Medicare for All

If I could only ask one question of the 20-odd candidates vying for the Democratic nomination for President at the next debate coming up right here in Detroit, Michigan, here's how I would word it. I've customized it for each of the five major candidates (apologies to the rest of them):

Preface to each of the candidates:

"Earlier this month, oral arguments were heard by the 5th Circuit Court of Appeals over a lawsuit against the Affordable Care Act filed by 20 Republican Attorneys General and fully supported by the Trump Administration.

"If the plaintiffs are successful and the ACA is struck down entirely, up to 20 million Americans would find themselves without healthcare coverage and tens of millions more with pre-existing conditions would lose critical protections, while states would lose hundreds of millions, or even billions of federal funding.

"Every Democratic candidate has come out in favor of significantly expanding publicly-funded healthcare coverage to some degree or another. Some want to build upon the Affordable Care Act. Some want to add a public option. Some want guaranteed universal coverage, and some are demanding universal single payer healthcare for everyone in the United States.

A few months back I posted a request for folks to vote for a healthcare panel I was hoping to be included at this summer's Netroots Nation conference in Philadelphia.

I'm happy to report that our panel did indeed make the final cut, and will be happening this Friday, July 12th:

FIX THE DAMN HEALTHCARE: SORTING OUT ACA 2.0, MFA, MED4AM AND MORE!

  • Friday, Jul. 12 4:30 PM, Room: 118C

The healthcare landscape is confusing and exciting in 2019. Reining in Big Pharma, strengthening the ACA, adding public options, “Medicare for America” or “Medicare for All”… the alphabet soup of plans can be confusing. Can improvements be implemented before 2021 at the federal level or is it all up to the states? And what about the latest lawsuit looming over everything? We’ll go beyond the slogans and into the details: How are the proposals similar and different, and what do patients, caregivers and other invested parties think.

With all the fuss & bother being made over whether Democratic Presidential candidates support or don't support eliminating private insurance in favor of a universal, fully-mandatory "Medicare for All" single-payer healthcare system (especially after the first official debates over the past couple of days), I decided to attempt to put together a comprehensive table listing which healthcare expansion/overhaul bills each of the candidates actually support or oppose.

This may sound like a simple question: Senators Booker, Gillibrand, Harris, Sanders (obviously) and Warren are all cosponsors of Bernie Sanders' "Medicare for All" bill, S.1129, while Representatives Gabbard, Ryand and Swalwell have cosponsored the House version (H.R.1384). Pretty cut 'n dry, right?

Over at Axios, Drew Altman of the Kaiser Family Foundation has posted about a new focus group study which has some depressing, if not surprising findings:

...voters were only dimly aware of candidates’ and elected officials’ health proposals.

  • ...These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all”...

(update: the video of the town hall has been removed from YouTube for whatever reason, but I have the transcript below anyway)

Last night on the Last Word with Lawrence O'Donnell, Democratic U.S. Senator and Presidential candidate Kamala Harris took her fourth (or fifth) shot at explaining exactly where she stands on Medicare for All and the elimination of private primary heatlh insurance.

As I've noted (mostly on Twitter...I just checked and it looks like I haven't written much about it on the site aside from a quick mention here), Harris has struggled to explain her position in several town hall appearances; she'll boldly stated that she supports "Medicare for All", but then stumbles when it comes to the "elimination of private insurance" issue.

 

OK, this probably won't be the most exciting Congressional hearing in the world, but it's a pretty important one both historically and for practical purposes. Any major healthcare reform bill will have to first be run through the Congressional Budget Office's scoring process...and before the CBO can do that, they first have to lay out the ground rules, which they did earlier this month.

Anyway, you can watch the hearings above; here's the details...which are pretty simple: Three CBO wonks will be testifying and questioned.

Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Date: Wednesday, May 22, 2019 - 10:00am

Location: 210 Cannon House Office Building

Witnesses

So, this is a thing which happened:

Had a great time discussing #MedicareForAll opposite @charles_gaba on Medicare for America for Ferndale Dems. Happy to report no one was called a neoliberal or a Bernie bro.

Follow @detroitdsam4a and @dsam4a for more on M4A. Charles' work can be found at https://t.co/RTP68atFhA

— Kyle Minton (@JuniorMinton) May 17, 2019

A few minutes ago the Congressional Budget Office released a new report on a national, universal single payer healthcare system (commonly known as "Medicare for All" these days, although that's a bit of a misnomer since the proposed "Medicare for All" bills are quite different from today's definition of Medicare).

It's important to note that while this report came from the CBO, it is not a budget analysis of either the House or Senate MFA bills; it instead lays out the structural components which would be required to be in place in order to put such a system together and, I presume, in order to run such a budget analysis.

I'm swamped today between the rollouts of both the Choose Medicare Act and the revised Medicare for America Act as well as this new CBO report, so for the moment I'll just repost the summary and link to the report itself, along with a few notes as I'm able to add them:

 

Regular readers know that I'm a strong supporter of going with the "Medicare for America"-style approach to achieving universal heatlhcare coverage as opposed to the "Medicare for All" proposal. Regardless, this is still an historic moment in U.S. history:

Chairman McGovern, Congresswoman Jayapal, and Congresswoman Dingell Announce Historic Rules Committee Hearing on the Medicare for All Act

WASHINGTON, DC — Rules Committee Chairman James P. McGovern (D-MA), Congresswoman Pramila Jayapal (D-WA), and Congresswoman Debbie Dingell (D-MI) announced today that the House Rules Committee will hold an original jurisdiction hearing on the Medicare for All Act of 2019 on Tuesday, April 30th at 10am ET in H-313, The Capitol. It marks the first time Congress has ever held a hearing on Medicare for All. Witnesses will be announced later this week. 

Saturday, May 18th, 9:00am: Fems for Change: Healthcare, Who Knew It Could Be So Complicated?

  • Birmingham First United Methodist Church, 1589 W. Maple Rd., Birmingham, MI 48009

Turn on the TV, open a newspaper, browse social media: everyone is talking about new ideas for expanding American healthcare coverage. As consumers and voters, it can be hard to know which option is best for our families, our neighbors, and our nation.

This timely forum will help you make sense of Medicare for All; Medicare and Medicaid Buy-Ins; adding public plan features to private insurance; improving the Affordable Care Act (ACA); and other options discussed in the media.

 

Nearly two years ago, I noted that the then-CEO of Aetna, Mark Bertolini, gave an unexpected response to to a question about single payer healthcare in a private meeting to Aetna employees:

Single-payer, I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57.

The government doesn’t administer anything. The first thing they’ve ever tried to administer in social programs was the ACA, and that didn’t go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation.

I've written several times over the past few months about the confusion regarding how much of an impact on the private insurance industry the move to a universal, 100% publicly-financed single payer healthcare system would have.

Most recently I noted that not only would the latest versions of the House and Senate "MFA" bills expand their reach even further by adding in Long-Term Services & Support (thus legally denying private insurers yet another range of services that they'd be legally allowed to duplicate), but in an interview ahead of the rollout, Bernie Sanders himself stated point-blank that private health insurance companies would be "reduced to nose jobs" and the like (which is of course the whole point).

In September 2017, Sen. Bernie Sanders introduced his "official" Medicare for All, universal single payer bill to much fanfare. At the time, it garnered a lot of attention, but it also had some gaping holes...most notably the lack of any actual funding mechanism or specifics, as well as a big coverage gap which could be found in both the "Medicare for America" bill which I'm a big fan of as well as the House MFA version.

Today, Sanders launched a revised version of the bill which supposedly addresses both of those issues along with others. Let's take a look.

First of all, who's co-sponsoring it? In 2017, it was cosponsored by 16 Democratic Senators:

Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mr. Franken, Mrs. Gillibrand, Ms. Harris, Mr. Heinrich, Ms. Hirono, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr.Schatz, Mrs. Shaheen, Mr. Udall, Ms. Warren, and Mr. Whitehouse) introduced the following bill; which was read twice and referred to the Committee on Finance

UPDATE: Please see Esther F's comment below this post for some important caveats/points regarding survey bias.

I had to think long and hard about what headline to use for this blog post. The first ones which came to mind were pretty crude, along the lines of "I've got mine, f*ck you!". After giving it some thought, I went with something a bit more genteel.

eHealth is one of the largest private online insurance brokers in the country. They sell ACA-compliant healthcare policies, but also sell other types of coverage, including non-ACA "short-term" plans, which regular readers (as well as eHealth) are aware I am not a fan of, to put it mildly.

Regardless, while I may not care for some of their offerings, they seem to be a reasonable company overall, and they regularly provide handy customer surveys on various ACA/healthcare topics which I find useful from time to time.

Today, no doubt in response to the new "Medicare for All" bill just released by the House Democrats, eHealth has released a new survey about Medicare attitudes:

 

Note: This is just an initial, cursory glance, not a deep dive.

Yesterday, amid much hoopla, the House Democrats official released an updated version of the long-awaited national universal single payer healthcare bill, aka "Medicare for All".

The official title of the bill is literally "The Medicare for All Act of 2019", and for the most part it's pretty similar to the Senate version rolled out in September 2017 by Sen. Bernie Sanders and a dozen or more Democratic Senators. However, there are several key differences between the two:

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