions should serve as areminder to all Americans that moving to Medicare for All is largerthan a mere political stance. It would completely overhaul ourhealth care system.

Medicare at 50

Another Medicare proposal coming to a campaign rally near you isthe "Medicare at 50 Act." This more moderate proposal is a buy-inoption for people ages 50 to 64 who want to get on Medicare plansprivately administered through exchanges. This would allow earlyretirees and those forced off their group plans to receive a solidgovernment-backed health care plan.

Senators in support of the bill argue that a less dramatic planlike this would not force anyone to switch plans and would also befar less expensive than a Medicare for All overhaul. Legislationlike this has been proposed in the past without much success, butit's likely that heading into the 2020 elections, it will be moreseriously considered.

When considering how Medicare at 50 would impact our health caresystem, the data points again suggest lower payouts to hospitalsand doctors but in a much less dramatic fashion than Medicare forAll. Hospitals and doctors will still have the balance of patientswith private coverage paying adequately versus lower Medicarepayouts.

Since Medicare historically reimburses health care providers ata lower rate than private insurers, the buy-in program couldpotentially offer lower premiums for beneficiaries. We also wouldexpect the quality of care to be similar to how Medicare Advantageplans currently cover beneficiaries.

Like any legislation on the table, Medicare at 50 has pros andcons; but there is no question that its impact on our health caresystem would be easier to manage than a complete transition tosingle-payer. Additionally, patients in the 50-64 age range wouldreap the benefits of quality health care, with the decision tobuy-in still in their hands.

Since Medicare at 50 would cause less radical change, it may endup being the option that we see some more moderate candidatesembrace so that they can show they are committed to reforminghealth care in America, while not completely ending the entireprivate health insurance system as we know it. If nothing else, thetwo proposals will make for a very interesting election seasonaltogether.

Do you have thoughts on Medicare for All or Medicare at 50? I'dlove to hear them.

About the Author: Danielle K. Roberts is a MedicareSupplement Accredited Advisor, member of the Forbes Finance Counciland co-founder of Boomer Benefits located in Fort Worth, TX. Heraward-winning agency is licensed and appointed in 47 states and hashelped tens of thousands of Medicare beneficiaries understand theirbenefits since 2004. Since starting her agency nearly 15 years ago,she and her brother have grown their company into amulti-million-dollar business that employs workers of all ages.They were recently awarded the 2019 Health Insurance Advisory Firmof the Year Award by Finance Monthly.