So, uh, I'm neither American nor European. Could you explain the difference between Medicare for all and the expansion thing? I'm trying to understand why online leftists are using this of all things as a purity test.
This obviously has some of my biases in it (as a supporter of a hybrid universal healthcare system via medicare expansion) but I tried to cover it. The short answer: Medicare for All is single payer, Healthcare Expansion/Medicare Expansion would provide a public option available to anyone while allowing private insurance as well, aka a hybrid system, and both are considered universal healthcare in that healthcare insurance is a guarantee, regardless of ability to pay.
Medicare is the United States’ public healthcare for seniors and some chronically ill and Medicaid is the equivalent for low-income people; Medicare for all is the name for a proposed implementation of a single-payer healthcare system across the board in the United States. All people would be insured under one government-run system. For reference, relatively few countries have a true single-payer system; some non-American or European examples are Taiwan and South Korea. For those playing along in the United States, this is what Bernie Sanders supports and what online leftists think is the only universal healthcare option.
Healthcare expansion or Medicare expansion refers to what most mainstream Democratic hopefuls in the United States who were not specifically for Medicare for All supported. The Affordable Care Act of 2010 was a limited expansion (thanks to considerable pushback by Republicans). The main difference is that an expansion, particularly an expansion that is aiming for universal healthcare, would be a hybrid model. If you were insured through a workplace or school, or if you were wealthy enough to afford private insurance on your own, you could choose to keep that private insurance. If you did not have access to private insurance or if you preferred the public health insurance, you could choose that without eligibility requirements (vs. currently, where Medicare/Medicaid specifically require an age, condition, or income limit). Australia has this type of system. For those playing along in the U.S., this is what Joe Biden supports.
Both Medicare For All and a full Universal Healthcare hybrid system, under which anyone could chose Medicare/Medicaid but private insurance remained an option, would effectively solve the problem of people being uninsured - if you lose your job or work a job that doesn’t need to provide insurance, you can switch to Medicare without issue. The Online Leftist argument that anything but Medicare For All is a death sentence is an outright lie - universal healthcare through Medicare expansion would provide uninsured people with the same exact health insurance as Medicare for All, it just wouldn’t require people with private insurance to give it up. And the passage of the Affordable Care Act showed that many people who do have private insurance prefer it to Medicare (Americans who were not children at the time can probably remember Obama’s line “If you like your insurance, you can keep it”, which was used to criticize Obama after some people did in fact have to change insurances thanks to new requirements regarding what insurance has to cover), and attempting to pass Medicare for All would be incredibly difficult because it’s not what many voters want - even in a Democrat-controlled Congress and Senate.
Single Payer healthcare options have been proposed in several states, and have often failed. No state in the U.S. has ever officially barred private health insurers, which is a feature of single payer.
So: thinking that Medicare For All (or, generically speaking, single payer) is the only possible universal healthcare solution in the United States (or worse, that it is universal healthcare and a hybrid system is not) is not only completely incorrect (many countries have universal healthcare via a hybrid system, and have for decades) but sets people up for pushing for an option that is more likely to fail. It’s fine if someone prefers single payer, but a hybrid system will not leave the uninsured to die in the streets (it will provide insurance for them, in fact) and it’s far more realistic.
