9/19/24 - United States ranks last in health care among wealthy countries
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Thursday, September 19, 2024
Monday, November 01, 2021
Musk offers $6 billion to solve world hunger
Last week, the director of the United Nation's World Food Programme said if the world's top billionaires just donated a fraction of their worth, millions of people who are at risk of starving to death can be saved. Elon Musk, the second wealthiest person in the world, said he'd give up some of his wealth – only if he knows exactly where the money is going.
David Beasley, director of the World Food Programme, said on CNN last week that a "one-time" donation from the top 400 billionaires, whose net worths are ever growing, in the U.S. could help save the lives of 42 million people this year.
"The world's in trouble and you're telling me you can't give me .36% of your net worth increase to help the world in trouble, in times like this?" he said. "What if it was your daughter starving to death? What if it was your family starving to death? Wake up, smell the coffee, and help."
Musk, the founder of Tesla and SpaceX who has an estimated net worth of $151 billion, according to Forbes, replied to a tweet questioning the group's figures. "If WFP can describe on this Twitter thread exactly how $6B will solve world hunger, I will sell Tesla stock right now and do it," Musk wrote. "But it must be open source accounting, so the public sees precisely how the money is spent."
Beasley said the organization has systems in place for transparency and open source accounting. "Your team can review and work with us to be totally confident of such," he replied.
Beasley also responded to a question about the group's existing spending, including $8.4 billion in 2020. "The $8.4B you refer to covers what we needed to reach 115 million people in 2020 with food assistance," he said. "We need $6B plus NOW on top of our existing funding requirements due to the perfect storm from the compounding impact of Covid, conflict and climate shocks."
He also shared CBS News' article, which explains how the current hunger crisis is a "toxic cocktail" of conflict, climate change, disasters, structural poverty and inequality. COVID-19 has only made it worse and on its website, the program says it needs $6 billion to avert worldwide famine this year.
"6B will not solve world hunger, but it WILL prevent geopolitical instability, mass migration and save 42 million people on the brink of starvation. An unprecedented crisis and a perfect storm due to Covid/conflict/climate crises," Beasley said in another tweet.
Friday, February 21, 2020
Bernie's Medicare-for-all study
A new analysis published in the journal Lancet
adds some empirical heft to an argument many progressives have been
making for years: A national single-payer health-care system would save
tens of thousands of lives each year — and hundreds of billions of
dollars.
If you watched last night’s Democratic debate in Nevada you might have heard Sen. Bernie Sanders (I-Vt.) cite “a major study [that] came out from Yale epidemiologist[s] in Lancet, one of the leading medical publications in the world” in support of his Medicare-for-all plan. He was talking about this study, which was just published last week.
The study’s lead author, Alison Galvani, is the director of Yale University’s Center for Infectious Disease Modeling and Analysis. The paper discloses that Galvani served as an “informal, unpaid advisor” to Sanders’s Senate office as it developed the Medicare For All Act. None of the other authors disclosed any outside or competing interests.
All told, the study concludes, a single-payer system akin to Sanders’s plan would slash the nation’s health-care expenditures by 13 percent, or more than $450 billion, each year. Not only that, “ensuring health-care access for all Americans would save more than 68,000 lives.”
In their breakdown of the numbers, researchers applied the existing Medicare fee structure across the entire health-care system and found it would save about $100 billion annually. Keep in mind that this basically represents less money going to doctors and hospitals, a major sticking point for medical groups that oppose Medicare-for-all. But those declines would be more than offset by several hundred billions in savings from reduced administrative and billing costs, Galvani and her colleagues estimate. The lack of patient billing under a Medicare-for-all system would also eliminate the roughly $35 billion a year that hospitals now pay to chase down unpaid bills.
The authors estimate an additional $219 billion in savings from reduced “administrative overhead” that the current decentralized system creates, including “the elimination of redundant corporate functions and the truncation of the top-heavy salary architecture of health insurance corporations.”
For instance, the plan would replace dozens of health insurance executives, many of whom make well over $20 million a year, with one administrator paid the same salary as the current Secretary of Health and Human Services.
Finally, letting the national Medicare system negotiate pharmaceutical prices would save about $180 billion, according to the analysis.
Add it all up and here’s what you get: a new system that would cost about $3 trillion a year, instead of the $3.5 trillion that is being spent now.
Galvani and her colleagues estimate that to fully fund Medicare-for-all, the federal government would have to bring in an additional $773 billion a year relative to current revenue levels. They estimate this could be paid for, in part, by a 10 percent payroll tax that would bring in $436 billion annually. Given that current employer contributions to health care work out to about 12 percent of payrolls, this would still be about $100 billion less than what employers currently pay.
The remaining funding could be paid via a 5 percent tax on household income, yielding $375 billion a year. Again, with the elimination of employee contributions to existing health insurance premiums, the average household could expect to save well over $2,000 a year — and have no co-pays or deductibles to worry about.
Galvani’s $3 trillion estimate is somewhat lower than the annual spending estimates produced by other observers, including the libertarian Mercatus Center ($3.3 trillion per year) and the more centrist-oriented Urban Institute ($3.4 trillion per year) and RAND Corporation ($3.9 trillion).
All of these estimates — Galvani’s included — are built on various assumptions about how costs and payments and patient behaviors would work in the real world with a Medicare-for-all plan in place: How much would doctors and hospitals actually save on administrative overhead? How many people would increase their use of medical services once they’re paid for? Would a single-payer system make it easier to detect medical fraud?
Experts answer those questions differently, which is reflected in their final cost estimates. And though we can’t predict the future, we do have plenty of data on what’s happening in the American health-care system right now. Relative to people in other wealthy nations, Americans are less likely to be in good health and more likely to die of preventable causes. Our babies and mothers are more likely to die after child birth, and our lives are shorter overall.
Lack of a universal health-care system means that regular medical care is unaffordable for many Americans: Fully one-quarter of us have put off needed care because of cost. More than 8 million Americans have started a crowdfunding campaign to pay for medical care, with approximately 1 in 5 Americans contributing to somebody else’s medical crowdfunding campaign. Ninety percent of those campaigns will fail to raise the necessary funds.
By addressing these and other problems, Galvani and her colleagues estimate that regardless of cost, Medicare-for-all would save about 69,000 lives each year. They end their paper by calling on the medical community to answer “the moral imperative to provide health care as a human right, not dependent on employment or affluence.”
If you watched last night’s Democratic debate in Nevada you might have heard Sen. Bernie Sanders (I-Vt.) cite “a major study [that] came out from Yale epidemiologist[s] in Lancet, one of the leading medical publications in the world” in support of his Medicare-for-all plan. He was talking about this study, which was just published last week.
The study’s lead author, Alison Galvani, is the director of Yale University’s Center for Infectious Disease Modeling and Analysis. The paper discloses that Galvani served as an “informal, unpaid advisor” to Sanders’s Senate office as it developed the Medicare For All Act. None of the other authors disclosed any outside or competing interests.
All told, the study concludes, a single-payer system akin to Sanders’s plan would slash the nation’s health-care expenditures by 13 percent, or more than $450 billion, each year. Not only that, “ensuring health-care access for all Americans would save more than 68,000 lives.”
In their breakdown of the numbers, researchers applied the existing Medicare fee structure across the entire health-care system and found it would save about $100 billion annually. Keep in mind that this basically represents less money going to doctors and hospitals, a major sticking point for medical groups that oppose Medicare-for-all. But those declines would be more than offset by several hundred billions in savings from reduced administrative and billing costs, Galvani and her colleagues estimate. The lack of patient billing under a Medicare-for-all system would also eliminate the roughly $35 billion a year that hospitals now pay to chase down unpaid bills.
The authors estimate an additional $219 billion in savings from reduced “administrative overhead” that the current decentralized system creates, including “the elimination of redundant corporate functions and the truncation of the top-heavy salary architecture of health insurance corporations.”
For instance, the plan would replace dozens of health insurance executives, many of whom make well over $20 million a year, with one administrator paid the same salary as the current Secretary of Health and Human Services.
Finally, letting the national Medicare system negotiate pharmaceutical prices would save about $180 billion, according to the analysis.
Add it all up and here’s what you get: a new system that would cost about $3 trillion a year, instead of the $3.5 trillion that is being spent now.
Galvani and her colleagues estimate that to fully fund Medicare-for-all, the federal government would have to bring in an additional $773 billion a year relative to current revenue levels. They estimate this could be paid for, in part, by a 10 percent payroll tax that would bring in $436 billion annually. Given that current employer contributions to health care work out to about 12 percent of payrolls, this would still be about $100 billion less than what employers currently pay.
The remaining funding could be paid via a 5 percent tax on household income, yielding $375 billion a year. Again, with the elimination of employee contributions to existing health insurance premiums, the average household could expect to save well over $2,000 a year — and have no co-pays or deductibles to worry about.
Galvani’s $3 trillion estimate is somewhat lower than the annual spending estimates produced by other observers, including the libertarian Mercatus Center ($3.3 trillion per year) and the more centrist-oriented Urban Institute ($3.4 trillion per year) and RAND Corporation ($3.9 trillion).
All of these estimates — Galvani’s included — are built on various assumptions about how costs and payments and patient behaviors would work in the real world with a Medicare-for-all plan in place: How much would doctors and hospitals actually save on administrative overhead? How many people would increase their use of medical services once they’re paid for? Would a single-payer system make it easier to detect medical fraud?
Experts answer those questions differently, which is reflected in their final cost estimates. And though we can’t predict the future, we do have plenty of data on what’s happening in the American health-care system right now. Relative to people in other wealthy nations, Americans are less likely to be in good health and more likely to die of preventable causes. Our babies and mothers are more likely to die after child birth, and our lives are shorter overall.
Lack of a universal health-care system means that regular medical care is unaffordable for many Americans: Fully one-quarter of us have put off needed care because of cost. More than 8 million Americans have started a crowdfunding campaign to pay for medical care, with approximately 1 in 5 Americans contributing to somebody else’s medical crowdfunding campaign. Ninety percent of those campaigns will fail to raise the necessary funds.
By addressing these and other problems, Galvani and her colleagues estimate that regardless of cost, Medicare-for-all would save about 69,000 lives each year. They end their paper by calling on the medical community to answer “the moral imperative to provide health care as a human right, not dependent on employment or affluence.”
Friday, February 14, 2020
$32 trillion for Medicare for All?
Democrats have done a miserable job selling “Medicare for all” to the American people.
They’re adept at highlighting the myriad problems with our healthcare system — the high costs, the millions uninsured, the financial devastation of getting sick.
But when it comes to solutions, most of the Democratic presidential candidates offer vague policy proposals and sidestep pointed questions about how much healthcare reform would cost.
This is simply foolish. On both counts — policy and price — the Dems have a winning political issue.
They can point to other developed countries in making the case for the economics and effectiveness of public health plans, whether we’re talking Medicare for all or a similar “public option.”
And they can point to current healthcare spending to make a case for why their proposals would cost less than the status quo that conservatives are determined to defend.
Gerald Kominski, a professor of health policy and management at UCLA, tells me the problem with communicating these ideas is that the scope of the problem is so large, and the underlying components so complex, many people can’t get their heads around such difficult policy matters.
“This easily slips into Nerd Land,” he said.
But once you clear away all the policy brush, Kominski observed, there’s a fairly simple message to be conveyed about Medicare for all or any other single-payer system.
“Most families would be better off,” he said.
There it is.
Yes, this is all very complicated. And, yes, there would be nothing easy about transforming the U.S. healthcare system into one more in line with our economic peers.
But let’s emphasize Kominski’s point: Most families would be better off.
Related video: Where the 2020 candidates stand on health care (provided by ABC News)
That’s the case Democrats should be making, again and again, to the American people.
More than a third of Democratic voters who turned out for New Hampshire’s first-in-the-nation primary this week said healthcare was the most important issue in this presidential election.
Even Republicans say healthcare is one of their most pressing concerns, according to a recent Gallup poll.
Yet critics of Medicare for all say the idea is a non-starter because of its astronomical cost.
They cite a study published last year showing that if Vermont Sen. Bernie Sanders’ proposal for a comprehensive single-payer system were enacted, it would cost about $32 trillion in new federal revenue over 10 years.
Thirty-two trillion! Many Americans couldn’t even tell you how many zeroes are in a number that grotesquely huge.
What Democrats have done a terrible job communicating is that we’re currently spending $3.6 trillion a year on healthcare. That translates to $36 trillion over the next decade.
But the status quo is actually way worse than that.
The federal government estimates that national healthcare spending will total about $48 trillion over the next 10 years as costs keep going up.
By 2027, according to the Centers for Medicare and Medicaid Services, we’ll be spending about $6 trillion annually on healthcare. Total spending over the subsequent 10 years likely will reach a staggering $60 trillion — at least.
That’s the cost of doing nothing. It’s what opponents of healthcare reform are saying is our best option.
And that, of course, is insane.
“We’ve gotten ourselves into a big hole by letting expenditures get out of hand,” said Vivian Ho, a healthcare economist at Rice University. “It’s happening right before our eyes, and we’re not doing anything about it.”
The American people already spend more for healthcare than citizens of any other developed country. Again, this is a message that Democrats fail to get across.
The average American represents more than $10,500 a year in healthcare spending, according to the Organization for Economic Cooperation and Development. (The U.S. government has an even higher figure: $11,172 per person.)
That compares with less than $6,000 per person in Germany, less than $5,000 in France and Canada, and about $4,000 in Britain, according to OECD statistics.
Are we at least getting a proportionally bigger bang for our healthcare buck? Apparently not.
Americans have shorter average lifespans and a higher infant-mortality rate than people in these other countries — two key metrics of healthcare efficacy.
How do other nations do it? Simple. Each of these countries has a variation of single-payer insurance systems that use economies of scale to make healthcare more accessible and affordable.
That’s the entire case for Medicare for all right there: It costs less and works better.
Here’s where opponents of healthcare reform raise their hands and say, “But higher taxes!”
And again, Democrats have failed spectacularly in explaining how these higher taxes would be offset by reductions in insurance premiums, copays and deductibles.
Yes, taxes would rise under a Medicare-for-all system. The system would be funded almost entirely by tax dollars, as is the case in other developed countries.
But when you take most insurance premiums, copays and deductibles out of the equation, guess what happens. Total out-of-pocket costs for most people go down.
Rand Corp. analysts studied a single-payer proposal for the state of New York. They found that “the majority of New Yorkers would pay less” under such a system, “while the highest-income residents would pay more.”
Researchers at the University of Massachusetts Amherst concluded that a nationwide Medicare-for-all system would result in about $5 trillion in savings over 10 years.
“There would also be broader macroeconomic benefits through operating the U.S. healthcare system under Medicare for all,” they noted.
“Among these are that improved health outcomes will raise productivity; Medicare for all will support greater income equality; and that Medicare for all should support net job creation, especially through lowering operating costs for small- and medium-sized businesses.”
This is the message single-payer advocates need to be conveying: Solutions are available, and they’ve already been battle tested in other countries.
Personally, I disagree with Sanders’ plan, which would eliminate private health insurers and place responsibility for coverage solely on the government.
A more practical (and politically feasible) approach would be to emulate the healthcare systems of Germany, France and Japan, which rely on payroll deductions to fund nonprofit private insurers.
Under such systems — known in healthcare circles as the Bismarck model — the government plays an active role in determining what must be covered and how much can be charged for treatment. No one is excluded, regardless of preexisting conditions.
Yet the market still benefits from having private insurers compete for business, which leaves room for more comprehensive coverage for anyone willing to pay more, as well as cheaper plans for younger people who may want to pay less.
Problems abound, of course. How much should doctors and hospitals be reimbursed for treatment? Who determines fair prices for prescription drugs?
Moreover, would having more people insured drive up doctor visits, placing an even greater strain on healthcare resources? These questions need to be answered and addressed.
Some experts say the cost-savings argument isn’t the pitch Medicare-for-all proponents should be making.
“What single-payer advocates should do, in my own opinion, is not make an argument about lowering costs or make an argument that this will not be an expensive endeavor,” said Anupam B. Jena, an associate professor of healthcare policy and management at Harvard University.
“The argument must be made on humanitarian grounds,” such as expanded coverage and accessible treatment, he said.
At least we wouldn’t be starting from scratch. We’d have the luxury of picking and choosing what works best from other countries’ decades of experience.
And if we do things right, Americans would enjoy the same savings as our counterparts abroad and, with hope, the same improvements in health outcomes.
That’s the story Democrats need to be telling.
And when opponents of reform put up a fight, the reply is, “So you like paying more for worse results?”
That’s a hard position to defend.
David Lazarus is an award-winning business columnist for the Los Angeles Times. He also appears daily on KTLA Channel 5. His work runs in newspapers across the country and has resulted in a variety of laws protecting consumers.
They’re adept at highlighting the myriad problems with our healthcare system — the high costs, the millions uninsured, the financial devastation of getting sick.
But when it comes to solutions, most of the Democratic presidential candidates offer vague policy proposals and sidestep pointed questions about how much healthcare reform would cost.
This is simply foolish. On both counts — policy and price — the Dems have a winning political issue.
They can point to other developed countries in making the case for the economics and effectiveness of public health plans, whether we’re talking Medicare for all or a similar “public option.”
And they can point to current healthcare spending to make a case for why their proposals would cost less than the status quo that conservatives are determined to defend.
Gerald Kominski, a professor of health policy and management at UCLA, tells me the problem with communicating these ideas is that the scope of the problem is so large, and the underlying components so complex, many people can’t get their heads around such difficult policy matters.
“This easily slips into Nerd Land,” he said.
But once you clear away all the policy brush, Kominski observed, there’s a fairly simple message to be conveyed about Medicare for all or any other single-payer system.
“Most families would be better off,” he said.
There it is.
Yes, this is all very complicated. And, yes, there would be nothing easy about transforming the U.S. healthcare system into one more in line with our economic peers.
But let’s emphasize Kominski’s point: Most families would be better off.
Related video: Where the 2020 candidates stand on health care (provided by ABC News)
That’s the case Democrats should be making, again and again, to the American people.
More than a third of Democratic voters who turned out for New Hampshire’s first-in-the-nation primary this week said healthcare was the most important issue in this presidential election.
Even Republicans say healthcare is one of their most pressing concerns, according to a recent Gallup poll.
Yet critics of Medicare for all say the idea is a non-starter because of its astronomical cost.
They cite a study published last year showing that if Vermont Sen. Bernie Sanders’ proposal for a comprehensive single-payer system were enacted, it would cost about $32 trillion in new federal revenue over 10 years.
Thirty-two trillion! Many Americans couldn’t even tell you how many zeroes are in a number that grotesquely huge.
What Democrats have done a terrible job communicating is that we’re currently spending $3.6 trillion a year on healthcare. That translates to $36 trillion over the next decade.
But the status quo is actually way worse than that.
The federal government estimates that national healthcare spending will total about $48 trillion over the next 10 years as costs keep going up.
By 2027, according to the Centers for Medicare and Medicaid Services, we’ll be spending about $6 trillion annually on healthcare. Total spending over the subsequent 10 years likely will reach a staggering $60 trillion — at least.
That’s the cost of doing nothing. It’s what opponents of healthcare reform are saying is our best option.
And that, of course, is insane.
“We’ve gotten ourselves into a big hole by letting expenditures get out of hand,” said Vivian Ho, a healthcare economist at Rice University. “It’s happening right before our eyes, and we’re not doing anything about it.”
The American people already spend more for healthcare than citizens of any other developed country. Again, this is a message that Democrats fail to get across.
The average American represents more than $10,500 a year in healthcare spending, according to the Organization for Economic Cooperation and Development. (The U.S. government has an even higher figure: $11,172 per person.)
That compares with less than $6,000 per person in Germany, less than $5,000 in France and Canada, and about $4,000 in Britain, according to OECD statistics.
Are we at least getting a proportionally bigger bang for our healthcare buck? Apparently not.
Americans have shorter average lifespans and a higher infant-mortality rate than people in these other countries — two key metrics of healthcare efficacy.
How do other nations do it? Simple. Each of these countries has a variation of single-payer insurance systems that use economies of scale to make healthcare more accessible and affordable.
That’s the entire case for Medicare for all right there: It costs less and works better.
Here’s where opponents of healthcare reform raise their hands and say, “But higher taxes!”
And again, Democrats have failed spectacularly in explaining how these higher taxes would be offset by reductions in insurance premiums, copays and deductibles.
Yes, taxes would rise under a Medicare-for-all system. The system would be funded almost entirely by tax dollars, as is the case in other developed countries.
But when you take most insurance premiums, copays and deductibles out of the equation, guess what happens. Total out-of-pocket costs for most people go down.
Rand Corp. analysts studied a single-payer proposal for the state of New York. They found that “the majority of New Yorkers would pay less” under such a system, “while the highest-income residents would pay more.”
Researchers at the University of Massachusetts Amherst concluded that a nationwide Medicare-for-all system would result in about $5 trillion in savings over 10 years.
“There would also be broader macroeconomic benefits through operating the U.S. healthcare system under Medicare for all,” they noted.
“Among these are that improved health outcomes will raise productivity; Medicare for all will support greater income equality; and that Medicare for all should support net job creation, especially through lowering operating costs for small- and medium-sized businesses.”
This is the message single-payer advocates need to be conveying: Solutions are available, and they’ve already been battle tested in other countries.
Personally, I disagree with Sanders’ plan, which would eliminate private health insurers and place responsibility for coverage solely on the government.
A more practical (and politically feasible) approach would be to emulate the healthcare systems of Germany, France and Japan, which rely on payroll deductions to fund nonprofit private insurers.
Under such systems — known in healthcare circles as the Bismarck model — the government plays an active role in determining what must be covered and how much can be charged for treatment. No one is excluded, regardless of preexisting conditions.
Yet the market still benefits from having private insurers compete for business, which leaves room for more comprehensive coverage for anyone willing to pay more, as well as cheaper plans for younger people who may want to pay less.
Problems abound, of course. How much should doctors and hospitals be reimbursed for treatment? Who determines fair prices for prescription drugs?
Moreover, would having more people insured drive up doctor visits, placing an even greater strain on healthcare resources? These questions need to be answered and addressed.
Some experts say the cost-savings argument isn’t the pitch Medicare-for-all proponents should be making.
“What single-payer advocates should do, in my own opinion, is not make an argument about lowering costs or make an argument that this will not be an expensive endeavor,” said Anupam B. Jena, an associate professor of healthcare policy and management at Harvard University.
“The argument must be made on humanitarian grounds,” such as expanded coverage and accessible treatment, he said.
At least we wouldn’t be starting from scratch. We’d have the luxury of picking and choosing what works best from other countries’ decades of experience.
And if we do things right, Americans would enjoy the same savings as our counterparts abroad and, with hope, the same improvements in health outcomes.
That’s the story Democrats need to be telling.
And when opponents of reform put up a fight, the reply is, “So you like paying more for worse results?”
That’s a hard position to defend.
David Lazarus is an award-winning business columnist for the Los Angeles Times. He also appears daily on KTLA Channel 5. His work runs in newspapers across the country and has resulted in a variety of laws protecting consumers.
Monday, December 09, 2019
Medicare for all?
[12/9/19 Star-Advertiser]
Should U.S. adopt 'Medicare for All'?
Yes by Robert Weissman
By almost every relevant metric, we do the worst or nearly the worst among all rich countries.
We are the only country to permit tens of millions to go uninsured, far more people in the United States report skipping care because of cost issues than other countries, our infant mortality rate is atrocious and our life expectancy trails other nations and is actually dropping.
There’s no excuse for any of this in such a rich nation. We can solve all of these problems — by expanding coverage, eliminating underinsurance and co-pays and improving health care and health outcomes — with “Medicare for All.”
Medicare for All would cover everyone, and end the outrage of a system that permits 27 million Americans to go uninsured.
No by Chris Talgo
For decades, the left has advocated for nationalizing the country's health-care system under a Medicare-for-all type of plan. Despite their rhetoric, however, this scheme would do much more harm than good.
M4A is completely unaffordable and would push the United States even further into the debt abyss. According to a study by the Mercatus Center, it "would add approximately $32.6 trillion to federal budget commitments during the first 10 years of its implementation (2022-2031)." The United States is already more than $23 trillion in debt; adding an extra $30 trillion in federal spending over the next decade would cause economic Armageddon.
[12/9/19] Misinformation about Medicare for All
[10/16/19] Sen. Elizabeth Warren’s refusal to answer repeated questions at Tuesday night’s debate about how she would fund Medicare for All underscores the challenge she faces finding a politically acceptable means to meet the idea’s huge price tag — a challenge that only intensified today with the release of an eye-popping new study.
The Urban Institute, a center-left think tank highly respected among Democrats, is projecting that a plan similar to what Warren and Sen. Bernie Sanders are pushing would require $34 trillion in additional federal spending over its first decade in operation. That’s more than the federal government’s total cost over the coming decade for Social Security, Medicare, and Medicaid combined, according to the most recent Congressional Budget Office projections.
In recent history, only during the height of World War II has the federal government tried to increase taxes, as a share of the economy, as fast as would be required to offset the cost of a single-payer plan, federal figures show. There are “no analogous peacetime tax increases,” says Leonard Burman, a public-administration professor at Syracuse University and a former top tax official in both the Bill Clinton administration and at the CBO. Raising that much more tax revenue “is plausible in the sense that it is theoretically possible,” Burman told me. “But the revolution that would come along with it would get in the way.”
At the debate, as throughout the campaign, Warren refused to provide any specifics about how she would fund a single-payer plan. Instead, whether questioned by moderators or challenged by other candidates, she recycled variants on the same talking points she has used in venues from campaign town halls to a recent appearance on The Late Show With Stephen Colbert. Rather than explaining what revenue she would raise to fund the plan, Warren insisted that under single payer, middle-income families would save more money with the elimination of health-care premiums, co-pays, and deductibles, regardless of any taxes imposed. “Costs will go up for the wealthy and for big corporations, and for hard-working middle-class families, costs will go down,” she said at the debate.
That calculation itself is disputed. And it begs the question: Even if families would eventually save under a single-payer system, a President Warren would still need to identify a politically plausible funding plan to pass such a program through Congress. By all indications, that looms as an extremely daunting project.
[6/5/10] Bob Jones' choice as the best health care insurance system for America
[4/21/19] Hospitals would get less from Medicare for all
[4/11/19] Krugman on Medicare for All (and the Green New Deal)
[2/27/19] House Democrats introduce Medicare-for-all bill
[2/24/19] WASHINGTON — "Medicare-for-all" can mean different things to different people.
Should U.S. adopt 'Medicare for All'?
Yes by Robert Weissman
By almost every relevant metric, we do the worst or nearly the worst among all rich countries.
We are the only country to permit tens of millions to go uninsured, far more people in the United States report skipping care because of cost issues than other countries, our infant mortality rate is atrocious and our life expectancy trails other nations and is actually dropping.
There’s no excuse for any of this in such a rich nation. We can solve all of these problems — by expanding coverage, eliminating underinsurance and co-pays and improving health care and health outcomes — with “Medicare for All.”
Medicare for All would cover everyone, and end the outrage of a system that permits 27 million Americans to go uninsured.
No by Chris Talgo
For decades, the left has advocated for nationalizing the country's health-care system under a Medicare-for-all type of plan. Despite their rhetoric, however, this scheme would do much more harm than good.
M4A is completely unaffordable and would push the United States even further into the debt abyss. According to a study by the Mercatus Center, it "would add approximately $32.6 trillion to federal budget commitments during the first 10 years of its implementation (2022-2031)." The United States is already more than $23 trillion in debt; adding an extra $30 trillion in federal spending over the next decade would cause economic Armageddon.
[12/9/19] Misinformation about Medicare for All
[10/16/19] Sen. Elizabeth Warren’s refusal to answer repeated questions at Tuesday night’s debate about how she would fund Medicare for All underscores the challenge she faces finding a politically acceptable means to meet the idea’s huge price tag — a challenge that only intensified today with the release of an eye-popping new study.
The Urban Institute, a center-left think tank highly respected among Democrats, is projecting that a plan similar to what Warren and Sen. Bernie Sanders are pushing would require $34 trillion in additional federal spending over its first decade in operation. That’s more than the federal government’s total cost over the coming decade for Social Security, Medicare, and Medicaid combined, according to the most recent Congressional Budget Office projections.
In recent history, only during the height of World War II has the federal government tried to increase taxes, as a share of the economy, as fast as would be required to offset the cost of a single-payer plan, federal figures show. There are “no analogous peacetime tax increases,” says Leonard Burman, a public-administration professor at Syracuse University and a former top tax official in both the Bill Clinton administration and at the CBO. Raising that much more tax revenue “is plausible in the sense that it is theoretically possible,” Burman told me. “But the revolution that would come along with it would get in the way.”
At the debate, as throughout the campaign, Warren refused to provide any specifics about how she would fund a single-payer plan. Instead, whether questioned by moderators or challenged by other candidates, she recycled variants on the same talking points she has used in venues from campaign town halls to a recent appearance on The Late Show With Stephen Colbert. Rather than explaining what revenue she would raise to fund the plan, Warren insisted that under single payer, middle-income families would save more money with the elimination of health-care premiums, co-pays, and deductibles, regardless of any taxes imposed. “Costs will go up for the wealthy and for big corporations, and for hard-working middle-class families, costs will go down,” she said at the debate.
That calculation itself is disputed. And it begs the question: Even if families would eventually save under a single-payer system, a President Warren would still need to identify a politically plausible funding plan to pass such a program through Congress. By all indications, that looms as an extremely daunting project.
[6/5/10] Bob Jones' choice as the best health care insurance system for America
[4/21/19] Hospitals would get less from Medicare for all
[4/11/19] Krugman on Medicare for All (and the Green New Deal)
[2/27/19] House Democrats introduce Medicare-for-all bill
[2/24/19] WASHINGTON — "Medicare-for-all" can mean different things to different people.
For
some, it's a single government-run health insurance plan for the whole
country. To others, it's giving consumers a choice to buy into Medicare
or keep their private insurance.
But whatever the form, the proposals are built on the premise that health insurance should be a guaranteed right.
Sen.
Bernie Sanders, a Vermont independent seeking the 2020 Democratic
presidential nomination, launched the debate over "Medicare-for-all."
Now, other Democratic presidential hopefuls are staking out their
positions on the concept, which President Donald Trump decries as
socialism.
But government-backed
insurance is already part of daily life, covering more than 130 million
Americans. A new report from the Centers for Medicare and Medicaid
Services projects that federal, state and local governments will be
paying nearly half the nation's health care tab by 2027.
A primer on Medicare and Medicare-inspired plans that have become a central focus for Democrats:
TRADITIONAL MEDICARE
Enacted
more than 50 years ago to cover people age 65 and older, Medicare
remains the government's flagship health care program. About 60 million
are enrolled, including some 9 million disabled people.
Benefits
include coverage for hospitalization, doctors' services, prescription
drugs, tests and imaging, rehab, medical equipment, and hospice. But
Medicare does not cover long-term care, routine dental care, hearing
aids or eyeglasses.
Medicare has significant copayments, and many beneficiaries purchase supplemental private insurance to protect against costs.
With
baby boomers aging into Medicare, taxes are not enough to cover future
costs. In just seven years — 2026— it's projected that the program's
giant trust fund for inpatient care won't have enough to cover medical
bills due.
'MEDICARE-FOR-ALL'
Two
bills, one by Sanders and another from House Democrats, would set up a
government-run health insurance plan for the entire country. It's also
called "single-payer" because a federal agency would pay the bills. Or
just "M4A."
Government coverage would replace private health insurance, including employer-sponsored plans that insure about 160 million people. Benefits for seniors would be improved beyond what Medicare now offers, with coverage for dental, vision and hearing aids. The House bill includes a new long-term care program.
Patients
would not have to pay premiums or deductibles, and cost-sharing would be
eliminated or greatly reduced. But taxes would go up significantly.
Costs would be limited through government-set payment rates across the
health care system.
Neither proposal
has a cost analysis from the Congressional Budget Office, but several
independent studies have estimated that government spending on health
care would increase dramatically, in the range of about $25 trillion to
$35 trillion or more over a 10-year period.
Democratic
presidential hopefuls Sens. Cory Booker of New Jersey, Kirsten
Gillibrand of New York, Kamala Harris of California, and Elizabeth
Warren of Massachusetts are co-sponsors of the Sanders' plan. So is
Oregon Sen. Jeff Merkley, who is considering a run.
Some co-sponsors also support less ambitious proposals to advance the goal of coverage for all.
MEDICARE BUY-IN
Several
Democratic lawmakers have unveiled plans that would let older adults
buy into Medicare. The idea would build on the Obama-era Affordable Care
Act because ACA subsidies would be available to help pay premiums for
those who qualify.
Sen. Sherrod
Brown, D-Ohio, who is weighing a presidential campaign, has proposed
giving people between the ages of 50 and 64 the option of buying into
Medicare. His "Medicare at 50" bill was co-authored by Sens. Debbie
Stabenow, D-Mich., and Tammy Baldwin, D-Wis.
While
that's not "Medicare-for-all," it would provide a backstop for a
demographic group whose members can suddenly find themselves uninsured
due to layoffs, plant closings, or involuntary retirement.
Presidential
hopefuls Booker, Gillibrand, Harris, are co-sponsors. So is Merkley.
And the list includes Sen. Amy Klobuchar, D-Minn., who's running for the
Democratic nomination and is not a co-sponsor of the Sanders bill.
MEDICARE PUBLIC OPTION
Legislation
from Merkley would allow people of any age to buy into a new public
plan modeled on Medicare. Employers would have the option of offering it
to workers. Financial assistance with premiums would be available
through the Affordable Care Act.
The
"Choose Medicare" bill echoes an earlier "public option" proposal for
government-run insurance to compete with private coverage, which
Democrats ultimately backed away from during the Obama years after
strong industry opposition.
The plan
would also improve benefits under traditional Medicare, setting a limit
on seniors' cost-sharing. And it would authorize Medicare to negotiate
drug prices.
Sens. Booker, Gillibrand and Harris are co-sponsors.
MEDICAID BUY-IN
Some
Democrats are proposing legislation that would allow states to open
their Medicaid programs up to people willing to pay premiums.
Although
Medicaid started out as a federal-state collaboration to cover the
poor, it now insures about 75 million people, making it the largest and
most diverse government health program.
The Medicaid buy-in idea builds on the Obama-era expansion of that program to low-income adults, adopted by most states.
Wednesday, October 09, 2019
President Elizabeth Warren: remaking capitalism
For the past generation, Democratic presidential candidates have mostly talked of redistributing the rewards of American capitalism while leaving its basic structure intact.
Elizabeth Warren promises to break that mold. The Massachusetts senator, who has moved to the front ranks of the field, talks of remaking capitalism from the ground up. As president, she would drastically cut back the size and influence of big business, push private companies from parts of the economy altogether, and shift power to government and to labor.
Businesses are meeting the rising prospect of a Warren presidency with a combination of concern, skepticism and, for a few, a sense of opportunity.
Companies are used to Democrats criticizing business, whether John Kerry, the 2004 nominee, for outsourcing jobs or President Obama, for causing the financial crisis. But no front-runner has issued so comprehensive an indictment as Ms. Warren, who has blamed business for, among other things stagnant wages, high student debt, global warming, gun violence, the prison population, high medical bills, and the shortage of affordable housing and child care.
And no front-runner has proposed such sweeping changes to how businesses operate. A President Warren would seek to regulate big tech companies as utilities, break up big banks and split them from securities dealers, ban fracking of oil and gas, phase out carbon emission from buildings, cars and power plants in eight to 15 years, require big companies to appoint worker representatives to at least 40% of board seats, ban private health insurance and, effectively, for-profit college, and negotiate down drug prices.
Her policies would directly affect companies with sales of nearly $5 trillion and stock-market value of more than $8 trillion, a third of the S&P 500 stock index. Taxes on the wealthy and corporations would rise sharply.
That, in turn, has led to nervousness among some executives. “She could create an environment where it is next to impossible to function” for health insurers, said Vicky Gregg, a former chief executive of BlueCross BlueShield of Tennessee and now partner in a private-equity firm. “There’s no question that keeps you up at night if you’re a health-plan executive.”
Others, particularly in Silicon Valley, are enthusiastic supporters of Ms. Warren despite, or for some because of, her plans to break up big tech companies. Some economists predict her plans could boost growth and that business warnings about the harm of her policies should be taken with a grain of salt.
“Businesses have cried wolf far too many times for that to be taken at face value during a presidential campaign,” said Austan Goolsbee, a University of Chicago economist who served under Mr. Obama.
When Ms. Warren first proposed companies should be responsible to all stakeholders, not just shareholders, some called it socialism, he noted. A year later, “the Business Roundtable announced something very much in the spirit of what Elizabeth Warren said.”
Some executives express the hope that her plans are so disruptive she would need to water them down significantly. A fracking ban “would decimate our industry,” said Scott Sheffield, CEO of Pioneer Natural Resources Co., one of the largest U.S. shale companies. “We understand candidates for the presidential nomination often run to the extremes during the campaign and moderate their positions once they are responsible for governing.”
Still, there is no sign of such moderation from Ms. Warren, and political analysts warn not to expect any: Presidential candidates of late, including Donald Trump, have governed much as they campaigned.
By arguing that the growth of corporate power over the last 35 years is at the root of many problems in the U.S., she would make the place of business in society a central theme of the election.
Ms. Warren, in laying out her case, has said she is “a capitalist to my bones,” whereas fellow candidate Sen. Bernie Sanders calls himself a “democratic socialist.”
“I love what markets can do, I love what functioning economies can do. They are what make us rich, they are what create opportunity,” Ms. Warren said on CNBC last year. “But only fair markets, markets with rules. Markets without rules is about the rich take it all, it’s about the powerful get all of it. And that’s what’s gone wrong in America.”
Supporters say her proposals wouldn’t displace capitalism but align it with the what prevailed in the 1950s and 1960s and still does in many other Western countries.
Ms. Warren would impose a 2% to 3% tax on wealth above $50 million, repeal President Trump’s tax cuts for corporations and the wealthy, impose a new 7% tax on big company profits and a 14.8% tax on incomes above $250,000 to finance expanded Social Security benefits.
Many economists say high tax rates discourage investment and work, and thus slow economic growth. Gabriel Zucman, a professor of economics at the University of California, Berkeley who advised Ms. Warren on the wealth tax, said it depends on how the money is spent. “If it’s spent on child care, and that increases women’s labor force participation, then you get an increase in income for part of the population.” He noted the wealthy paid 91% rates on incomes and 77% on estates in the 1950s and 1960s and “there’s no evidence it killed innovation or growth.”
Mark Zandi, economist at Moody’s Analytics, wrote in a series of reports that the taxes required to pay for Ms. Warren’s proposals would damp investment and work by the wealthy, but that effect would also be more than offset by increased spending by lower-income people, such as child-care workers.
Supporters note almost every advanced capitalist economy has single-payer health care, and in Germany, big companies have worker representatives on their boards. “It has not killed German capitalism,” said Mr. Zucman. “They have some pretty strong corporations.”
If each Warren proposal has some precedent in U.S. or foreign experience, in its totality her program would be a sharp break with capitalism as American companies know it.
A senior executive at a Washington-based trade group who works closely with top CEOs said of the distinction often drawn between Ms. Warren’s capitalism and Mr. Sanders’ socialism: “I don’t know if business is buying that distinction. From a policy standpoint there doesn’t seem to be a great deal of difference.” (Mr. Sanders sought the nomination in 2016 but unlike Ms. Warren now, never led the Real Clear Politics polling average or online prediction markets.)
A common refrain among business is that Ms. Warren seems to thrive on attacking them, indeed considers it part of her brand. She retweets articles about their criticism with: “I approve this message.”
The rancor is most acute among financiers Ms. Warren regularly casts as villains, even after a decade of postcrisis reforms that have made banks safer, less profitable and their treatment of consumers more tightly regulated. She called her capital-gains-tax proposal, introduced this summer, the Stop Wall Street Looting Act. Some still stew over her blocking investment banker Antonio Weiss from a Treasury job under Mr. Obama in 2015, despite his Democratic credentials, because he worked on deals that moved some companies’ domiciles abroad.
Few, however, will say so publicly, fearful of the damage she can do to their companies and share prices. Two weeks ago, she knocked 3% off the shares of the two big bond-rating agencies by challenging the impartiality of their ratings in a letter to regulators. When the chief executive of UnitedHealth Group Inc., parent of the country’s largest health insurer, briefly addressed the impact of Medicare for All in an earnings call, it was blamed for driving down the entire sector’s share prices.
UnitedHealth says it “welcomes the renewed national discussion on how to achieve universal coverage.”
In July, Facebook Inc. CEO Mark Zuckerberg, referring to Ms. Warren’s plan to break up Facebook, said in remarks to employees reported by The Verge, a technology-news site: “If she gets elected president, then I would bet that we will have a legal challenge, and I would bet that we will win the legal challenge,” adding that “at the end of the day, if someone’s going to try to threaten something that existential, you go to the mat and you fight.”
Ms. Warren shot back on Twitter that Facebook has “a lot of power—and [faces] little competition or accountability.”
Last week, Mr. Zuckerberg held another employee Q&A, which was publicly livestreamed. Asked about Ms. Warren’s plans and how Facebook’s platform would remain unbiased toward her, he joked he would “try not to antagonize her further,” then added employees needed to be neutral and empathetic to a wide range of opinions. “The value that we care about is giving people a voice and allowing people to express themselves,” he said. “We obviously try not to be biased.”
The consensus among business leaders is that few of Ms. Warren’s big initiatives will be enacted, because she will tack toward the center if she secures the nomination or the White House, or because Congress and the courts won’t let her. An antitrust lawsuit against a big tech company would take a decade or longer and probably fail, Barclays analysts said in a July note.
Medicare for All “would destroy” private insurers, said Matthew Borsch, an analyst with BMO Capital Markets. But, he said, an executive of a major health insurer, in a recent private meeting, put the odds of such a plan passing at “10,000 to one.”
Many business leaders have no problem with Ms. Warren’s goals, but do with the speed and means by which she means to reach them. Minneapolis-based electric utility Xcel Energy, which serves eight states, in December pledged to slash its carbon emissions 80% by 2030 and 100% 2050. That’s not good enough for Ms. Warren, who has targeted 100% by 2035.
The problem, said CEO Ben Fowke, is that getting from 80% to 100% depends on as-yet-unproven advances in storage, carbon capture, and nuclear and hydrogen generation. Ms. Warren “would set up some unrealistic expectations.”
Automobile manufacturers are rolling out electric models, but none has yet found a way to make such a car affordable to mainstream consumers and profitable. “The current market is 1% electric vehicles. All of those, 100%, are sold at a loss. The industry isn’t here as a non-profit,” said one auto executive. The economics will improve, yet Ms. Warren’s plan to make all new cars emissions-free by 2030 “is, simply put, preposterous.”
The Trump administration is already mulling action on drug prices. Ms. Warren would go much further, letting Medicare negotiate prices with suppliers, permitting imports of cheaper foreign medicines and having the federal government manufacture scarce generics.
Ron Cohen, CEO of biotech drugmaker Acorda Therapeutics said there are legitimate concerns about drug costs and some price increases have been excessive. But her proposals won’t work, he said: Patients could lose access to vital drugs if Medicare and manufacturers can’t agree on a price, and it would be more efficient for the federal government to offer existing manufacturers incentives such as tax breaks to make scarce generics.
Ms. Warren’s sympathizers aren’t surprised by the blowback. They see big-company CEOs as preoccupied with their own welfare rather than that of the economy as a whole. Small banks, they argue, would benefit from breaking up big banks, and startup technology companies would benefit from breaking the grip of big tech companies on internet search, social media and e-commerce.
“Breaking up big tech is pro-growth and pro-innovation,” said Bharat Ramamurti, who heads Ms. Warren’s economic policy team. “In the 90s, Microsoft was threatening to corner the internet via Internet Explorer and Windows, and federal government antitrust action helped pave the way for companies like Google and Facebook to emerge in the first place. And now Google and Facebook dominate that space, and smaller tech companies are run out of business or snapped up—undermining innovation and dynamism.”
Some private analysts agree: “If Warren does break up the big tech giants, we will see more competitors and innovation,” said Jonathan Tepper, head of a financial markets advisory firm Variant Perception, who has been critical of the companies. “The telecoms and tech boom happened after AT&T no longer had a stranglehold on U.S. telecoms. Likewise, breaking IBM’s hold of hardware and software led to the software boom of the 1980s and 1990s.”
Ms. Warren does draw business support, in particular in Silicon Valley, because some agree with her plans for business, don’t think they’ll happen or simply consider the rest of her agenda more important. Venture capitalist and liberal donor Chris Sacca called her wealth tax “*extremely* and *radically*... reasonable” on Twitter.
In June, venture capitalist and former Facebook executive Chamath Palihapitiya tweeted: “I don’t agree with many of her proposals but I donated to Elizabeth Warren because SHE IS THE ONLY MAJOR CANDIDATE WITH STUFF WRITTEN DOWN.” In an email, Mr. Palihapitiya predicted big tech wouldn’t ultimately be one of the issues Ms. Warren prioritizes.
In response to concerns that phasing out fossil fuels would kill jobs, Ms. Warren has said her green energy and climate adaptation plans will create millions of even better paying jobs.
Businesses have a history of adapting to, and ultimately profiting from, expanded government. Accountants vehemently opposed being regulated under the 2002 Sarbanes-Oxley Act, then made a fortune advising companies on the law’s provisions, notes one former Democratic staffer who worked on the law.
Some health-insurance executives hope Ms. Warren’s push for Medicare for All will fall short and, to win over moderate legislators, she will instead expand coverage in a way that would bring them more customers—as Mr. Obama’s Affordable Care Act did.
And for many business leaders, Mr. Trump, given his attacks on free trade, immigration and companies that cross him, isn’t an overly appetizing alternative. Thus, uneasy as they at the prospect of a Warren presidency, few would act actively work to re-elect Mr. Trump, the Washington trade executive speculated.
Elizabeth Warren promises to break that mold. The Massachusetts senator, who has moved to the front ranks of the field, talks of remaking capitalism from the ground up. As president, she would drastically cut back the size and influence of big business, push private companies from parts of the economy altogether, and shift power to government and to labor.
Businesses are meeting the rising prospect of a Warren presidency with a combination of concern, skepticism and, for a few, a sense of opportunity.
Companies are used to Democrats criticizing business, whether John Kerry, the 2004 nominee, for outsourcing jobs or President Obama, for causing the financial crisis. But no front-runner has issued so comprehensive an indictment as Ms. Warren, who has blamed business for, among other things stagnant wages, high student debt, global warming, gun violence, the prison population, high medical bills, and the shortage of affordable housing and child care.
And no front-runner has proposed such sweeping changes to how businesses operate. A President Warren would seek to regulate big tech companies as utilities, break up big banks and split them from securities dealers, ban fracking of oil and gas, phase out carbon emission from buildings, cars and power plants in eight to 15 years, require big companies to appoint worker representatives to at least 40% of board seats, ban private health insurance and, effectively, for-profit college, and negotiate down drug prices.
Her policies would directly affect companies with sales of nearly $5 trillion and stock-market value of more than $8 trillion, a third of the S&P 500 stock index. Taxes on the wealthy and corporations would rise sharply.
That, in turn, has led to nervousness among some executives. “She could create an environment where it is next to impossible to function” for health insurers, said Vicky Gregg, a former chief executive of BlueCross BlueShield of Tennessee and now partner in a private-equity firm. “There’s no question that keeps you up at night if you’re a health-plan executive.”
Others, particularly in Silicon Valley, are enthusiastic supporters of Ms. Warren despite, or for some because of, her plans to break up big tech companies. Some economists predict her plans could boost growth and that business warnings about the harm of her policies should be taken with a grain of salt.
“Businesses have cried wolf far too many times for that to be taken at face value during a presidential campaign,” said Austan Goolsbee, a University of Chicago economist who served under Mr. Obama.
When Ms. Warren first proposed companies should be responsible to all stakeholders, not just shareholders, some called it socialism, he noted. A year later, “the Business Roundtable announced something very much in the spirit of what Elizabeth Warren said.”
Some executives express the hope that her plans are so disruptive she would need to water them down significantly. A fracking ban “would decimate our industry,” said Scott Sheffield, CEO of Pioneer Natural Resources Co., one of the largest U.S. shale companies. “We understand candidates for the presidential nomination often run to the extremes during the campaign and moderate their positions once they are responsible for governing.”
Still, there is no sign of such moderation from Ms. Warren, and political analysts warn not to expect any: Presidential candidates of late, including Donald Trump, have governed much as they campaigned.
By arguing that the growth of corporate power over the last 35 years is at the root of many problems in the U.S., she would make the place of business in society a central theme of the election.
Ms. Warren, in laying out her case, has said she is “a capitalist to my bones,” whereas fellow candidate Sen. Bernie Sanders calls himself a “democratic socialist.”
“I love what markets can do, I love what functioning economies can do. They are what make us rich, they are what create opportunity,” Ms. Warren said on CNBC last year. “But only fair markets, markets with rules. Markets without rules is about the rich take it all, it’s about the powerful get all of it. And that’s what’s gone wrong in America.”
Supporters say her proposals wouldn’t displace capitalism but align it with the what prevailed in the 1950s and 1960s and still does in many other Western countries.
Ms. Warren would impose a 2% to 3% tax on wealth above $50 million, repeal President Trump’s tax cuts for corporations and the wealthy, impose a new 7% tax on big company profits and a 14.8% tax on incomes above $250,000 to finance expanded Social Security benefits.
Many economists say high tax rates discourage investment and work, and thus slow economic growth. Gabriel Zucman, a professor of economics at the University of California, Berkeley who advised Ms. Warren on the wealth tax, said it depends on how the money is spent. “If it’s spent on child care, and that increases women’s labor force participation, then you get an increase in income for part of the population.” He noted the wealthy paid 91% rates on incomes and 77% on estates in the 1950s and 1960s and “there’s no evidence it killed innovation or growth.”
Mark Zandi, economist at Moody’s Analytics, wrote in a series of reports that the taxes required to pay for Ms. Warren’s proposals would damp investment and work by the wealthy, but that effect would also be more than offset by increased spending by lower-income people, such as child-care workers.
Supporters note almost every advanced capitalist economy has single-payer health care, and in Germany, big companies have worker representatives on their boards. “It has not killed German capitalism,” said Mr. Zucman. “They have some pretty strong corporations.”
If each Warren proposal has some precedent in U.S. or foreign experience, in its totality her program would be a sharp break with capitalism as American companies know it.
A senior executive at a Washington-based trade group who works closely with top CEOs said of the distinction often drawn between Ms. Warren’s capitalism and Mr. Sanders’ socialism: “I don’t know if business is buying that distinction. From a policy standpoint there doesn’t seem to be a great deal of difference.” (Mr. Sanders sought the nomination in 2016 but unlike Ms. Warren now, never led the Real Clear Politics polling average or online prediction markets.)
A common refrain among business is that Ms. Warren seems to thrive on attacking them, indeed considers it part of her brand. She retweets articles about their criticism with: “I approve this message.”
The rancor is most acute among financiers Ms. Warren regularly casts as villains, even after a decade of postcrisis reforms that have made banks safer, less profitable and their treatment of consumers more tightly regulated. She called her capital-gains-tax proposal, introduced this summer, the Stop Wall Street Looting Act. Some still stew over her blocking investment banker Antonio Weiss from a Treasury job under Mr. Obama in 2015, despite his Democratic credentials, because he worked on deals that moved some companies’ domiciles abroad.
Few, however, will say so publicly, fearful of the damage she can do to their companies and share prices. Two weeks ago, she knocked 3% off the shares of the two big bond-rating agencies by challenging the impartiality of their ratings in a letter to regulators. When the chief executive of UnitedHealth Group Inc., parent of the country’s largest health insurer, briefly addressed the impact of Medicare for All in an earnings call, it was blamed for driving down the entire sector’s share prices.
UnitedHealth says it “welcomes the renewed national discussion on how to achieve universal coverage.”
In July, Facebook Inc. CEO Mark Zuckerberg, referring to Ms. Warren’s plan to break up Facebook, said in remarks to employees reported by The Verge, a technology-news site: “If she gets elected president, then I would bet that we will have a legal challenge, and I would bet that we will win the legal challenge,” adding that “at the end of the day, if someone’s going to try to threaten something that existential, you go to the mat and you fight.”
Ms. Warren shot back on Twitter that Facebook has “a lot of power—and [faces] little competition or accountability.”
Last week, Mr. Zuckerberg held another employee Q&A, which was publicly livestreamed. Asked about Ms. Warren’s plans and how Facebook’s platform would remain unbiased toward her, he joked he would “try not to antagonize her further,” then added employees needed to be neutral and empathetic to a wide range of opinions. “The value that we care about is giving people a voice and allowing people to express themselves,” he said. “We obviously try not to be biased.”
The consensus among business leaders is that few of Ms. Warren’s big initiatives will be enacted, because she will tack toward the center if she secures the nomination or the White House, or because Congress and the courts won’t let her. An antitrust lawsuit against a big tech company would take a decade or longer and probably fail, Barclays analysts said in a July note.
Medicare for All “would destroy” private insurers, said Matthew Borsch, an analyst with BMO Capital Markets. But, he said, an executive of a major health insurer, in a recent private meeting, put the odds of such a plan passing at “10,000 to one.”
Many business leaders have no problem with Ms. Warren’s goals, but do with the speed and means by which she means to reach them. Minneapolis-based electric utility Xcel Energy, which serves eight states, in December pledged to slash its carbon emissions 80% by 2030 and 100% 2050. That’s not good enough for Ms. Warren, who has targeted 100% by 2035.
The problem, said CEO Ben Fowke, is that getting from 80% to 100% depends on as-yet-unproven advances in storage, carbon capture, and nuclear and hydrogen generation. Ms. Warren “would set up some unrealistic expectations.”
Automobile manufacturers are rolling out electric models, but none has yet found a way to make such a car affordable to mainstream consumers and profitable. “The current market is 1% electric vehicles. All of those, 100%, are sold at a loss. The industry isn’t here as a non-profit,” said one auto executive. The economics will improve, yet Ms. Warren’s plan to make all new cars emissions-free by 2030 “is, simply put, preposterous.”
The Trump administration is already mulling action on drug prices. Ms. Warren would go much further, letting Medicare negotiate prices with suppliers, permitting imports of cheaper foreign medicines and having the federal government manufacture scarce generics.
Ron Cohen, CEO of biotech drugmaker Acorda Therapeutics said there are legitimate concerns about drug costs and some price increases have been excessive. But her proposals won’t work, he said: Patients could lose access to vital drugs if Medicare and manufacturers can’t agree on a price, and it would be more efficient for the federal government to offer existing manufacturers incentives such as tax breaks to make scarce generics.
Ms. Warren’s sympathizers aren’t surprised by the blowback. They see big-company CEOs as preoccupied with their own welfare rather than that of the economy as a whole. Small banks, they argue, would benefit from breaking up big banks, and startup technology companies would benefit from breaking the grip of big tech companies on internet search, social media and e-commerce.
“Breaking up big tech is pro-growth and pro-innovation,” said Bharat Ramamurti, who heads Ms. Warren’s economic policy team. “In the 90s, Microsoft was threatening to corner the internet via Internet Explorer and Windows, and federal government antitrust action helped pave the way for companies like Google and Facebook to emerge in the first place. And now Google and Facebook dominate that space, and smaller tech companies are run out of business or snapped up—undermining innovation and dynamism.”
Some private analysts agree: “If Warren does break up the big tech giants, we will see more competitors and innovation,” said Jonathan Tepper, head of a financial markets advisory firm Variant Perception, who has been critical of the companies. “The telecoms and tech boom happened after AT&T no longer had a stranglehold on U.S. telecoms. Likewise, breaking IBM’s hold of hardware and software led to the software boom of the 1980s and 1990s.”
Ms. Warren does draw business support, in particular in Silicon Valley, because some agree with her plans for business, don’t think they’ll happen or simply consider the rest of her agenda more important. Venture capitalist and liberal donor Chris Sacca called her wealth tax “*extremely* and *radically*... reasonable” on Twitter.
In June, venture capitalist and former Facebook executive Chamath Palihapitiya tweeted: “I don’t agree with many of her proposals but I donated to Elizabeth Warren because SHE IS THE ONLY MAJOR CANDIDATE WITH STUFF WRITTEN DOWN.” In an email, Mr. Palihapitiya predicted big tech wouldn’t ultimately be one of the issues Ms. Warren prioritizes.
In response to concerns that phasing out fossil fuels would kill jobs, Ms. Warren has said her green energy and climate adaptation plans will create millions of even better paying jobs.
Businesses have a history of adapting to, and ultimately profiting from, expanded government. Accountants vehemently opposed being regulated under the 2002 Sarbanes-Oxley Act, then made a fortune advising companies on the law’s provisions, notes one former Democratic staffer who worked on the law.
Some health-insurance executives hope Ms. Warren’s push for Medicare for All will fall short and, to win over moderate legislators, she will instead expand coverage in a way that would bring them more customers—as Mr. Obama’s Affordable Care Act did.
And for many business leaders, Mr. Trump, given his attacks on free trade, immigration and companies that cross him, isn’t an overly appetizing alternative. Thus, uneasy as they at the prospect of a Warren presidency, few would act actively work to re-elect Mr. Trump, the Washington trade executive speculated.
Sunday, May 05, 2019
Medicare for America
On one side, there’s “Medicare for All,” which has come to mean the
Bernie Sanders position: replacing the entire existing U.S. health
insurance system with a Medicare-type program in which the government
pays most medical bills directly.
On the other side, there’s “Medicare for America,” originally a proposal from the Center for American Progress, now embodied in legislation. While none of the announced Democratic candidates has endorsed this proposal yet, it’s a good guess that most of them will come around to something similar.
The big difference from a Sanders-type plan is that people would be allowed to keep private coverage if they chose — but they or their employers would also have the option of buying into an enhanced version of Medicare, with substantial subsidies for lower- and middle-income families.
On the other side, there’s “Medicare for America,” originally a proposal from the Center for American Progress, now embodied in legislation. While none of the announced Democratic candidates has endorsed this proposal yet, it’s a good guess that most of them will come around to something similar.
The big difference from a Sanders-type plan is that people would be allowed to keep private coverage if they chose — but they or their employers would also have the option of buying into an enhanced version of Medicare, with substantial subsidies for lower- and middle-income families.
The most important thing you need to know about these rival plans is that both of them would do the job.
Many
people realize, I think, that we’re the only advanced country that
doesn’t guarantee essential health care to its legal residents. My guess
is that fewer realize that nations achieve that goal in a variety of
ways — and they all work.
Every two years the Commonwealth Fund provides an invaluable survey
of major nations’ health care systems. America always comes in last; in
the latest edition, the three leaders are Britain, Australia and the
Netherlands.
What’s remarkable about those top three is that they have radically
different systems. Britain has true socialized medicine — direct
government provision of health care. Australia has single-payer — it’s
basically Bernie down under. But the Dutch rely on private insurance companies
— heavily regulated, with lots of subsidies, but looking more like a
better-funded version of Obamacare than like Medicare for All. And the
Netherlands actually tops the Commonwealth Fund rankings.
So which system should Democrats advocate? The answer, I’d argue, is the
system we’re most likely actually to create — the one that will play
best in the general election, and is then most likely to pass Congress
if the Democrat wins.
--- Paul Krugman, 3/21/19
--- Paul Krugman, 3/21/19
who will lose insurance if ObamaCare is overturned?
The Affordable Care Act once again faces legal hurdles after
President Donald Trump and his administration supported a lawsuit
questioning the health-care law's constitutionality.
If the lawsuit succeeds and the courts decide to repeal the Affordable Care Act, also known as Obamacare, millions of Americans could lose their health care if a replacement plan is not established. Though Trump wanted to replace the law with a new Republican plan before the 2020 elections, the GOP refused to bring forward its own proposal until it wins a majority in the House of Representatives.
The Department of Justice on Wednesday asked the U.S. Court of Appeals for the 5th Circuit to overturn Obamacare after a federal judge in Texas ruled the law unconstitutional, citing the removal of a tax penalty levied against citizens without health insurance. The Trump administration reduced the tax penalty, called the individual mandate, to $0 in the 2017 Tax Cuts and Jobs Act.
Though Obamacare remains law while it awaits deliberation in the courts, about 25 million Americans may be left uninsured if the law is struck down in its entirety.
If the lawsuit succeeds and the courts decide to repeal the Affordable Care Act, also known as Obamacare, millions of Americans could lose their health care if a replacement plan is not established. Though Trump wanted to replace the law with a new Republican plan before the 2020 elections, the GOP refused to bring forward its own proposal until it wins a majority in the House of Representatives.
The Department of Justice on Wednesday asked the U.S. Court of Appeals for the 5th Circuit to overturn Obamacare after a federal judge in Texas ruled the law unconstitutional, citing the removal of a tax penalty levied against citizens without health insurance. The Trump administration reduced the tax penalty, called the individual mandate, to $0 in the 2017 Tax Cuts and Jobs Act.
Though Obamacare remains law while it awaits deliberation in the courts, about 25 million Americans may be left uninsured if the law is struck down in its entirety.
Wednesday, May 01, 2019
Alabama approves abortion ban
Alabama's House of Representatives overwhelmingly approved a near-total abortion ban, a piece of legislation that the bill's sponsor called a "direct attack" on Roe v. Wade, the landmark Supreme Court decision that protects a woman's right to an abortion. Politicians in the statehouse voted against adding an amendment that would have added an exception for victims of rape and incest.
After several hours of contentious debate Tuesday evening, Alabama politicians overwhelmingly passed House Bill 314, the "Human Life Protection Act," 74 to 3, pushing the bill forward to the state Senate. Of the state's 105 representatives, 28 refused to vote after Republicans blocked the rape and incest amendment.
If passed into law, the legislation would criminalize abortion, classifying it as a Class A felony in Alabama. That means that a doctor caught performing abortions in the state would face up to 99 years in prison under the proposed law.
"The heart of this bill is to confront a decision that was made by the courts in 1973 that said the baby in the womb is not a person," said Representative Terri Collins, the bill's sponsor, during the debate. "This bill addresses that one issue. Is that baby in the womb a person? I believe our law says it is."
Because federal law supersedes state law, Alabama would be in violation of the U.S. Constitution if lawmakers attempted to implement the legislation, noted several politicians. If passed, the legislation would likely join a host of other contested laws that anti-abortion activists hope will rise to the Supreme Court and potentially overturn Roe v. Wade. The proposed law flatly rejects the decision, saying that "judges and legal scholars have disagreed and dissented with its finding."
After several hours of contentious debate Tuesday evening, Alabama politicians overwhelmingly passed House Bill 314, the "Human Life Protection Act," 74 to 3, pushing the bill forward to the state Senate. Of the state's 105 representatives, 28 refused to vote after Republicans blocked the rape and incest amendment.
If passed into law, the legislation would criminalize abortion, classifying it as a Class A felony in Alabama. That means that a doctor caught performing abortions in the state would face up to 99 years in prison under the proposed law.
"The heart of this bill is to confront a decision that was made by the courts in 1973 that said the baby in the womb is not a person," said Representative Terri Collins, the bill's sponsor, during the debate. "This bill addresses that one issue. Is that baby in the womb a person? I believe our law says it is."
Because federal law supersedes state law, Alabama would be in violation of the U.S. Constitution if lawmakers attempted to implement the legislation, noted several politicians. If passed, the legislation would likely join a host of other contested laws that anti-abortion activists hope will rise to the Supreme Court and potentially overturn Roe v. Wade. The proposed law flatly rejects the decision, saying that "judges and legal scholars have disagreed and dissented with its finding."
Wednesday, April 17, 2019
Universal Health Care for the United States?
[4/18/19] U.S. health care system is being destroyed by insurance and drug companies (letter to the editor)
***
PAEONIAN SPRINGS, Va. — Conservatives and progressives agree that everyone should be able to get health insurance and have access to quality health care. But the divide over how to accomplish that goal is wide and deep.
***
PAEONIAN SPRINGS, Va. — Conservatives and progressives agree that everyone should be able to get health insurance and have access to quality health care. But the divide over how to accomplish that goal is wide and deep.
Progressives
believe the government should make decisions about allocation of the
resources in our health sector while conservatives believe these
decisions should be controlled by individuals and families.
The
sales pitch for Medicare for all is appealing — universal coverage,
free access to doctors and hospitals, and no insurance premiums,
copayments or deductibles.
But
then come the tradeoffs: Washington bureaucrats would decide what
services are covered and how much doctors and hospitals would be paid.
Everyone
would be required to give up the coverage they have now — including 173
million American who get health insurance at work — and taxes would be
much higher to finance $32 trillion in added government spending over
the next decade. For comparison, federal revenues last year totaled $3.4
trillion.
“If you
look at polling data, it’s great until you tell them taxes would double
and they’d have to give up their employer coverage,” Sen. Bill Cassidy,
R-La. noted recently.
***
In Canada, everyone in the country is guaranteed access to health care by the government.
The
same is true for France, the United Kingdom, Germany, Netherlands and
every other country that we think of as comparable in terms of levels of
wealth, democracy and economic development.
In spite of providing universal care, these countries also all spend much less on health care than the United States.
In
Canada, per person spending is 60 percent what it is in the United
States. In Germany spending per person is 56 percent and in the United
Kingdom just 42 percent of what we spend.
And
these countries all have comparable outcomes. People in other wealthy
countries not only have longer life expectancies and lower
infant-mortality rates, they also have comparable outcomes when looking
at more narrow health issues, like treatment for cancer or heart
disease.
The basic story is
that we spend roughly twice as much per person as people in other
wealthy countries and we have pretty much nothing to show for it in
terms of better health.
This is the context in which critics of Medicare for all are telling us it is not possible.
If
the argument is that it won’t be easy, the critics have a point. The
reason we spend twice as much for our health care is that big actors in
the industry get twice as much money here.
Drug
companies get away with charging us twice as much for drugs as they do
in other wealthy countries. The same is true for medical equipment
companies who charge far more for kidney dialysis machines and MRIs than
in France and Germany.
And our doctors and dentists get paid twice as much, on average, as their counterparts in other wealthy countries.
In addition, we spend more than $250 billion a year paying insurance companies to administer our chaotic system.
Doctors’
offices, hospitals and other providers spend tens of billions more on
administrative personnel who have to deal with the paperwork and issues
that are caused by having a range of insurers, each with their own
payment rules and practices.
These interest groups will use all of their political power to protect the income they get under the current system.
These interest groups will use all of their political power to protect the income they get under the current system.
The
pharmaceutical industry will fight measures to rein in their profits in
the same way the tobacco industry fought public health advocates who
sought to curb smoking.
The same is true for the medical equipment industry.
And doctors and dentists will fight like crazy to preserve a pay structure that puts most of them in the top 1 percent of wage earners.
This will also be true of insurers faced with a more efficient system that will put most of them out of business.
While a well-designed pathway can get us to Medicare for all, even we can’t do it all at once.
For
beginners, we can look to lower the age of Medicare eligibility from
the current 65 to 60 or even 55 in an initial round. We can also allow
people of all ages to have the option to buy into a public Medicare-type
system.
We can also look to start getting our costs down. This means lowering drug prices, both by negotiating in the same way as other countries, and directly funding research so that newly developed drugs can be sold as cheap generics.
We should do the same with medical
equipment. And we can subject our doctors and dentists to the same sort
of foreign and domestic competition that workers in other professions
face.
These steps can get us on
a path to Medicare for all, on which we will quickly be extending
coverage to millions of people, while substantially reducing the cost of
care for everyone.
Monday, March 18, 2019
health care in Cuba
All of this despite Cuba spending just $813 per person annually on health care compared with America’s $9,403.
In Cuba, health care is protected under the constitution as a fundamental human right. As a poor country, Cuba can’t afford to equivocate and waste money upholding that. This pressure seems to have created efficiency. Instead of pouring money into advanced medical technology, the system is forced to keep people healthy.
It’s largely done, as the BBC has reported, through an innovative approach to primary care. Family doctors work in clinics and care for everyone in the surrounding neighborhood. At least once a year, the doctor knocks on your front door (or elsewhere, if you prefer) for a check-up.
Sunday, March 03, 2019
Hawaii health care
At 94 percent coverage, Hawaii is a national leader in access to
quality health care. With political will, public support and a viable
plan, Hawaii can become the first state to achieve 100 percent health insurance coverage and serve as a model for the rest of the nation.
How did we come so far?
How did we come so far?
Tuesday, October 17, 2017
repealing and replacing Obamacare
[10/19/17] Shutdown of insurance subsidies could mean more free insurance coverage
[10/17/17] Alexander and Murray reach bipartisan deal to restore subsidies
[10/13/17] Eighteen U.S. states vowed to sue President Donald Trump’s administration on Friday to stop him from scrapping a key component of Obamacare, subsidies to insurers that help millions of low-income people pay medical expenses
[10/13/17] Trump to stop subsidy payments to insurers
[10/2/17] There is nothing sacred about single-payer
[9/26/17] Trump to work with Democrats
[9/26/17] GOP healthcare bill fails again
[9/22/17] McCain opposes this bill too
[9/21/17] Senator Cassidy health care fact check
[9/21/17] Santorum on Paul on health care bill
[9/21/17] Rand Paul: new plan keeps Obamacare funding giving more to Republican states
[9/20/17] Huelskoetter: Graham-Cassidy is the most harmful version yet.
[9/20/17] Ned Ryun: Graham-Cassidy is like lukewarm gruel but better than ObamaCare
[9/20/17] Kimmel blasts Brian Kilmeade too
[9/20/17] It would depend on where Billy Kimmel lives
[9/20/17] Jimmy Kimmel blasts Graham-Cassidy bill
[8/10/17] - Trump tells McConnell to get back to work
[7/31/17] - Should Trump let Obamacare fail? (Yes / No)
[7/28/17] McCain votes no on Obamacare repeal, wants input from both sides of the aisle
[5/7/17] Charlie Munger on healthcare
[5/4/17] Relieved Republicans muscled their health care bill through the House today, taking their biggest step toward dismantling the Obama health care overhaul since Donald Trump took office. They won passage only after overcoming their own divisions that nearly sank the measure six weeks ago.
The measure skirted through the House by a thin 217-213 vote, as all voting Democrats and a group of mostly moderate Republican holdouts voted no. A defeat would have been politically devastating for President Trump and Speaker Paul Ryan, R-Wis.
Passage was a product of heavy lobbying by the White House and Republicans leaders, plus late revisions that nailed down the final supporters needed. The bill now faces an uncertain fate in the Senate, where even GOP lawmakers say major changes are likely.
[3/14/17] health care bill fact check
[3/13/17] President Donald Trump's administration on Monday rejected a report by the U.S. Congressional Budget Office that concluded millions of Americans would lose health insurance under a Republican plan to dismantle Obamacare.
U.S. health secretary Tom Price told reporters at the White House that the administration strenuously disagreed with the report, which he said did not look at the full Republican plan and did not take into account regulatory reforms and other efforts to reform healthcare.
[3/13/17] Fourteen million Americans would lose medical insurance by next year under a Republican plan to dismantle Obamacare, the nonpartisan U.S. Congressional Budget Office said on Monday in a report that dealt a potential setback to President Donald Trump's first major legislative initiative.
The eagerly awaited CBO report also forecast that 24 million more people would be uninsured in 2026 if the plan being considered in the House of Representatives were adopted. Obamacare enabled about 20 million previously uninsured Americans to obtain medical insurance.
The CBO projected that 52 million people would be uninsured by 2026 if the bill became law, compared to 28 million who would not have coverage that year if former President Barack Obama's signature healthcare law remained unchanged.
[3/6/17] House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.
The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.
The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.
[10/17/17] Alexander and Murray reach bipartisan deal to restore subsidies
[10/13/17] Eighteen U.S. states vowed to sue President Donald Trump’s administration on Friday to stop him from scrapping a key component of Obamacare, subsidies to insurers that help millions of low-income people pay medical expenses
[10/13/17] Trump to stop subsidy payments to insurers
[10/2/17] There is nothing sacred about single-payer
[9/26/17] Trump to work with Democrats
[9/26/17] GOP healthcare bill fails again
[9/22/17] McCain opposes this bill too
[9/21/17] Senator Cassidy health care fact check
[9/21/17] Santorum on Paul on health care bill
[9/21/17] Rand Paul: new plan keeps Obamacare funding giving more to Republican states
[9/20/17] Huelskoetter: Graham-Cassidy is the most harmful version yet.
[9/20/17] Ned Ryun: Graham-Cassidy is like lukewarm gruel but better than ObamaCare
[9/20/17] Kimmel blasts Brian Kilmeade too
[9/20/17] It would depend on where Billy Kimmel lives
[9/20/17] Jimmy Kimmel blasts Graham-Cassidy bill
[8/10/17] - Trump tells McConnell to get back to work
[7/31/17] - Should Trump let Obamacare fail? (Yes / No)
[7/28/17] McCain votes no on Obamacare repeal, wants input from both sides of the aisle
[5/7/17] Charlie Munger on healthcare
[5/4/17] Relieved Republicans muscled their health care bill through the House today, taking their biggest step toward dismantling the Obama health care overhaul since Donald Trump took office. They won passage only after overcoming their own divisions that nearly sank the measure six weeks ago.
The measure skirted through the House by a thin 217-213 vote, as all voting Democrats and a group of mostly moderate Republican holdouts voted no. A defeat would have been politically devastating for President Trump and Speaker Paul Ryan, R-Wis.
Passage was a product of heavy lobbying by the White House and Republicans leaders, plus late revisions that nailed down the final supporters needed. The bill now faces an uncertain fate in the Senate, where even GOP lawmakers say major changes are likely.
[3/14/17] health care bill fact check
[3/13/17] President Donald Trump's administration on Monday rejected a report by the U.S. Congressional Budget Office that concluded millions of Americans would lose health insurance under a Republican plan to dismantle Obamacare.
U.S. health secretary Tom Price told reporters at the White House that the administration strenuously disagreed with the report, which he said did not look at the full Republican plan and did not take into account regulatory reforms and other efforts to reform healthcare.
[3/13/17] Fourteen million Americans would lose medical insurance by next year under a Republican plan to dismantle Obamacare, the nonpartisan U.S. Congressional Budget Office said on Monday in a report that dealt a potential setback to President Donald Trump's first major legislative initiative.
The eagerly awaited CBO report also forecast that 24 million more people would be uninsured in 2026 if the plan being considered in the House of Representatives were adopted. Obamacare enabled about 20 million previously uninsured Americans to obtain medical insurance.
The CBO projected that 52 million people would be uninsured by 2026 if the bill became law, compared to 28 million who would not have coverage that year if former President Barack Obama's signature healthcare law remained unchanged.
[3/6/17] House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.
The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.
The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.
Tuesday, September 12, 2017
Bernie Sanders to introduce Medicare for all
Sen. Bernie Sanders (I-Vt.) will introduce legislation on Wednesday that would expand Medicare into a universal health insurance program with the backing of at least 15 Democratic senators — a record level of support for an idea that had been relegated to the fringes during the last Democratic presidency.
“This is where the country has got to go,” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.
The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
Private insurers would remain, with fewer customers, to pay for elective treatments such as plastic surgery — a system similar to Australia, which President Trump has praised for having a “much better” insurance regime than the United States.
But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country’s universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.
“When you have co-payments — when you say that health care is not a right for everybody, whether you’re poor or whether you’re a billionaire — the evidence suggests that it becomes a disincentive for people to get the health care they need,” Sanders said. “Depending on the level of the copayment, it may cost more to figure out how you collect it than to not have the copayment at all.”
As he described his legislation, Sanders focused on its simplicity, suggesting that Americans would be happy to pay higher taxes if it meant the end of wrangling with health-care companies. The size of the tax increase, he said, would be determined in a separate bill.
Sanders acknowledged that the plan would be costly but pointed to the experience of other industrialized countries that provided universal coverage through higher taxes. The average American paid $11,365 per year in taxes; the average Canadian paid $14,693. But the average American paid twice as much for health care as the average Canadian.
[9/14/17] Trump calls Sanders' plan a curse on the U.S.
“This is where the country has got to go,” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.
The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
Private insurers would remain, with fewer customers, to pay for elective treatments such as plastic surgery — a system similar to Australia, which President Trump has praised for having a “much better” insurance regime than the United States.
But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country’s universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.
“When you have co-payments — when you say that health care is not a right for everybody, whether you’re poor or whether you’re a billionaire — the evidence suggests that it becomes a disincentive for people to get the health care they need,” Sanders said. “Depending on the level of the copayment, it may cost more to figure out how you collect it than to not have the copayment at all.”
As he described his legislation, Sanders focused on its simplicity, suggesting that Americans would be happy to pay higher taxes if it meant the end of wrangling with health-care companies. The size of the tax increase, he said, would be determined in a separate bill.
Sanders acknowledged that the plan would be costly but pointed to the experience of other industrialized countries that provided universal coverage through higher taxes. The average American paid $11,365 per year in taxes; the average Canadian paid $14,693. But the average American paid twice as much for health care as the average Canadian.
[9/14/17] Trump calls Sanders' plan a curse on the U.S.
Thursday, December 01, 2016
Obamacare poll
Despite sharp partisan differences over the Affordable Care Act, Democrats and Republicans, including voters who backed President-elect Donald Trump, strongly support most of the law’s key provisions, a new national poll indicates.
And although most Trump voters still favor repealing the law, often called Obamacare, an increasing share of Americans overall oppose that approach, according to the poll, which was conducted in mid-November, following Trump’s election.
Just a quarter of Americans say they wanted to scrap the law, down from nearly a third in October.
By contrast, nearly half say they want the law expanded or implemented as it is. Another 17% say they want the law scaled back.
The new findings from the nonprofit Kaiser Family Foundation are the most extensive sample of public opinion about the health law since last month’s election.
And they underscore the challenge confronting the incoming Trump administration and congressional Republicans, who have pledged to roll back key parts of the 2010 health law early next year.
“While President-elect Donald Trump and Republican leaders in Congress work on a replacement to the Affordable Care Act, the new poll finds many of the law’s specific provisions remain popular even among President-elect Trump’s supporters, potentially complicating the path ahead,” the survey’s authors note.
More than 8 in 10 Americans say they like provisions in the law that eliminate out-of-pocket costs for many preventive services such as cancer screenings and that allow young adults to remain on their parents’ health plans until they are 26.
Even the law’s program for providing federal aid to states to help them expand their Medicaid programs for the poor is supported by 80% of Americans.
The same strong majority supports the law’s system of insurance marketplaces – such as HealthCare.gov – where people who don’t get coverage through an employer can shop for health plans.
And 80% of Americans favor the government subsidies provided through the law to help low- and moderate-income people buy health insurance on the marketplaces.
Congressional Republicans are working on a plan that would repeal the Medicaid expansion and the insurance subsidies for lower-income consumers.
And Trump has pledged to act quickly to scrap the law. He and his congressional allies have promised to develop a replacement, but they have not indicated what that might include.
The repeal calls have always been extremely popular with Republican voters. And even now, 81% of people who voted for Trump hold an unfavorable view of Obamacare, according to the Kaiser poll. Half say they want the entire law repealed.
This apparent paradox – in which Americans view the law unfavorably but overwhelmingly support most of its key provisions – has characterized opinion about Obamacare for years, said Robert Blendon, an authority on public attitudes about healthcare at Harvard University.
“It’s long been clear that what is driving opposition to the law are the mandates,” he said.
The law’s requirement that Americans have health insurance or pay a tax penalty is by far the least popular part of Obamacare.
And Republicans have exploited it as a potent symbol of what they have said is Obamacare’s dangerous expansion of government. That argument has resonated powerfully with conservative voters nationwide.
Today, the insurance mandate is view favorably by just 35% of Americans.
But that makes it the only one of 10 provisions of the health law that does not command majority support in the Kaiser poll.
Several Republican plans to replace the health law include an alternative mechanism to encourage healthy consumers to sign up for coverage that would penalize people who do not maintain continuous coverage.
Both conservative and liberal insurance experts say that any system that guarantees coverage to people, even if they are sick, must include some kind of penalty for not having coverage.
That insurance guarantee is a key part of the health law.
The Kaiser poll was conducted Nov. 15-21 among a nationwide sample of 1,202 adults. The margin of error for the full sample was plus or minus 3 percentage points.
And although most Trump voters still favor repealing the law, often called Obamacare, an increasing share of Americans overall oppose that approach, according to the poll, which was conducted in mid-November, following Trump’s election.
Just a quarter of Americans say they wanted to scrap the law, down from nearly a third in October.
By contrast, nearly half say they want the law expanded or implemented as it is. Another 17% say they want the law scaled back.
The new findings from the nonprofit Kaiser Family Foundation are the most extensive sample of public opinion about the health law since last month’s election.
And they underscore the challenge confronting the incoming Trump administration and congressional Republicans, who have pledged to roll back key parts of the 2010 health law early next year.
“While President-elect Donald Trump and Republican leaders in Congress work on a replacement to the Affordable Care Act, the new poll finds many of the law’s specific provisions remain popular even among President-elect Trump’s supporters, potentially complicating the path ahead,” the survey’s authors note.
More than 8 in 10 Americans say they like provisions in the law that eliminate out-of-pocket costs for many preventive services such as cancer screenings and that allow young adults to remain on their parents’ health plans until they are 26.
Even the law’s program for providing federal aid to states to help them expand their Medicaid programs for the poor is supported by 80% of Americans.
The same strong majority supports the law’s system of insurance marketplaces – such as HealthCare.gov – where people who don’t get coverage through an employer can shop for health plans.
And 80% of Americans favor the government subsidies provided through the law to help low- and moderate-income people buy health insurance on the marketplaces.
Congressional Republicans are working on a plan that would repeal the Medicaid expansion and the insurance subsidies for lower-income consumers.
And Trump has pledged to act quickly to scrap the law. He and his congressional allies have promised to develop a replacement, but they have not indicated what that might include.
The repeal calls have always been extremely popular with Republican voters. And even now, 81% of people who voted for Trump hold an unfavorable view of Obamacare, according to the Kaiser poll. Half say they want the entire law repealed.
This apparent paradox – in which Americans view the law unfavorably but overwhelmingly support most of its key provisions – has characterized opinion about Obamacare for years, said Robert Blendon, an authority on public attitudes about healthcare at Harvard University.
“It’s long been clear that what is driving opposition to the law are the mandates,” he said.
The law’s requirement that Americans have health insurance or pay a tax penalty is by far the least popular part of Obamacare.
And Republicans have exploited it as a potent symbol of what they have said is Obamacare’s dangerous expansion of government. That argument has resonated powerfully with conservative voters nationwide.
Today, the insurance mandate is view favorably by just 35% of Americans.
But that makes it the only one of 10 provisions of the health law that does not command majority support in the Kaiser poll.
Several Republican plans to replace the health law include an alternative mechanism to encourage healthy consumers to sign up for coverage that would penalize people who do not maintain continuous coverage.
Both conservative and liberal insurance experts say that any system that guarantees coverage to people, even if they are sick, must include some kind of penalty for not having coverage.
That insurance guarantee is a key part of the health law.
The Kaiser poll was conducted Nov. 15-21 among a nationwide sample of 1,202 adults. The margin of error for the full sample was plus or minus 3 percentage points.
Thursday, November 10, 2016
death knell for Obamacare?
[12/21/16] Federal health officials Wednesday touted a record 6.4 million customers sign-ups on the federal Obamacare marketplace HealthCare.gov so far this open enrollment season — topping last year's pace during the same time period by 400,000 customers.
And they sharply warned that insurance coverage gains under Obamacare could be lost if President-elect Donald Trump and Congressional Republicans follow through on their threats to repeal the Affordable Care Act. Those threats have led some would-be HealthCare.gov customers to ask whether they should sign up for coverage for 2017, officials revealed.
"The American people don't want to go backwards," said U.S. Health and Human Services Department Secretary Sylvia Burwell, who cited analysis that has projected up to 30 million people would lose coverage if Obamacare were to be repealed without a replacement plan in place.
"These are people's cancer therapies, diabetes medications and mental health treatments on the line," Burwell told reporters during a conference call.
"Every one of the 6.4 million people enrolled represents a story about how the Affordable Care Act has changed health care in America, and why coverage matters," she said.
"We're going to keep moving forward, we're going to finish open enrollment by enrolling more people than ever," said Burwell, who in late January is set to be replaced as HHS secretary by Trump's nominee to the department, Rep. Tom Price, R-Ga.
[11/10/16] WASHINGTON — Donald Trump's election ushers in a time of high anxiety for people with health insurance under President Barack Obama's law, which expanded coverage to millions but has struggled to find widespread public acceptance.
While repeal now seems likely, that may take Congress months. A replacement for the 2010 health care law could take even longer, and may retain some of its features. Republicans are saying they want to protect people who now are covered from losing health care in the shift.
Voters "don't want Washington to fix Obamacare, they want to make health care affordable," said House Ways and Means Chairman Kevin Brady, R-Calif., whose committee oversees much of health care. "I'm confident we will have more truly affordable health care for just as many Americans."
"It's our goal to dismantle Obamacare and actually focus on lowering the cost of coverage for people," said Sen. John Barrasso, R-Wyo., a member of the Republican leadership. "It's a commitment on behalf of Congress and the president-elect to get this done."
[10/25/16] Obamacare premiums to rise 25% in 2017
***
[8/30/16] WASHINGTON >> With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.
If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.
“There are turbulent waters,” said Kathleen Sebelius, Obama’s first secretary of Health and Human Services. “But do I see this as a death knell? No.”
Next year’s health insurance sign-up season starts a week before the Nov. 8 election, and the previews have been brutal. Premiums are expected to go up sharply in many insurance marketplaces, which offer subsidized private coverage to people lacking access to job-based plans.
At the same time, retrenchment by insurers that have lost hundreds of millions of dollars means that more areas will become one-insurer markets, losing the benefits of competition. The consulting firm Avalere Health projects that seven states will have only a single insurer in each of their marketplace regions next year.
Administration officials say insurers set prices too low in a bid to gain market share, and the correction is leading to sticker shock. Insurers blame the problems on sicker-than-expected customers, disappointing enrollment and a premium stabilization system that failed to work as advertised. They also say some people are gaming the system, taking advantage of guaranteed coverage to get medical care only when they are sick.
Not all state markets are in trouble. What is more important, most of the 11 million people covered through HealthCare.gov and its state-run counterparts will be cushioned from premium increases by government subsidies that rise with the cost.
But many customers may have to switch to less comprehensive plans to keep their monthly premiums down. And millions of people who buy individual policies outside the government marketplaces get no financial help. They will have to pay the full increases or go without coverage and risk fines. (People with employer coverage and Medicare are largely unaffected.)
Tennessee’s insurance commissioner said recently that the individual health insurance market in her state is “very near collapse.” Premiums for the biggest insurer are expected to increase by an average of 62 percent. Two competitors will post average increases of 46 percent and 44 percent.
But because the spigot of federal subsidies remains wide open, an implosion of health insurance markets around the country seems unlikely. More than 8 out of 10 HealthCare.gov customers get subsidies covering about 70 percent of their total premiums. Instead, the damage is likely to be gradual. Rising premiums deter healthy people from signing up, leaving an insurance pool that’s more expensive to cover each succeeding year.
“My real concern is 2018,” said Caroline Pearson, a senior vice president with Avalere. “If there is no improvement in enrollment, we could see big sections of the country without any plans participating.”
If Republican Donald Trump wins the White House, he’d start dismantling the Affordable Care Act. But Clinton would come with a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored “public option” as an alternative to private insurers. Not all her ideas would require congressional action.
“She is going to find it important to continue to expand health care,” said Joel Ario, a former Obama administration official who’s now with the consulting firm Mannatt Health.
People in the Clinton camp say she recognizes that as president she’d have to get Obama’s law working better, and is taking nothing off the table.
A look at some major ideas and their prospects:
PUBLIC OPTION
Clinton’s primary rival, Vermont Sen. Bernie Sanders, advocated “Medicare for all” and that pushed Clinton to a fuller embrace of government-run insurance. But Democrats could not get a public option through Congress even when they had undisputed control. Whichever party wins the Senate in November, the balance is expected to be close and Republicans are favored to retain control of the House.
While a new national insurance program seems a long shot, Obama’s law allows states to experiment. “I think the public option is more likely to be tested at a state level,” Sebelius said.
SWEETENING SUBSIDIES
Clinton has proposed more generous subsidies and tax credits for health care, which might also entice more people to sign up. But she’d have a tough time selling Republicans. It may be doable in the bargaining around budget and tax bills, but Democrats would be pressed to give up some of the health law’s requirements, including a premiums formula that tends to favor older people over young adults.
INCREMENTAL CHANGES
Whether it’s fixing a “family glitch” that can prevent dependents from getting subsidized coverage, requiring insurers to cover more routine services outside the annual deductible, or reworking the premium stabilization program for insurers, incremental changes seem to offer a president Clinton her easiest path.
MEDICAID EXPANSION
Expect a Clinton White House to tirelessly court the 19 states that have yet to expand Medicaid for low-income people. She’d ask Congress to provide the same three full years of federal financing that early-adopting states got under the health law. GOP governors would demand more flexibility with program rules.
“I’m just hoping that reality begins to sink in when she is inaugurated,” Sebelius said. “If the law is not going to go away, then let’s make it work.”
And they sharply warned that insurance coverage gains under Obamacare could be lost if President-elect Donald Trump and Congressional Republicans follow through on their threats to repeal the Affordable Care Act. Those threats have led some would-be HealthCare.gov customers to ask whether they should sign up for coverage for 2017, officials revealed.
"The American people don't want to go backwards," said U.S. Health and Human Services Department Secretary Sylvia Burwell, who cited analysis that has projected up to 30 million people would lose coverage if Obamacare were to be repealed without a replacement plan in place.
"These are people's cancer therapies, diabetes medications and mental health treatments on the line," Burwell told reporters during a conference call.
"Every one of the 6.4 million people enrolled represents a story about how the Affordable Care Act has changed health care in America, and why coverage matters," she said.
"We're going to keep moving forward, we're going to finish open enrollment by enrolling more people than ever," said Burwell, who in late January is set to be replaced as HHS secretary by Trump's nominee to the department, Rep. Tom Price, R-Ga.
[11/10/16] WASHINGTON — Donald Trump's election ushers in a time of high anxiety for people with health insurance under President Barack Obama's law, which expanded coverage to millions but has struggled to find widespread public acceptance.
While repeal now seems likely, that may take Congress months. A replacement for the 2010 health care law could take even longer, and may retain some of its features. Republicans are saying they want to protect people who now are covered from losing health care in the shift.
Voters "don't want Washington to fix Obamacare, they want to make health care affordable," said House Ways and Means Chairman Kevin Brady, R-Calif., whose committee oversees much of health care. "I'm confident we will have more truly affordable health care for just as many Americans."
"It's our goal to dismantle Obamacare and actually focus on lowering the cost of coverage for people," said Sen. John Barrasso, R-Wyo., a member of the Republican leadership. "It's a commitment on behalf of Congress and the president-elect to get this done."
[10/25/16] Obamacare premiums to rise 25% in 2017
***
[8/30/16] WASHINGTON >> With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.
If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.
“There are turbulent waters,” said Kathleen Sebelius, Obama’s first secretary of Health and Human Services. “But do I see this as a death knell? No.”
Next year’s health insurance sign-up season starts a week before the Nov. 8 election, and the previews have been brutal. Premiums are expected to go up sharply in many insurance marketplaces, which offer subsidized private coverage to people lacking access to job-based plans.
At the same time, retrenchment by insurers that have lost hundreds of millions of dollars means that more areas will become one-insurer markets, losing the benefits of competition. The consulting firm Avalere Health projects that seven states will have only a single insurer in each of their marketplace regions next year.
Administration officials say insurers set prices too low in a bid to gain market share, and the correction is leading to sticker shock. Insurers blame the problems on sicker-than-expected customers, disappointing enrollment and a premium stabilization system that failed to work as advertised. They also say some people are gaming the system, taking advantage of guaranteed coverage to get medical care only when they are sick.
Not all state markets are in trouble. What is more important, most of the 11 million people covered through HealthCare.gov and its state-run counterparts will be cushioned from premium increases by government subsidies that rise with the cost.
But many customers may have to switch to less comprehensive plans to keep their monthly premiums down. And millions of people who buy individual policies outside the government marketplaces get no financial help. They will have to pay the full increases or go without coverage and risk fines. (People with employer coverage and Medicare are largely unaffected.)
Tennessee’s insurance commissioner said recently that the individual health insurance market in her state is “very near collapse.” Premiums for the biggest insurer are expected to increase by an average of 62 percent. Two competitors will post average increases of 46 percent and 44 percent.
But because the spigot of federal subsidies remains wide open, an implosion of health insurance markets around the country seems unlikely. More than 8 out of 10 HealthCare.gov customers get subsidies covering about 70 percent of their total premiums. Instead, the damage is likely to be gradual. Rising premiums deter healthy people from signing up, leaving an insurance pool that’s more expensive to cover each succeeding year.
“My real concern is 2018,” said Caroline Pearson, a senior vice president with Avalere. “If there is no improvement in enrollment, we could see big sections of the country without any plans participating.”
If Republican Donald Trump wins the White House, he’d start dismantling the Affordable Care Act. But Clinton would come with a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored “public option” as an alternative to private insurers. Not all her ideas would require congressional action.
“She is going to find it important to continue to expand health care,” said Joel Ario, a former Obama administration official who’s now with the consulting firm Mannatt Health.
People in the Clinton camp say she recognizes that as president she’d have to get Obama’s law working better, and is taking nothing off the table.
A look at some major ideas and their prospects:
PUBLIC OPTION
Clinton’s primary rival, Vermont Sen. Bernie Sanders, advocated “Medicare for all” and that pushed Clinton to a fuller embrace of government-run insurance. But Democrats could not get a public option through Congress even when they had undisputed control. Whichever party wins the Senate in November, the balance is expected to be close and Republicans are favored to retain control of the House.
While a new national insurance program seems a long shot, Obama’s law allows states to experiment. “I think the public option is more likely to be tested at a state level,” Sebelius said.
SWEETENING SUBSIDIES
Clinton has proposed more generous subsidies and tax credits for health care, which might also entice more people to sign up. But she’d have a tough time selling Republicans. It may be doable in the bargaining around budget and tax bills, but Democrats would be pressed to give up some of the health law’s requirements, including a premiums formula that tends to favor older people over young adults.
INCREMENTAL CHANGES
Whether it’s fixing a “family glitch” that can prevent dependents from getting subsidized coverage, requiring insurers to cover more routine services outside the annual deductible, or reworking the premium stabilization program for insurers, incremental changes seem to offer a president Clinton her easiest path.
MEDICAID EXPANSION
Expect a Clinton White House to tirelessly court the 19 states that have yet to expand Medicaid for low-income people. She’d ask Congress to provide the same three full years of federal financing that early-adopting states got under the health law. GOP governors would demand more flexibility with program rules.
“I’m just hoping that reality begins to sink in when she is inaugurated,” Sebelius said. “If the law is not going to go away, then let’s make it work.”
Friday, June 03, 2016
many satisfied with Obamacare (and some not)
More than 60% of working-age Americans who signed up for Medicaid or a
private health plan through the Affordable Care Act are getting
healthcare they couldn’t previously get, a new nationwide survey
indicates.
And consumers are broadly satisfied with the new coverage, despite some cost challenges and an ongoing Republican campaign to discredit the law.
Overall, 82% of American adults enrolled in private or government coverage through the health law said they were “somewhat” or “very” satisfied, according to the report from the nonprofit Commonwealth Fund.
“If the fundamental purpose of health insurance is to provide people with adequate access to needed healthcare, then it would seem that, on balance, the Affordable Care Act’s coverage expansions are working well for most of the people who have enrolled in them,” the report concluded.
The findings paralleled a recent nationwide survey by the nonprofit Kaiser Family Foundation, which found that two-thirds of people in a marketplace plan created through the law rated their coverage “excellent” or “good.”
Unlike the new report, the Kaiser survey did not include people newly enrolled in Medicaid through the law, which is often called Obamacare.
New Medicaid enrollees are even happier with their health coverage than Americans in commercial health plans purchased through the marketplaces, with 88% reporting they are somewhat or very satisfied, the Commonwealth Fund found.
Americans with employer-provided health plans – which have lower premiums and deductibles than many marketplace plans – are the happiest, with 90% reporting satisfaction with their coverage.
The high marks are not universal, cautioned fund Vice President Sara Collins, the report’s lead author.
Indeed, some consumers who had coverage before the health law was implemented have seen their premiums and deductibles increase as insurers have absorbed millions of new consumers, many of whom could not obtain health insurance previously because they had a pre-existing medical condition.
The Commonwealth Fund, like Kaiser, has found that many Americans are concerned about the cost of their healthcare.
Nearly half of consumers in marketplace plans reported difficulty paying premiums in 2015. The fund plans to update those findings with 2016 numbers later this year.
“This [report] doesn’t mean that the law is working well for every single person,” Collins said. “But in general, it seems to be enabling people to get the healthcare that they need.”
More than eight in 10 people said their ability to get needed care has either improved or stayed the same since they enrolled in coverage through the health law.
The law allows Americans who don't get health benefits at work to shop among plans on state-based exchanges operated by the federal government or by the states themselves.
Consumers making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for subsidies. Insurers must provide a basic set of benefits and cannot turn away consumers, even if they are sick.
Very low-income Americans in most states can enroll in the government's Medicaid program at virtually no cost, an option provided by the health law that leaders in 31 states and the District of Columbia have elected to make available to their residents.
The dual coverage expansions have led to the largest drop in the nation’s uninsured rate in at least half a century, surveys show.
The new Commonwealth Fund survey found that 45% of adults enrolled in a marketplace plan in 2016 and 62% of adults newly covered by Medicaid were previously uninsured.
More state leaders are now considering Medicaid expansions, including in very conservative states such as Oklahoma.
And enrollment in the marketplaces has been increasing, albeit at a slower rate than initially forecast; there are about 12 million people in marketplace plans.
But the law remains a political hot button, with Republican congressional leaders and presumptive GOP presidential nominee Donald Trump promising full repeal.
At the same time, many insurers are seeking significant premium increases next year, in part because enrollees in marketplace plans are sicker and more expensive than they anticipated.
The Commonwealth Fund survey was conducted between Feb. 2 and April 5 among a random, nationally representative sample of 4,802 adults ages 19 to 64. It has a margin of error of plus or minus 2 percentage points.
And consumers are broadly satisfied with the new coverage, despite some cost challenges and an ongoing Republican campaign to discredit the law.
Overall, 82% of American adults enrolled in private or government coverage through the health law said they were “somewhat” or “very” satisfied, according to the report from the nonprofit Commonwealth Fund.
“If the fundamental purpose of health insurance is to provide people with adequate access to needed healthcare, then it would seem that, on balance, the Affordable Care Act’s coverage expansions are working well for most of the people who have enrolled in them,” the report concluded.
The findings paralleled a recent nationwide survey by the nonprofit Kaiser Family Foundation, which found that two-thirds of people in a marketplace plan created through the law rated their coverage “excellent” or “good.”
Unlike the new report, the Kaiser survey did not include people newly enrolled in Medicaid through the law, which is often called Obamacare.
New Medicaid enrollees are even happier with their health coverage than Americans in commercial health plans purchased through the marketplaces, with 88% reporting they are somewhat or very satisfied, the Commonwealth Fund found.
Americans with employer-provided health plans – which have lower premiums and deductibles than many marketplace plans – are the happiest, with 90% reporting satisfaction with their coverage.
The high marks are not universal, cautioned fund Vice President Sara Collins, the report’s lead author.
Indeed, some consumers who had coverage before the health law was implemented have seen their premiums and deductibles increase as insurers have absorbed millions of new consumers, many of whom could not obtain health insurance previously because they had a pre-existing medical condition.
The Commonwealth Fund, like Kaiser, has found that many Americans are concerned about the cost of their healthcare.
Nearly half of consumers in marketplace plans reported difficulty paying premiums in 2015. The fund plans to update those findings with 2016 numbers later this year.
“This [report] doesn’t mean that the law is working well for every single person,” Collins said. “But in general, it seems to be enabling people to get the healthcare that they need.”
More than eight in 10 people said their ability to get needed care has either improved or stayed the same since they enrolled in coverage through the health law.
The law allows Americans who don't get health benefits at work to shop among plans on state-based exchanges operated by the federal government or by the states themselves.
Consumers making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for subsidies. Insurers must provide a basic set of benefits and cannot turn away consumers, even if they are sick.
Very low-income Americans in most states can enroll in the government's Medicaid program at virtually no cost, an option provided by the health law that leaders in 31 states and the District of Columbia have elected to make available to their residents.
The dual coverage expansions have led to the largest drop in the nation’s uninsured rate in at least half a century, surveys show.
The new Commonwealth Fund survey found that 45% of adults enrolled in a marketplace plan in 2016 and 62% of adults newly covered by Medicaid were previously uninsured.
More state leaders are now considering Medicaid expansions, including in very conservative states such as Oklahoma.
And enrollment in the marketplaces has been increasing, albeit at a slower rate than initially forecast; there are about 12 million people in marketplace plans.
But the law remains a political hot button, with Republican congressional leaders and presumptive GOP presidential nominee Donald Trump promising full repeal.
At the same time, many insurers are seeking significant premium increases next year, in part because enrollees in marketplace plans are sicker and more expensive than they anticipated.
The Commonwealth Fund survey was conducted between Feb. 2 and April 5 among a random, nationally representative sample of 4,802 adults ages 19 to 64. It has a margin of error of plus or minus 2 percentage points.
Subscribe to:
Posts (Atom)