What Do The Midterms Mean For Medicare For All?
by Sanjay Kishore, Micah Johnson and Don Berwick - Health Affairs - December 3, 2018
Health care was the most important issue for voters in the 2018 Congressional elections, in which Democrats won a significant majority in the US House of Representatives. A major health care proposal supported by many Democrats is “Medicare for All”, which would create a publicly-financed, single-payer health insurance system for all Americans.
Many observers dismiss single-payer health care as a political non-starter , but this traditional view ignores an explosion of support for the idea in recent years. In one recent poll, over 70 percent of Americans said they would support “a policy of Medicare for All”, including 85 percent of Democrats and even 52 percent of Republicans. A subsequent poll asked “do you support providing Medicare for every American” and found nearly identical results, including majorities of support from respondents in the South, those who live in rural areas, and those who say they “lean conservative.”
Political leaders are responding to this surge. In 2017, 17 Senators and 124 Representatives sponsored or co-sponsored Medicare for All bills. In 2018, the Congressional “Medicare For All Caucus” launched, which had 76 members as of August 2018. Most of the likely Democratic contenders for President in 2020 have also announced their support. Even Barack Obama, who eschewed single-payer in favor of the Affordable Care Act during his Presidency, has now endorsed Medicare for All.
What insights do the 2018 elections provide into the future political prospects of Medicare for All?
House Of Representatives
In the 2018 elections, Democrats regained a majority in the House of Representatives, winning almost 40 seats back from Republican control in the biggest pickup for Democrats since the post-Watergate elections in 1974.
We analyzed the campaign platforms, bill co-sponsorship records, and public statements of the newly elected members of Congress, and found that the number of Representatives supporting Medicare for All has risen to at least 133, now representing almost 60 percent of the Democratic Congressional delegation (Figure 1).
These supporters include over 100 incumbent co-sponsors of H.R.676 who won re-election (H.R.676 is the Medicare for All bill in the House). There are also many new political faces who support Medicare for All, including progressive newcomers Alexandria Ocasio-Cortez (NY-14), Ayanna Pressley (MA-07), Rashida Tlaib (MI-13), Ilhan Omar (MN-5), and Jahana Hayes (CT-2). Medicare for All supporters also won elections in swing Congressional districts and traditionally conservative states. California’s 48th district has elected a Republican Congressman for nearly 30 years; Harley Rouda narrowly defeated the incumbent this year, calling for health care as a right and pursuing “Medicare for All as a long-term solution.” Sylvia Garcia is a first-time candidate who won election in Texas by promising, “I will fight for Medicare for All."
There are also a number of Representatives who have not explicitly declared their support for Medicare for All, but have signaled that they remain open to the idea. Joe Kennedy (MA-04), a rising star in the Democratic Party, did not co-sponsor H.R.676; however, he has said he would consider co-sponsoring an updated version of a Medicare for All bill if it addressed his concerns with the current version.
In the 2018 elections, Democrats lost seats in the Senate, leaving them with a total of 47 seats.
We analyzed campaign platforms, bill co-sponsorship records, and public comments made by both incumbent and newly elected Senators, and found that at least 16 Democratic Senators support Medicare for All in the upcoming Congress (Figure 2). This count does not include Senators who have indicated an openness to Medicare for All without issuing their support—for instance, centrist Montana Senator Jon Tester has said Congress should take a “solid look” at single payer. Compared to the House, relatively few new political faces entered the Senate this year; newcomers Kyrsten Sinema (AZ) and Jacky Rosen (NV) did not explicitly support Medicare for All. States with two Senators who support Medicare for All include Massachusetts, Vermont, New Mexico, and Hawaii.
Implications For The 116th Congress
Medicare for All will not become law in the next two years, but the incoming 116th Congress could play an important role in determining the future of the proposed reform.
First, this Congress will have an opportunity to distinguish Medicare for All from other Democratic proposals to expand public coverage. To capitalize on the popularity of Medicare for All, some organizations have released more moderate proposals with sound-alike names such as “Medicare Extra for All”; others have started to brand Medicare buy-in proposals with slogans like “Medicare Available to All” or “Medicare for Anyone.” These alternatives are essentially variations on a public option. These proposals vary in their details and scope, and their relative merits are worthy of debate in the upcoming Congress. However, they differ substantially from the actual Medicare for All bills that have been proposed in Congress for many years. The 116th Congress will have an opportunity to clarify these differences, and to build further public understanding of Medicare for All.
Second, the 116th Congress can start building consensus on key policy elements of a Medicare for All proposal, including knotty issues such as determining the covered benefits of the plan, exploring alternative revenue sources and cost controls, deciding how providers would be paid and at what prices, how to pave a practical transition pathway from current health plans, how to craft a soft landing for the employees of the current insurance industry, and more. Ideally, this exploration will help foster a deeper and more mature discussion of Medicare for All among legislators in the future.
The legislative process provides a roadmap by which policy consensus can be pursued. Rep. Pramila Jayapal (WA-7), co-chair of the Medicare for All Caucus, will become the primary sponsor of the House Medicare for All bill, and a revised version of the bill will almost certainly be released early in the Congressional session. The bill will then fall to two key committees with relevant jurisdiction: Ways and Means, and Energy and Commerce. These committees have the opportunity to “mark up” the bill and hold public hearings. The degree to which Medicare for All receives hearings—and whether it is ultimately voted out of committee—will depend heavily on the degree of support from the leadership and membership on these two committees.
On the Energy and Commerce Committee, incoming Chairman Frank Pallone (NJ-6) has said he has “always been an advocate for Medicare for All or single payer”, but he has not co-sponsored H.R.676 and has said that his priority as Chairman will be to stabilize the Affordable Care Act. The member most likely to head the Health Subcommittee of Energy and Commerce is Anna Eshoo (CA-18), a co-sponsor of H.R.676 and supporter of Medicare for All. On the Ways and Means Committee, neither the incoming Chairman (Richard Neal, MA-1), nor the favorite to head its Health Subcommittee (Lloyd Doggett, TX-35), have indicated support for Medicare for All. Additionally, the likely Chair of the Budget Committee (John Yarmuth, KY-3) has stated that he plans to hold hearings on Medicare for All.
Though these procedural machinations don’t often make headlines, House committees have a critical opportunity to raise national awareness of Medicare for All, bring stakeholders to the table, and work toward consensus on policy details—if the powerful members of these committees choose to do so.
Finally, it is possible that the 116th Congress could bring Medicare for All to a vote on the floor of the US House of Representatives. To pass the House, an additional 85 members of Congress would need to join the 133 supporters we have identified to compose a 218-vote majority. If Medicare for All passes the House, it would be a powerful symbolic step showing that Congress is serious about pursuing this reform, and underlining its widespread support. Even if Medicare for All does not pass the House, a vote would force Representatives to officially declare their positions. Holdouts may face increased pressure during the 2020 elections, especially if public support for Medicare for All continues to grow.
Implications For 2020 Elections And Beyond
Passage of Medicare for All will remain highly implausible without Democratic control of the Presidency and both chambers of Congress. Even if Democrats regain the Presidency in 2020 and retain a majority in the House, the loss of Senate seats in the 2018 midterms make the prospect of united government in 2020 more difficult. In 2020, 33 Senate seats will be up for election, and Democrats must regain at least four of them to win a majority. The most likely path towards a Senate majority would involve winning elections in four states currently controlled by Republicans: Maine, North Carolina, Iowa, and Arizona. Democrats would also need to hold their current seats in states like Michigan, Alabama, and Virginia. In short, Democratic control of the Senate, House, and Presidency in 2020 remains highly uncertain.
Furthermore, history has shown that even a unified government does not guarantee the success of comprehensive health reform. Supporters must contend with intra-party disagreements, attempts at filibuster in the Senate, and garnering the support of key and powerful stakeholders in the health care industry. But these are obstacles faced by any meaningful health reform, not just Medicare for All.
It is time to re-frame the public debate: the path to Medicare for All is difficult, not impossible. In a democracy, it is strange and basically untenable to insist that an idea at least nominally supported by 70 percent of the citizenry is not even worthy of serious consideration. Medicare for All, though difficult, is now within the realm of political possibility, and the surge of enthusiasm among new members in the House of Representatives is evidence of renewed public interest in expanding access to health coverage and controlling costs.
As Presidential contenders enter the 2020 primaries, Medicare for All will almost certainly become a focal point of national discourse. Instead of pretending that Medicare for All is impossible, health policy experts and Congressional leaders should deepen their knowledge of the promise and challenges of single-payer health reform, and start working seriously on the hard job of crafting the best possible version of Medicare for All.
Health care industry is geared up to fight Medicare for All
by Diane Archer - JustCare - November 28, 2018
With momentum for Medicare for all growing, the Intercept reports that the health care industry is already geared up to fight it. Medicare for all’s biggest opponents are the insurance and pharmaceutical industries, and the businesses they contract with, including the Council of Insurance Agents and Brokers. These businesses have a lot to lose financially when Medicare for All becomes law.
Make no mistake. Health care corporations are responsible for driving health care costs up and jeopardizing people’s health and financial well-being. As corporations, they are legally required to put their shareholders’ profits ahead of people’s health care needs.
Government-administered insurance, Medicare, is less expensive, more equitable, and better ready to meet your needs than corporate commercial insurance. Ask anyone with traditional Medicare. The government lets your doctors decide the care you need. Commercial insurers tell you which doctors you can see and tell those doctors what care they will cover, often wrongly denying needed care to enhance their profits.
Not surprisingly, Americans are far more satisfied with Medicare than with commercial health insurance. That’s one reason why Medicare has survived more than 50 years of attacks by Republicans and conservative Democrats alike.
Medicare for all offers better care at less cost than traditional Medicare, with coverage of dental, hearing and vision care and with no premiums, coinsurance or deductibles. Given how difficult it can be to get needed care today in our commercial health insurance system, opponents of Medicare for all face a serious challenge.
Today, seven in ten Americans support Medicare for all. A total of 123 House Democrats have co-sponsored Medicare for All legislation. And, 48 new members of Congress campaigned to support it.
Medicare for all’s opponents have formed the “Partnership for America’s Health Care Future.” They are trying to undermine Medicare for all through campaign contributions to, and talking points for, Democratic candidates who have pledged to oppose it. The talking points are designed to scare people by focusing on the cost of Medicare for all. In truth, the talking points bury the lede.
Medicare for all reduces overall health care costs while guaranteeing everyone coverage. It saves $2 trillion over ten years, by conservative estimates, and lets people see the doctors they know and trust anywhere in America with no premiums, copays or deductibles. Not surprisingly, many of the Democrats who opposed Medicare for all lost in the midterms, including Bill Nelson, Joe Donnelly and Danny O’Connor (D-OH).
The Democrats will need a Democratic majority in the House and Senate, along with a Democratic President to pass Medicare for all. But, that could be just two years away. To succeed, the public needs to be ready to respond to the Partnership’s key talking points. They claim that Medicare for all would mean “ripping apart our current system.” In truth, Americans would not feel even a small tear, as they would continue to be able to see the doctors and use the hospitals they know and trust.
Opponents will also emphasize that Medicare for all would mean the end of employer-based coverage, tax increases and greater government control over the health care system. In fact, people would see higher wages, wages that had formerly gone to paying for their health care, and still be able to see the doctors they know and trust. They would pay less overall for their care and would have no out-of-pocket costs for their care. Moreover, Medicare for all would displace the insurance company bureaucrats who tend to offer poor provider networks and get between patients and their doctors. These bureaucrats’ big skill is in knowing how to keep people from getting care when they need it.
Truly, if commercial health plans are really smart innovators, why has not one of them ever spoken out about the ways they select their network providers or how they deliver high-value care?
Today, many people can no longer afford to see the doctor or to fill their prescriptions. Some die. We rank lower than people in most other developed countries on life expectancy, infant mortality and more. Medicare for all will bring us better care. The right politics and the right policy is to end the horrors of our commercial health care system. In fact, it is the only positive and viable solution.
If you support Medicare for all, please sign this petition to Congress.
'Easy to pay for something that costs less': New study shows 'Medicare for All' would save US $5.1 trillion over 10 years
by Jake Johnson - Common Dreams - December 1,2018
Confronting the question most commonly asked of the growing number of Americans who support replacing America's uniquely inefficient and immoral for-profit healthcare system with Medicare for All—"How do we pay for it?"—a new paper released Friday by researchers at the Political Economy Research Institute (PERI) shows that financing a single-payer system would actually be quite simple, given that it would cost significantly less than the status quo.
"We really can get more and pay less."
"It's easy to pay for something that costs less," Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlingon, Vermont, where Pollin unveiled the paper for the first time.
According to the 200-page analysis (pdf) of Sen. Bernie Sanders' (I-Vt.) Medicare for All Act of 2017, the researchers found that "based on 2017 U.S. healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses."
The most significant sources of savings from Medicare for All, the researchers found, would come in the areas of pharmaceutical drug costs and administration.
In a statement, Pollin said his research makes abundantly clear that the moral imperative of guaranteeing decent healthcare for all does not at all conflict with the goal of providing cost-effective care.
"The most fundamental goals of Medicare for All are to significantly improve healthcare outcomes for everyone living in the United States while also establishing effective cost controls throughout the healthcare system," Pollin said. "These two purposes are both achievable."
"Medicare for All promises a system that is fairer, more efficient, and vastly less expensive than America's bloated, monopolized, over-priced and under-performing private health insurance system."
—Jeffrey Sachs, Columbia University
—Jeffrey Sachs, Columbia University
As Michael Lighty, former director of public policy for National Nurses United, put it during The Sanders Institute Gathering on Friday, "We really can get more and pay less."
The official roll-out of PERI's analysis came on the heels of a panel discussion of the moral urgency of Medicare for All, particularly during a time when tens of millions of Americans are uninsured, life expectancy is declining, and thousands of families are bankrupted by soaring medical costs each year.
Far from being an unaffordable "pipe dream," Columbia University professor Jeffrey Sachs—who introduced the panel at The Sanders Institute Gathering on Friday—argued that the PERI study shows Medicare for All "offers a proven and wholly workable way forward."
"Medicare for All promises a system that is fairer, more efficient, and vastly less expensive than America's bloated, monopolized, over-priced and under-performing private health insurance system," Sachs said. "America spends far more on healthcare and gets far less for its money than any other high-income country."
Watch the full discussion of the new paper between Pollin and Lighty at The Sanders Institute Gathering below:
Ocasio-Cortez: 'Frustrating' that lawmakers oppose Medicare-for-All while enjoying cheap government insurance
by John Bowden - The Hill - December 1, 2018
Incoming Rep. Alexandria Ocasio-Cortez (D-N.Y.) tweeted Saturday that she was frustrated to learn that her health-care costs would be chopped by more than half upon entering Congress, accusing her fellow lawmakers of enjoying cheap government health insurance while opposing similar coverage for all Americans.
In a tweet, the New York freshman lawmaker-elect wrote that her health care as a waitress was "more than TWICE" as high as what she would pay upon taking office as a congresswoman next month.
"In my on-boarding to Congress, I get to pick my insurance plan. As a waitress, I had to pay more than TWICE what I’d pay as a member of Congress," Ocasio-Cortez wrote Saturday afternoon.
"It’s frustrating that Congressmembers would deny other people affordability that they themselves enjoy. Time for #MedicareForAll," she added.
‘The Numbers Are So Staggering.’
Overdose Deaths Set a Record Last Year.
by Josh Katz and Margot Sanger Katz - NYT - November 29, 2018
A class of synthetic drugs has replaced heroin in many major American drug markets, ushering in a more deadly phase of the opioid epidemic.
New numbers Thursday from the Centers for Disease Control and Prevention show that drug overdoses killed more than 70,000 Americans in 2017, a record. Overdose deaths are higher than deaths from H.I.V., car crashes or gun violenceat their peaks. The data also show that the increased deaths correspond strongly with the use of synthetic opioids known as fentanyls.
Since 2013, the number of overdose deaths associated with fentanyls and similar drugs has grown to more than 28,000, from 3,000. Deaths involving fentanyls increased more than 45 percent in 2017 alone.
“If we're talking about counting the bodies, where they lie, and the cause of death, we're talking about a fentanyls crisis,” said Jon Zibbell, a senior public health scientist at the research group RTI International.
The recent increases in drug overdose deaths have been so steep that they have contributed to reductions in the country’s life expectancy over the last three years, a pattern unprecedented since World War II. Life expectancy at birth has fallen by nearly four months, and drug overdoses are the leading cause of death for adults under 55.
“The idea that a developed wealthy nation like ours has declining life expectancy just doesn’t seem right,” said Robert Anderson, the chief of mortality statistics at the C.D.C., who helped prepare the reports. “If you look at the other wealthy countries of the world, they're not seeing the same thing.”
In a separate report, the C.D.C. also documented a 3.7 percent increase in the suicide rate, another continuation of a recent trend. The increases were particularly concentrated in rural America, and among middle-aged women, though the suicide rate for men remains higher than that for women at every age.
Recent federal public policy responses to the opioid epidemic have focused on opioid prescriptions. But several public health researchers say that the rise of fentanyls requires different tools. Opioid prescriptions have been falling, even as the death rates from overdoses are rising.
“Fentanyl deaths are up, a 45 percent increase; that is not a success,” said Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco. “We have a heroin and synthetic opioid epidemic that is out of control and needs to be addressed.”
Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons. They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now.
Fentanyl’s contribution to the overdose death rate in selected states, 2015 to 2017
15 overdose. The trends in overdose deaths vary widely across the country. The epidemic has been strongest in Northeast, Midwest and mid-Atlantic states. In the West, where heroin is much less likely to be mixed with fentanyls, overdose rates are far lower. Data from the C.D.C. indicate that a state’s overdose trend closely tracks the number of fentanyl-related deaths.
Despite the sharp recent increases in drug-related deaths, some early signs suggest that 2017 could be the peak of the overdose epidemic. Preliminary C.D.C. data show death rates leveling off nationally in the early months of this year, though there is still a lot of local variation. Several states and cities have embarked on ambitious public health programs to reduce the deadliness of drug use and connect more drug users with treatment, and some of those changes may be bearing fruit, for instance in Dayton, Ohio, where local officials have worked hard to push down the overdose rate. And in a ruling with implications for prisons and jails nationwide, a federal judge in Massachusetts this week ordered a jail to offer an addicted man access to methadone.
“What’s encouraging to me is that it’s sort of an all-hands-on-deck problem, and we’ve got all hands on deck,” said Anna Lembke, an associate professor of psychiatry at Stanford, and the author of a book on how medical practice contributed to the opioid epidemic.
But there is still a very long way to go. “The concept of a plateau doesn’t fill me with a lot of optimism, given how high the numbers are,” said Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health, and the former secretary of health and mental hygiene in Maryland, where overdoses continue to rise. “The numbers are so staggering.”