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Monday, March 2, 2020

Health Care Reform Articles -March 2, 2020

Here’s what Bernie Sanders’ ‘Medicare for All’ proposal actually says

By Zachary B. Wolf, Tami Luhby and Curt Merril - CNN - March 2, 2020

S. 1129 To establish a Medicare-for-all national health insurance program. IN THE SENATE OF THE UNITED STATES APRIL 10, 2019 Mr. SANDERS (for himself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, Mrs. GILLIBRAND, Ms. HARRIS, Mr. LEAHY, Mr. MARKEY, Mr. MERKLEY, Mr. SCHATZ, Mr. UDALL, Ms. WARREN, Mr. WHITEHOUSE, Ms. HIRONO, and Mr. HEINRICH) introduced the following bill; which was read twice and referred to the Committee on Finance
The first thing to note is that Sanders’ proposal has only 14 co-sponsors in the Senate. That’s not even a majority of Democrats. That’s less than a third of the 60 votes usually required to overcome a filibuster and pass major legislation, although he has said he would support ending the practice of the filibuster in order to get Medicare for All passed.
SEC. 102. UNIVERSAL ENTITLEMENT. (a) IN GENERAL.—Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act. (b) TREATMENT OF OTHER INDIVIDUALS.—The Secretary— (1) may make eligible for benefits for health care services under this Act other individuals not described in subsection (a) and regulate their eligibility to ensure that every person in the United States has access to health care; and (2) shall promulgate a rule, consistent with Federal immigration laws, to prevent an individual from traveling to the United States for the sole purpose of obtaining health care services provided under this Act.
In Sanders’ proposal, everyone who is a US resident, including undocumented immigrants, gets coverage. That would be a likely point of contention with this plan. There is a prohibition on traveling to the US for free medical care.
SEC. 103. FREEDOM OF CHOICE. Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
Medicare for All is meant to be an extremely egalitarian proposal in which everyone has access to any provider. That’s certainly not the current system in the US, in which there are extreme differences based on the quality of a patient’s insurance and wealth.
SEC. 104. NON-DISCRIMINATION. (a) IN GENERAL.—No person shall, on the basis of race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in, be denied the benefits of, or be subjected to discrimination by any participating provider as defined in section 301, or any entity conducting, administering, or funding a health program or activity, including contracts of insurance, pursuant to this Act.
This is a general nondiscrimination statement except it includes the language “including termination of pregnancy.” The issue of how the federal government should (or should not) provide access to abortion nearly sank passage of the Affordable Care Act in 2009 and 2010. Here Sanders appears to go in the opposite direction and enshrine abortion rights in the language.
The bill also says the health and human services secretary will lay out a system by which claims of discrimination should be adjudicated and that courts can grant damages.
SEC. 105. ENROLLMENT. (a) IN GENERAL.—The Secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under this Act. The mechanism shall— (1) include a process for the automatic enrollment of individuals at the time of birth in the United States or upon the establishment of residency in the United States;
Americans would be automatically enrolled for benefits at birth or when they move to the US. A subsequent section describes a Universal Medicare Card.
SEC. 106. EFFECTIVE DATE OF BENEFITS. (a) IN GENERAL.—Except as provided in subsection (b), benefits shall first be available under this Act for items and services furnished on January 1 of the fourth calendar year that begins after the date of enactment of this Act.
Sanders envisions a four-year transition period. Children under 19 would get universal coverage one year after the bill is signed into law. Everyone else would have the option of keeping their current coverage during the transition or of buying into Medicare or a transitional public plan. Four years to transition from a mostly private system to an entirely public one would be a quick pace. Automatic enrollment is also a departure from the current Medicare system. There would be no precedent for administering this kind of federal program in the US.
SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. (a) IN GENERAL.—Beginning on the effective date described in section 106(a), it shall be unlawful for— (1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or (2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
This is the most controversial element of this bill. Sanders would make it illegal to sell private health insurance that covers the benefits offered by Medicare for All. This provision would certainly be subject to lawsuits. A subsequent section says additional benefits not covered by Medicare for All (cosmetic surgery, for instance) could be covered by a supplemental insurance plan.
This is the nationalization of an industry in an unprecedented way. It’s important to note here that about one-third of the American seniors who currently get Medicare get it through private Medicare Advantage plans offered by health insurance companies. Those plans would go away.
SEC. 201. COMPREHENSIVE BENEFITS. (a) IN GENERAL.—Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:
There is a generous list of covered health, vision and dental benefits, and some long-term care benefits including:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs. (2) Ambulatory patient services. (3) Primary and preventive services, including chronic disease management. (4) Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products. (5) Mental health and substance abuse treatment services, including inpatient care. (6) Laboratory and diagnostic services. (7) Comprehensive reproductive, maternity, and newborn care. (8) Pediatrics, including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r))). (9) Oral health, audiology, and vision services. (10) Short-term rehabilitative and habilitative services and devices. (11) Emergency services and transportation. (12) Necessary transportation to receive health care services for individuals with disabilities and low income individuals. (13) Home and community-based long-term services and supports
The HHS secretary would be in charge of regularly recommending improvements and adjustments to the benefits package for Congress to consider. States can offer their residents supplementary benefits, but can’t offer their own version of Medicare for All benefits.
SEC. 202. NO COST-SHARING. (a) IN GENERAL.—The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits provided under this Act, except as described in subsection (b). (b) EXCEPTIONS.—The Secretary may set a cost sharing schedule for prescription drugs and biological products—
People who get Medicare for All would not pay for any part of their health care except, in some cases, up to $200 for prescription drugs for individuals making more than $25,200 annually or families of four making more than $52,400 (200% of the federal poverty level in 2020). The average cost of drugs per person per year in the US is currently more than $1,000 for drugs bought at pharmacies, but the average out-of-pocket spending per person is only $144. However, the current costs are concentrated more on some people than others. This would spread those costs.
SEC. 203. EXCLUSIONS AND LIMITATIONS. (a) IN GENERAL.—Benefits for services are not available under this Act unless the services meet the standards specified in section 201(a), as defined by the Secretary. (b) TREATMENT OF EXPERIMENTAL SERVICES AND DRUGS.— (1) IN GENERAL.—In applying subsection (a), the Secretary shall make national coverage determinations with respect to services that are experimental in nature.
The HHS secretary has a lot of power in this plan to determine what is covered, including what experimental and new services are covered. Currently, for people with private health insurance, those determinations are made by insurance companies.
SEC. 204. COVERAGE OF INSTITUTIONAL LONG-TERM CARE SERVICES UNDER MEDICAID. Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting the following section after section 1946: “STATE PLAN FOR PROVIDING INSTITUTIONAL LONG TERM CARE SERVICES
Sanders changed his plan in 2019 to include home- and community-based long-term care after lobbying by disability rights groups and to come more in line with a single-payer insurance plan put forward by progressives in the House. But this portion of his proposal, which stretches over multiple pages, would rely on a state plan to provide institutional long-term care services. Separately, he gives states the ability to set their own standards under Medicare for All as long as they are not less generous than the federal system.
SEC. 301. PROVIDER PARTICIPATION AND STANDARDS. (a) IN GENERAL.—An individual or other entity furnishing any covered service under this Act is not a qualified provider unless the individual or entity— (1) is a qualified provider of the services under section 302; (2) has filed with the Secretary a participation agreement described in subsection (b); and (3) meets, as applicable, such other qualifications and conditions with respect to a provider of services under title XVIII of the Social Security Act as described in section 1866 of the Social Security Act (42 U.S.C. 1395cc).
Sanders promises Americans access to the doctors they currently see and more. But his system assumes that doctors will take part. Just as many doctors do not take part in the current Medicare and insurance systems, some would likely sidestep the government program and seek payment on a fee-for-service basis outside Medicare for All.
While providers would have protections under the plan, they would also have responsibilities. And it is an either-or scenario. Either they enroll as a Medicare for All provider or they go outside the system.
SEC. 303. USE OF PRIVATE CONTRACTS. (a) IN GENERAL.—Subject to the provisions of this subsection, nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service—
The bill does specifically envision private agreements — not insurance — between individuals and providers or groups of providers outside of Medicare for All. But providers, once they enter into such agreements, cannot participate in the government program for a year.
SEC. 401. ADMINISTRATION. (a) GENERAL DUTIES OF THE SECRETARY.— (1) IN GENERAL.—The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including related to— (A) eligibility for benefits; (B) enrollment; (C) benefits provided; (D) provider participation standards
This would be a massive new federal bureaucracy, replacing, by some estimates, 2 million US insurance and health industry jobs. Setting up, enforcing and evolving a health care system for about 320 million people and transitioning more than 200 million from a private system to a public one would be a gargantuan undertaking. Sanders’ proposal imagines a regional administration system that would coordinate individual states and filter up to the HHS secretary, who would be in charge of setting policies. An official ombudsman would collect and hear grievances.
SEC. 411. APPLICATION OF FEDERAL SANCTIONS TO ALL FRAUD AND ABUSE UNDER UNIVERSAL MEDICARE PROGRAM. The following sections of the Social Security Act shall apply to this Act in the same manner as they apply to State medical assistance plans under title XIX of such Act:
When the federal government takes over trillions of dollars in spending, there is a real danger of waste, fraud and abuse. Sanders envisions applying existing protections that govern Medicaid funding to protect this Medicare for All investment. There are also sections that mandate the creation of an annual health care budget and a focus on cost containment.
A key selling point of a single-payer system is that the government can keep costs down by setting prices to pay doctors, hospitals and drug companies. It’s also why the industries will fight this tooth and nail. It would almost definitely set lower payments to doctors and hospitals than private insurers. More on that in a moment.
(4) TEMPORARY WORKER ASSISTANCE.—For up to 5 years following the date on which benefits first become available as described in section 106(a), up to 1 percent of the budget may be allocated to programs providing assistance to workers who perform functions in the administration of the health insurance system and who may experience economic dislocation as a result of the implementation of this Act.
By replacing the entire health insurance industry, the government could displace 2 million workers, according to some estimates. Some of those would find jobs in the new government systems. Others could be eligible for up to five years of temporary assistance.
(5) RESERVE FUND.—The Secretary shall establish and maintain a reserve fund to respond to the costs of treating an epidemic, pandemic, natural disaster, or other such health emergency.
Coronavirus? Hurricane? Earthquake. The government should be prepared.
(a) APPLICATION OF PAYMENT PROCESSES UNDER TITLE XVIII.—Except as otherwise provided in this section, the Secretary shall establish, by regulation, fee schedules that establish payment amounts for benefits under this Act in a manner that is consistent with processes for determining payments for items and services under title XVIII of the Social Security Act
One fact of US health care is that American doctors make more money than their counterparts in other countries. There are many reasons for that, but one clear way to contain the cost of health care is to contain the amount doctors are paid. Granted, they should have a much simpler time being reimbursed under a single-payer system and more of their time will be spent treating patients. But their bottom lines might also shrink. That’s one reason some doctors could opt out. Hospitals too. In the current system, private insurance pays higher rates to hospitals and doctors than Medicare and Medicaid do.
SEC. 613. OFFICE OF PRIMARY HEALTH CARE. (a) IN GENERAL.—There is established within the Agency for Healthcare Research and Quality an Office of Primary Health Care, responsible for coordinating with the Secretary, the Health Resources and Services Administration, and other offices in the Department as necessary,
The federal government would take a much bigger role in assessing the landscape of educating doctors and determining how many specialists are needed in a given field. The US currently has a system that prioritizes specialization over general medicine. And that’s not saving anyone money.
SEC. 614. PAYMENTS FOR PRESCRIPTION DRUGS AND APPROVED DEVICES AND EQUIPMENT. (a) NEGOTIATED PRICES.—The prices to be paid for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Secretary.
Drug companies are going to fight this with all their might (and they have a lot of money). Instead of setting a price in the market for a drug, they’d have fewer people to negotiate with and may have to accept what the government gives them. It’s no coincidence that Americans pay a lot more for the same prescription drugs than people in countries with single-payer systems. So, yes, this would remove some of the profit motive of the pharmaceutical industry. On the other hand, it’s not at all an agreed-upon fact that drug companies should be able to charge exorbitant prices for lifesaving drugs.
SEC. 701. UNIVERSAL MEDICARE TRUST FUND. (a) IN GENERAL.—There is hereby created on the books of the Treasury of the United States a trust fund
This is a massive new program and paying for it isn’t going to be easy. Sanders has plenty of ideas, however. For starters, everything that goes into the Medicare trust fund would now go into this new, larger fund. So would money that now goes toward the health care of veterans and pays states to provide Medicaid.
The federal government gives tax breaks to employers for providing health insurance. With those benefits now outlawed, the savings in tax breaks would go into the trust fund.
But it’s certainly not clear how the numbers would add up. Sanders has proposed a menu of options to offset the costs of this program. They are not all outlined in this text. The dollars and cents of this are less important to Sanders than the moral imperative. Here’s a look at Sanders’ math.
SEC. 901. RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS.
There are many pages of this bill that deal with sunsetting the bramble of ways the US government currently helps Americans with health care — Medicare, Obamacare, Tricare, federal employee benefits and more — and unifying them in this new plan.
TITLE X—TRANSITION 19 Subtitle A—Transitional Medicare Buy-In Option and Transitional Public Option
During the four years during which Sanders envisions the Medicare for All system being set up, there is a rolling admission to traditional Medicare, with its low premiums, starting with 55-year-olds in the first year after the law is passed, 45-year-olds in the second and 35-year-olds in the third.
There would similarly be a public health insurance option offered on the individual market for those not yet qualified for Medicare.
The rest of the bill concerns this transition period. It zeroes out some Medicare premiums during that period and accounts for subsidies some Americans get under Obamacare.
But the meat of the bill is what happens after the federal government begins to pay for every American’s health insurance.
 
https://www.cnn.com/interactive/2020/03/politics/medicare-for-all-annotated/ 
 
Editor's Note -
 
Follow the hot-link above for an animated version with commentary of the Sanders MFA bill.
 
-SPC

Millions of uninsured Americans like me are a coronavirus timebomb

by Carl Gibson - The Guardian - February 28, 2020

Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise. But now that there are confirmed coronavirus cases in the United States, the deadly virus could spread rapidly, thanks to others like me who have no feasible way to get the care we need if we start exhibiting symptoms.
According to the Centers for Disease Control and Prevention, there are confirmed coronavirus cases in at least 50 countries on six continents, and more than 2,800 patients have died from the virus. This certainly qualifies as a pandemic under the World Health Organization’s (WHO) definition of the term, which, under a typical presidency, should necessitate a swift response from US health officials. However, the Trump administration appears to still be prioritizing the profit margin of the healthcare industry over preventing the spread of a deadly pandemic.
Earlier this week, the Department of Health and Human Services secretary, Alex Azar, (a former senior executive at pharmaceutical manufacturer Eli Lilly) refused to commit to implementing price controls on a coronavirus vaccine “because we need the private sector to invest … price controls won’t get us there”. Even the House speaker, Nancy Pelosi, notably didn’t use the word “free” when referring to a coronavirus vaccine, and instead used the word “affordable”. What may be considered affordable for the third-most powerful person in the US government with an estimated net worth of $16m may not be affordable for someone who can’t afford a basic private health insurance plan that still requires a patient to pay thousands of dollars out of pocket.
Given the high cost of healthcare in the US, I haven’t seen a doctor since 2013, when I visited an emergency room after being run off the road while riding my bike. After waiting for four hours, the doctor put my arm in a sling, prescribed pain medication and sent me home. That visit cost more than $4,000, and the unpaid balance eventually went to collections and still haunts my credit to this day, making it needlessly difficult to rent an apartment or buy a car. But even a low-premium bronze plan on the exchange comes with a sky-high deductible in the thousands of dollars, meaning even if I was insured, I’d have still paid for that ER visit entirely out of pocket.
This system is exactly why a 2018 West Health Institute/NORC at the University of Chicago national poll found that 44% of Americans declined to see a doctor due to cost, and why nearly a third of Americans polled said they didn’t get their prescriptions filled due to the high cost of their medicine. This is the same system that killed 38-year-old Texas public school teacher Heather Holland, who couldn’t afford the $116 co-pay for her flu medication and later died from flu complications. It’s the same system that Guardian contributor Luke O’Neil refers to as “Go viral or die trying”, in which Americans who can’t afford life-saving healthcare procedures are forced to become their own advocate and PR agency by launching a viral GoFundMe campaign to ask strangers on the internet to save their lives.
When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster. This could be somewhat remedied if the US had a single-payer, universal healthcare system, like every other industrialized nation. And as a team of Yale epidemiologists discovered in a study recently published in the Lancet, a single-payer healthcare system in the US could simultaneously save 68,000 lives and $450bn in taxpayer dollars each year.
Yes, countries with single-payer systems still have coronavirus cases, Italy and Japan. But the spread of the virus in those countries would likely pale in comparison to the potential spread of coronavirus in the US, in which a significant portion of the population simply won’t go to the doctor if they’re sick. Coronavirus is a worldwide public health emergency, and massive profits for health insurers and pharmaceutical manufacturers shouldn’t come before the basic health and safety of human beings.
https://www.theguardian.com/commentisfree/2020/feb/28/coronavirus-millions-of-americans-uninsured

Coronavirus makes the case for Medicare-for-all




Osmel Martinez Azcue wanted to do the right thing, for both his own health and the health of the nation. When the Florida resident came down with flu-like symptoms shortly after returning from a trip to China, he immediately went to a local hospital to get tested for coronavirus.
A few weeks later, according to the Miami Herald, Azcue received an invoice for more than $3,000. His insurer claims he’s responsible for $1,400 of the total. He’s expecting even more bills to arrive over the next few weeks.
We’re all fixated on the Trump administration’s day-late-and-billions-of-dollars-short response to the increasing likelihood that coronavirus will cause a public-health crisis in the United States. But the fact remains that even if the government were fully prepared, many Americans will face another barrier to receiving care that will make the crisis worse.
That barrier is their wallet.
Medicare-for-all is usually presented as a moral argument: The United States is the richest country ever known; it is not right that we don’t guarantee access to easily affordable and accessible health care like every other First World country. But this situation is not simply immoral — it also leaves the United States at a major disadvantage when it comes to combating global pandemics.
We don’t want people to be wondering whether they can afford to visit the doctor if they think they’ve got this contagious and possibly deadly disease. But by happenstance, ideology and shortsighted, penny-wise-pound-foolish thinking, we’ve set up a situation that will force many to do just that.
According to the Kaiser Family Foundation, more than half of all workers with employer-provided health insurance face an annual individual deductible of more than $1,000. In a survey conducted with the Los Angeles Times, about half of respondents said they or a family member postponed needed care because they were worried they couldn’t afford the bill.
The situation can be even worse for people who purchase their insurance on the individual market. The average individual deductible for a plan purchased on an Affordable Care Act exchange is more than $4,000, and only about half of purchasers receive any help with that sum via cost-sharing subsidies. The Trump administration has compounded this financial quagmire by approving the sale of so-called junk insurance plans that place hard limits on how much the plan will pay out in hospital and pharmaceutical costs in return for a lower monthly premium — frequently leading to high bills that the plans may or may not cover.
There is also the growing problem of surprise medical bills. These occur when someone seeks treatment in an emergency — and I think we can all agree that suspected coronavirus is the definition of an emergency — from a hospital or other medical facility in their network, only to subsequently receive a bill from a doctor or lab affiliated with that institution who wasn’t in network after all.
The idea that people won’t think about all this when they consider going to the doctor is bonkers. Our system is set up to ensure that people prioritize their finances when they are sick. It’s the end result of the concept known as “skin in the game,” the idea — pitched by everyone from health-care wonks to insurance company insiders — that the way to get control of the high cost of American medical care is to turn the patient into a bargain-savvy shopper.
Instead of confronting the medical-industrial complex, the onus is on the sick person to fight the health-care power. The result? People skip out on seeing the doctor, hoping things will get better. They cut their prescription pills in half because they can’t afford to get a refill. We are a country where people in their 20s die because they can’t afford their insulin bill. “The costs they have to incur are a real barrier to getting the care they need,” longtime Medicare-for-all advocate Wendell Potter explained to me.
Or, as Azcue told the Herald, “How can they expect normal citizens to contribute to eliminating the potential risk of person-to-person spread if hospitals are waiting to charge us $3,270 for a simple blood test and a nasal swab?”
Viruses and infectious diseases don’t check your deductibles, co-pays and network access before they strike. Doubters may claim that our nation can’t afford Medicare-for-all, but it’s increasingly likely that we are about to discover just how costly our current system really is.
https://www.washingtonpost.com/opinions/2020/02/26/coronavirus-makes-case-medicare-for-all/

The Basics of ‘Medicare for All’

What to know about Bernie Sanders’s health care plan, plus further reading for the nerds among you.

by Margot Sanger-Katz - NYT - February 25, 2020

It’s possible you’ve tuned out when the Democrats running for president have tussled over “Medicare for all.” But now that Bernie Sanders, who introduced the Medicare for All Act in the Senate, is ascending in the nominating contest, it’s a good time to take a closer look at what it would mean for the health system, your health insurance and finances, and the federal budget.
Here’s our quick primer, with some suggestions for further reading.
Yes. When you think about Medicare for all, it is more helpful to focus on the “all” part than the “Medicare” part. Mr. Sanders’s proposal would set up a brand-new government health insurance system, with many more benefits than Medicare. Everyone in the United States would get health insurance from this new, generous government system. Existing private health insurance plans would be eliminated. So would insurance premiums, deductibles and co-payments.
Medicare for all insurance would cover many services that most health plans omit now, including dental care, eyeglasses, hearing aids and home-based long-term care for people with disabilities.
It would also make major changes to how health care is financed in the United States. Now, we pay for health care through federal taxes and state taxes, as well as premiums and cash when we go to the doctor or the pharmacy counter. Under Medicare for all, federal taxes would pay for the entire system.
Here’s a summary of how the plan would affect different groups of Americans.
A lot, but be wary of any politician brandishing a precise number. Medicare for all would be a very big change to many parts of the health system and the government, and it would involve a lot of tough policy decisions. That makes calculating a price tricky.
Economists have produced various estimates. It’s probably most helpful to think about the range. Give or take, they said the Medicare for all system would cost around the same as the current system — government, employer and individual spending combined. But even the most conservative spending estimate would involve a huge shift of health care dollars from individuals and businesses to the federal government. Medicare for all would be an enormous expansion of government spending, and would almost certainly require large tax increases.
Mr. Sanders recently released a fact sheet with some ideas about how he might finance the system. His proposal is centered on a large payroll tax that would be paid by medium and large companies and by families earning more than $29,000 a year. But it also would include higher taxes on corporations and people with high incomes. Altogether, his proposed taxes would raise far less money than most estimates of what the program would cost.
These articles may help you understand the different cost estimates.
Yes. People who get their coverage from Medicare would see the smallest change. They would keep getting insurance called Medicare from the government, only with new benefits and fewer fees. People with nearly any other type of insurance would have to switch to the government plan.
But, as Mr. Sanders often points out, people who lose their private insurance would, in almost all cases, get more generous government insurance instead. Nearly every doctor and hospital in the country would probably accept the new Medicare insurance, so changing your insurance would probably not mean changing doctors, as it often means now when you change your private insurer.
Here’s a closer look at what it would mean to abolish private insurance.
Under Medicare for all, doctors and hospitals would remain in private hands. But because the government insurance would effectively be their only source of income, the government would have much more control over the medical system. Nearly every estimate of the cost of Medicare for all assumes that the public system would pay doctors and hospitals less than they currently earn from private insurers. That could mean substantial pay cuts for certain health care providers who see a lot of privately insured patients.
Drug companies would probably take the biggest cut. Estimates tend to assume that the government would pay them substantially lower prices for their products than they currently receive.
Here’s more detail on what the plan would mean for hospitals.
Not exactly. Nearly every peer country has universal health insurance coverage. But Mr. Sanders proposes a plan with the government providing insurance to everyone directly, and with people responsible for almost no out-of-pocket costs. It comes the closest to the Canadian system, also called Medicare. But in Canada, Medicare does not cover prescription drugs or dental care, for example. In most European countries, there is a mix of private and public sources of insurance.
Play along in this “tournament” of international health systems, and you can get a sense of some of the different models out there.
Probably not. Mr. Sanders says a market might spring up for cosmetic surgery insurance in a Medicare-for-all world. But many experts say you’d still have to pay out of pocket for a face-lift.
It’s pretty popular — with a big caveat. In recent surveys, just over half of Americans consistently say they approve of the idea. Medicare for all polls even better among Democratic voters, the people who are participating in presidential primaries and caucuses.
But support has proved malleable. Public opinion surveys also show that many voters who say they like Medicare for all don’t know much about the details, and some change their minds after learning about certain features, like the loss of private insurance or possible tax increases. In a general election, voters are likely to hear far more about these counterarguments than they are now.
Democratic health proposals that would allow people to choose a government plan or keep their current insurance arrangements are also quite popular.
With the exception of Elizabeth Warren, who also endorses a Medicare for all plan, the other top remaining Democratic presidential candidates have all backed flavors of a “public option” health plan, in which people can choose between buying a government plan or buying private health insurance. These various public-option plans would expand the reach of government insurance and improve the generosity of government subsidies to help middle-income people pay for insurance. They would also probably affect insurance markets, causing some people to lose their current coverage even if they did not choose the public plan.
But “public option” approaches would preserve more of the current structure of our health system, with its varying plans, premiums, deductibles and co-payments. These approaches would also require increases in federal spending, but the increases would be smaller because people, businesses and state governments would largely continue paying for health care in the manner they do now.
See how a public option plan might change our current health insurance system.
https://www.nytimes.com/2019/09/19/upshot/health-care-home-metaphor.html?action=click&module=RelatedLinks&pgtype=Article

Economists conclude that Medicare for All (M4A) could be considerably less expensive than the current healthcare finance system

by James G. Kahn, Jeffrey Sachs, Anders Fremstad, Robert Reich, Robert Pollin, Leonard Rodberg, Emmanuel Saez, Gabriel Zucman, Alison Galvani, Gerald Friedman - The Hopbrook Institute - February 28, 2020We are economists interested in public policy and healthcare. Some of us have worked to estimate the cost of alternative healthcare programs. Others have reviewed such estimates. We believe the available research supports the conclusion that a program of Medicare for All (M4A) could be considerably less expensive than the current system, reducing waste and profiteering inherent in the current system, and could be financed in a way to ensure significant financial savings for the vast majority of American households.  Of course, the details would depend on the design of the M4A system. 

Compared with the current system, Medicare for All would achieve considerable savings on administration and by reducing payments to monopoly drug companies and hospital networks.  Within a few years of operation, M4A could save hundreds of billions of dollars per year from these sources.  Additional savings will come when a rational healthcare finance system allows needed investments in coordinated care and preventive care, as well as reductions in fraudulent billing. Over time, global budgeting would slow the rate of future healthcare costs significantly, as has been done in Canada and other countries. Bending the cost curve could save more than $2 trillion over the next decade, and even more with a well-designed system.  Costs will be predictable, enabling households and businesses to plan in a way that is impossible today.
There are added costs associated with Medicare for All.  Universal coverage and increased utilization, coming from reduction or elimination of cost sharing, will add costs, but studies show that these added costs will be far less than the savings outlined above.
The need for increased public funds (replacing premiums) can be financed with some combination of payroll, income, and wealth taxes.  By eliminating insurance premiums and out-of-pocket expenses, and lowering overall healthcare costs, Medicare for All will result in enormous savings for almost all households, all except the richest households who will pay more in taxes.  Shifting the burden from per-person payments for premiums and cost sharing to income- and wealth-related taxation will magnify the savings for most households. The current system is particularly burdensome for middle-income working households who receive relatively little support through Medicaid or other public programs but are responsible for health insurance premiums either paid directly or by their employer as nonwage compensation.  A system that cuts costs and shifts financing to income and wealth taxes will dramatically lower this burden, producing significant savings for workers and businesses.
The net financial savings will be accompanied by substantial improvements in productivity through improved health, and the elimination of “job lock” coming from the need to stay on a job to retain health coverage.  Most important, Medicare for All will reduce morbidity and save tens of thousands of lives each year.
https://www.hopbrook-institute.org/single-post/2020/02/28/Economists-conclude-that-Medicare-for-All-M4A-could-be-considerably-less-expensive-than-the-current-healthcare-finance-system

Supreme Court to Hear Obamacare Appeal

The Affordable Care Act, which has survived two major challenges in the Supreme Court, faces another test.
by Adam Liptak - NYT - March 2, 2020
WASHINGTON — The Supreme Court on Monday agreed to hear a third major case on the Affordable Care Act, President Barack Obama’s health care law, granting petitions from Democratic state officials and the House of Representatives in a case with the potential to wipe out the entire law.
The court did not say when it would hear the case, but, under its ordinary practices, arguments would be held in the fall and a decision would land in the spring or summer of 2021.
Democrats, who consider health care a winning issue and worry about possible changes in the composition of the Supreme Court, had urged the justices to act quickly even though lower courts had not issued definitive rulings. They wanted to keep the fate of the Affordable Care Act, sometimes called Obamacare, in the public eye during the presidential campaign and to ensure that the appeal was decided while justices who had rejected earlier challenges remain the court.
In the meantime, the law remains almost entirely intact but faces an uncertain future.
The case was brought by Republican state officials, who argued that when Congress eliminated the law’s requirement in 2017 that most Americans obtain health insurance, the law became unconstitutional. The Trump administration sided with the state officials, arguing that the rest of the health care law could not survive without the requirement, sometimes called the individual mandate.
A Federal District Court judge in Texas agreed, ruling that the entire law was invalid, but he postponed the effects of his ruling until the case could be appealed. In December, the United States Court of Appeals for the Fifth Circuit, in New Orleans, agreed that the mandate was unconstitutional but declined to rule on the fate of the remainder of the health law, asking the lower court to reconsider the question in more detail.
The Democratic states and the House, which intervened in the case to defend the health law, asked the Supreme Court put its consideration of whether to hear the appeal on an unusually fast track. The court turned down that request in January.
Having lost that fight, the states and the House asked the court to hear their appeal in the ordinary course. They said Supreme Court review was warranted because part of a federal law had been held to be unconstitutional, which is often reason enough for the justices to agree to hear a case. They added that the lower courts’ rulings had created uncertainty about the balance of the law.
“The uncertainty created by this litigation is especially problematic because individuals, businesses, and state and local governments make important decisions in reliance on the A.C.A.,” lawyers for the states wrote. “Prolonged uncertainty about whether or to what extent important provisions of the A.C.A. might be invalidated makes these choices more difficult, threatening adverse consequences for American families, health care markets and the broader economy.”
In urging the court to deny review, the Trump administration said that the justices should wait for a definitive ruling from the lower courts. “Immediate review is unwarranted in the case’s present posture,” the administration’s brief said, “because the court of appeals did not definitively resolve any question of practical consequence.”
The Supreme Court has already ruled in two major cases challenging core provisions of the health law. In both cases, it left most of the law in place.
In 2012, the court upheld the law’s requirement that most Americans obtain insurance or pay a penalty, saying it was authorized by Congress’s power to assess taxes. The vote was 5 to 4, with Chief Justice John G. Roberts Jr. writing the controlling opinion, which was joined in its key section by the court’s four-member liberal wing.
In 2015, the court said the federal government can provide nationwide tax subsidies to help poor and middle-class people buy health insurance, rejecting an argument that the subsidies were only available in states that had created marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans. A contrary ruling would have created havoc in the insurance markets and undermined the law.
The vote was 6 to 3, with Chief Justice Roberts and Justice Anthony M. Kennedy joining the court’s four more liberal members to form a majority.
Justice Kennedy retired in 2018, but the remaining members of the majorities in the two cases are still on the court.
https://www.nytimes.com/2020/03/02/us/supreme-court-obamacare-appeal.html?emc=edit_na_20200302&ref=cta&nl=breaking-news&campaign_id=60&instance_id=0&segment_id=21789&user_id=b89f0952de9e14745c8336c215350c1f&regi_id=1311158


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