Medicare for All

 

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:

 

via Clarisse Loughrey of The Independent:

Early concept art has revealed a very different look for Toy Story's dynamic duo, Woody and Buzz Lightyear.

Pixar's first feature started life as a full-length take on their short Tin Story, which saw a mechanical drummer attempting to navigate his way through a baby's playroom. The drummer was soon ditched for a more glamorously conceived "space toy" named Lunar Larry, later renamed Buzz Lightyear in honour of famed astronaut Edwin "Buzz" Aldrin.

The original concept pitched its drummer against an antagonistic ventriloquist's dummy, who gradually evolved into a pull-string cowboy doll named Woody, inspired by Western actor Woody Strode.

Yes, Woody was originally the bad guy; though his character didn't prove popular with his voice actor Tom Hanks, who reportedly shouted "This guy is a jerk!" while recording lines for the story reel.

In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Legislation, including the Hyde Amendment, generally restricts the use of funds allocated for the Department of Health and Human Services and consequently has significant effects involving Medicaid recipients. Medicaid currently serves approximately 6.5 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).

Federal dollars can't be used to pay for abortion outside of the above restrictions, but Medicaid is funded via hybrid federal/state funding, so there are 15 states where Medicaid does pay for abortion using the state's portion of the funding.

Yesterday I posted an entry which gained some attention in which I noted that yes, Bernie Sanders' specific single payer bill (aka "Medicare for All", S.1804) would in fact eliminate "nearly all" private healthcare insurance...and in fact, that's one of the primary selling points of the legislation in the first place. I wasn't arguing for or against the bill, mind you, I was just asking supporters to stop misleading people about this point.

Note: I'm going to use "Bernie-MFA" going forward instead of just "MFA" because the term "Medicare for All" has been turned into some sort of catch-all rallying cry for universal coverage even though there are major differences between some of the bills and proposals on the table, and on this subject it's important to be clear about which bill I'm talking about.

As the 2020 Presidential race starts to heat up, one of if not the biggest issue which will be on the minds of every Democratic candidate and primary voter will be about the Next Big Thing in U.S. Healthcare policy.

By the time January 20, 2021 rolls around, the Affordable Care Act will be just shy of 11 years old...assuming, that is, that it manages to survive the insanely idiotic #TexasFoldEm lawsuit (as an aside, it looks like the 5th Circuit of Appeals will likely take up the case this July).

The ACA has done a fantastic job of expanding healthcare coverage to over 20 million more people, lowering or eliminating costs for millions of them, and completely changing the zeitgeist about what's acceptable (no longer acceptable: denying coverage to or discrimininating against those with pre-existing conditions). Unfortunately, while it was a major step forward, it was still only a step, and between its intrinsic limitations, original flaws and major incidents of sabotage both passive (refusal to expand Medicaid in many states) and active (the Risk Corridor Massacre, CSR cut-off, mandate repeal, etc), the Democratic base is hungry for a truly universal healthcare coverage system.

And so, the $64,000 question for every 2020 Democratic candidate is whether or not they support "Medicare for All"...and, as a subsection of that, do they insist on "Medicare for All" as the only way forward.

With the 2019 Open Enrollment Period starts in less than 24 hours, it probably isn't the best timing for this, but with the elections also coming up in just six days, perhaps it is.

Axios just published a new national survey via SurveyMonkey which asks two simple but important questions:

  • Generally speaking, when you hear candidates talking about “Medicare for All,” what do you think they are proposing?
    • A single, government-run health insurance program to cover all Americans
    • An optional government-run program that would compete with private insurance
    • Neither of these
  • And which of the following options for health care would you favor most?
    • A single, government-run health insurance program to cover all Americans
    • An optional government-run program that would compete with private insurance
    • Neither of these

The results are pretty telling:

For as much as I write about healthcare policy, I actually don't write about Medicare itself all that often...at least not Medicare as it's defined today.

However, given all the excitement and confusion about what Medicare is and isn't, here's a handy reminder. Just moments ago the Centers for Medicare & Medicaid published information about 2019 Meciare Parts A & B premiums and deductibles:

CMS announces 2019 Medicare Parts A & B premiums and deductibles

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.

There's a lot of fuss and bother yesterday about a brand-new report which tries to project what the costs and savings would be if Bernie Sanders' so-called "Medicare for All" proposal were to actually become law.

The biggest gnashing of teeth was over headlines like this one from CBS and this one from Axios screaming about how "IT WOULD COST $33 TRILLION!!!"

...which is, of course, incredibly disingenous and irresponsible on the face of it for several reasons, primarily because that's over a 10 year period.

OK, here it is. I've linked to a PDF with the full legislative text at the bottom of this blog entry; here's the summary version, with some notes:

TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM

Establishes a Universal Medicare Program for every resident of the United States, including the District of Columbia and the territories. Guarantees patients the freedom to choose their health care provider. Provides for the issuance of Universal Medicare cards that all residents may use to get the health care they need upon enrollment. Prohibits discrimination against anyone seeking benefits under this act.

OK, so it apparently would cover undocumented immigrants, and every doctor/hospital/clinic/etc. would be required to participate, with anyone in the country being covered by any healthcare provider nationally.

For the past year and a half, of all the proxy battles between "Team Hillary" and "Team Bernie" on the left side of the aisle, no issue has been more repsentative of both how passionate people are or how much each "side" misunderstands the other than the future of the American healthcare system.

"Team Bernie", in essence, consisted of progressives (and Democrats) who believe that while the ACA may have improved things to some degree in some ways, it not only isn't enough long-term, it isn't nearly enough short-term either; the next step (and for many, the only acceptable next step) must be moving the entire U.S. population over to a universal Medicare-style Single Payer system, with everyone in the country being covered through a single, comprehensive healthcare program funded entirely (or nearly entirely) by taxes.

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