What Are The Other Implications Of The Candidates Plans
While our analysis is focused on the fiscal impact of the presidential candidates health care plans, it is critical to also consider other implications of their proposals. These include, but are not limited to, their impact on health insurance coverage, national health expenditures, distribution of spending, and economic performance, as well as the effect on quality of care, access to care, provider viability, medical and pharmaceutical innovation, federal tax capacity, and other factors.
Our analysis provides some insight into how each plan might affect coverage, total costs, distribution, and economic growth though estimates in these areas are rough and meant to show order of magnitude. Others have written on these and many other potential implications.7
National Health Expenditures
While all the candidates would increase federal health spending, the effects of each plan on total health spending including spending from households and businesses are more uncertain. National health expenditures would grow as a result of expanding coverage to more individuals, covering more services, and reducing or eliminating cost sharing and provider networks. Conversely, they would shrink due to lower drug costs, reduced reimbursements to providers, and administrative savings and efficiencies. The net effect for each of the candidates on total expenditures is likely small, and in most cases directionally ambiguous.
Distribution of Health Spending
How Much Lower Would Prescription Costs Be
Estimated reduction in drug spending
Patients in the United States pay the highest prices in the world for prescription drugs. Thats partly a result of a fractured system in which different payers negotiate separately for drug benefits. But it also reflects national preferences: An effective negotiator needs to be able to say no, and American patients tend to want access to the widest array of cutting-edge drugs, even if it means paying more.
A Medicare for all system would have more leverage with the drug industry because it could bargain for the whole countrys drug supply at once. But politics would still be a constraint. A system willing to pay for fewer drugs could probably get bigger discounts than one that wanted to preserve the current set of choices. That would mean, though, that some patients would be denied the medications they want.
All of our economists thought a Medicare for all system could negotiate lower prices than the current ones. But they differed in their assessments of how cutthroat a negotiator Medicare would be. Mr. Friedman thought Medicare for all could reduce drug spending by nearly a third. The Urban team said the savings would be at least 20 percent. The other researchers imagined more modest reductions.
How Much Will Bernie Sanders Medicare For All Legislation Cost
Bernie Sanders today unveiled his Medicare for All Act of 2017 at the U.S. Capitol. The plan is seen as dead-on-arrival given Republican control of Congress, but considering the growing support for single-payer health care in the country, it may serve as a blueprint for the future of the American system. Unfortunately, theres one major thing missing from Bernies generous plan: how Americans will pay for it.
Sanders initiative would be the most generous single-payer health care plan in the world. Americans would have comprehensive coverage that would include doctors visits, hospital stays, preventative care, mental health services, vision care, dental care, addiction treatment, and prescription drugs. Although the plan has yet to be scored by the Congressional Business Office, Sanders projected a $1.4 trillion annual price tag for a similar plan he announced during the 2016 campaign.
Image by Scott Pelkey/ScottP-Photography/Flickr.
For some perspective, the U.S. federal government took in $3.3 trillion in revenue last year while spending $3.9 trillion and contributing $587 billion to the national debt. In his previous plan, Sanders said he would raise taxes 2.2% on all Americans and levy a 6.2% tax on employers. Americas wealthiest would also see an unspecified but most likely hefty tax increase as well.
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Will Preexisting Conditions Be Covered
Yes. Under the Affordable Care Act, a health insurer cant refuse to give you coverage because of a health issue you already have. That includes cancer, diabetes, asthma, and even high blood pressure.
Before the ACA, private insurers were allowed to turn down prospective members, charge higher premiums, or limit benefits based on your health history.
Medicare for All plans will operate in the same way as the ACA.
Sen Bernie Sanders’ Medicare For All Act Of 2017
|Federal policy on healthcare, 2017-2020|
The Medicare for All Act of 2017 was introduced by Senator Bernie Sanders on September 13, 2017. The bill would establish a national health insurance system and automatically enroll all residents. The government-run system would reimburse physicians and other healthcare providers for healthcare services. Enrollees would not be responsible for any cost-sharing and providers would not be allowed to bill enrollees for covered services. The system would be financed through a tax-funded government trust fund. Medicare, Medicaid, and the Children’s Health Insurance Program would no longer be administered.
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Medicare For All: What Is It And How Will It Work
Experts answer your most pressing questions and explain how Medicare for All could change healthcare in America.
Ask someone what they think about the idea of Medicare for All that is, one national health insurance plan for all Americans and youll likely hear one of two opinions: One, that it sounds great and could potentially fix the countrys broken healthcare system. Or two, that it would be the downfall of our countrys healthcare system.
What you likely wont hear? A succinct, fact-based explanation of what Medicare for All would actually entail and how it could affect you.
Its a topic that is especially relevant right now. In the midst of the 2020 U.S. presidential election, Medicare for All has become a key point of contention in the Democratic Party primary. From Senators Bernie Sanders and Elizabeth Warrens embrace of single-payer healthcare to former Vice President Joe Biden and Sen. Amy Klobuchars embrace of reforms to the Affordable Care Act , how to best improve healthcare in America is a divisive issue for voters.
It also can become confusing and difficult to parse out differences between different policies in order to assess how they might impact your day-to-day life if enacted. The other question in this divisive political climate: Will any of these plans be enacted in a Washington D.C. that has been defined more by its partisan divides and policy inaction?
Bernie The Technocrat Vs Warren The Populist
The odds of these bills passing Congress are extremely low. And even if it did, Congress would write the bill and theres no reason to think either Sanders or Warren have fundamental, principles-driven objections to either way of doing this.
But the plans candidates release are illustrative of how they think about things, and this particular case is interesting because it runs somewhat contrary to the stereotype.
Warren has much more of a reputation as the uber-wonk with plans for everything, while Sanders is seen more as a moralist and a populist who cares less about the technical merits of proposals than whether they illustrate underlying points.
In this particular case, however, that dynamic is reversed. Its Warren whose plan optimizes for easily illustrating the point that almost everyones costs will go down, even at the cost of embracing a vision thats not going to be technically sustainable for very long. Shes then vague about the timing of the transition off her plan, and is going to transition to something thats probably a worse deal for many people than a more technocratic alternative would be.
Sanders, by contrast, is proposing a big new broad tax, even though big new broad taxes tend to be unpopular. This is how foreign single-payer systems are typically designed, and its almost certainly what a team of policy wonks would recommend if they were setting all political considerations aside.
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Can Bernie Sanders Medicare For All Work No Time Soon Princeton Professor Says At Penn
The cost of Medicare for All could turn the government into “a health insurance company with armed forces,” Princeton economist Paul Starr said Friday at a health care cost event by University of Pennsylvania’s Leonard Davis Institute.
Medicare for All is one of the most talked-about policy proposals of the 2020 Democratic primary but could it ever happen?
According to Paul Starr, a Pulitzer Prize-winning health sociologist who worked on the failed Bill Clinton health-care plan in the 1990s, the answer is: not any time soon. For one thing, extending the program for older and disabled Americans to everyone would consume so much of the federal governments resources, it would require massive tax increases and turn the government into a health insurance company with armed forces, Starr said Friday at a health care cost conference held by the University of Pennsylvanias Leonard Davis Institute.
Whats more, he noted, putting everyone on government health care would completely dismantle the highly profitable insurance industry while lowering payments to the medical industry both of which hold huge political sway.
During the most recent Democratic debate, Sanders pointed to a study in the medical journal Lancet that found a Medicare for All plan like his could save billions of dollars a year.
Will Quality Of Care Go Down
The rhetorical response to single-payer health insurance is that its government-controlled healthcare. Its then used to argue that the government would be making important decisions about the care you get and dont get, and who you see, Weil said.
But Medicare for All could actually give you more choice than private insurance.
With Medicare, you can go to any doctor, Weil said. I have private insurance and have a lot more restrictions as to who I see.
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The Sanders Bill Includes An Exceptionally Generous Benefit Package
Sanderss single-payer proposal would create a universal Medicare program that covers all American residents in one government-run health plan.
It would bar employers from offering separate plans that compete with this new, government-run option. It would largely sunset Medicare and Medicaid, transitioning their enrollees into the new universal plan. It would, however, allow two existing health systems to continue to operate as they do now: the Veterans Affairs health system and the Indian Health Services.
Those who qualify for the new universal Medicare plan would get four years to transition into the new coverage. In the interim, they would have the option to buy into Medicare or another publicly run option that does not currently exist.
Eventually, though, they would all end up in the same plan, which includes an especially robust set of benefits. It would cover hospital visits, primary care, medical devices, lab services, maternity care, and prescription drugs as well as vision and dental benefits.
The biggest difference between this plan and the version Sanders introduced in 2017 is the addition of a long-term care benefit that would cover care for Americans with disability at home or in community settings. This benefit was also added into the House version of the Medicare-for-all bill earlier this year.
What Would Medicare For All Cost
The term Medicare for All is currently used to describe political proposals for expanding or replacing both of the now functioning Medicare and Medicaid programs. Even if Medicare for All may never be introduced into legislation, it can be helpful to understand what the conversations are about, and what the pros and cons of the debate are.
An MFA plan would eliminate the need for private health insurance coverage. This plan was proposed in 2017 by Vermonts Independent Senator, Bernie Sanders and has yet to receive sufficient support from his fellow politicians to become a law. Another MFA bill has been introduced by Washington States Democratic Representative Pramila Jayapal that would have the federal government manage the countrys healthcare system. This bill will expand healthcare from the current number of Medicare recipients to everyone in the United States.
Prior Attempts to Enact Medicare for AllThe idea of a single-payer, government-managed, healthcare system was first proposed in 1945 by President Harry Truman. That proposal was never enacted. Further attempts to create a single-payer healthcare system that would provide Medicare benefits for everyone were made by both President Richard Nixon and President Bill Clinton. These proposals were met with various forms of opposition from not being inclusive enough to being too costly and hard to manage.
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Current System Is Unsustainable
Now, our patchwork system for those under age 65 treats health care as a commodity sold to those who can afford it or whose insurance companies will cover it. Some patients receive excessive care, and some none at all. This as much as the average in other advanced countries, while the outcomes are generally worse. Overhead costs are among the highest in the world. Private insurance companies, for example, spend about 12% to 18% of their revenue on overhead Medicare spends less than 2%.
Prices in the health care system consistently rise faster than the background inflation rate because they can. Witness the big drug companies, which charge whatever the market will bear even as their profits soar. The same is true of many for-profit providers and health facilities, such as outpatient imaging centers. As prices go up, payers reduce benefit packages and increase out-of-pocket costs to try to lessen the impact. I believe an important part of Medicare for All should be to move to a largely nonprofit-provider system to curb the incentive to raise prices.
Would Sanderss Health Plan Lower American Health Spending Its Hard To Tell
One of Sanderss main arguments in favor of his health care bill is that American health spending is out of control and single-payer would rein it in.
There is broad consensus from conservative to progressive economists that the Senate Medicare for All bill, as written, would result in substantial savings to the American people, a paper released by his office argues.
There are certainly policies in the Sanders plan that would reduce American health care spending. For one, moving all Americans on to one health plan would reduce the administrative waste in our health care system in the long run.
American doctors spend lots of money dealing with insurers because there are thousands of them, each negotiating their own rate with every hospital and doctor. An appendectomy, for example, can cost anywhere from $1,529 to $186,955, depending on how good of a deal an insurer can get from a hospital.
That doesnt happen in a single-payer system like the one Sanders proposes. Instead of dealing with dozens of insurers that set hundreds of prices, doctors only need to send bills to the federal government.
One 2003 article in the New England Journal of Medicineestimates that the United States spends twice as much on administrative costs as Canada. A 2011 study in the journal Health Affairs estimates American doctors spend four times as much dealing with insurance companies compared with Canada.
Health Care As A Human Right
We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right. All Americans are entitled to go to the doctor when they’re sick and not go bankrupt after staying in the hospital.
Bernie Sanders: Cost For ‘medicare For All’ Is ‘impossible To Predict’
Bernie Sanders was confronted on the mathematics of funding his socialist-inspired agenda, including programs such as “Medicare for all.”
Sanders, a Vermont senator who has pitched the ideas of free healthcare and free college as a front-runner for the Democratic 2020 presidential nomination, was pressed on his proposals’ estimated $60 trillion price tag over 10 years during an interview with CBS News.
“Well, look, we have political opponents,” he started before host Norah ODonnell cut in, asking whether he didn’t know how much his plans cost.
Sanders, 78, replied: “You don’t know. Nobody knows. This is impossible to predict.”
He added that his “‘Medicare for all’ single-payer system” would be less expensive than the status quo.
Tough CBS interview tn ODONNELL: You don’t know how much your plan costs? SANDERS: You don’t know. Nobody knows. This is impossible to predict.
Embracing Sanders’s signature legislation has hurt his rivals in the Democratic race for the White House, including Sens. Kamala Harris of California and Elizabeth Warren of Massachusetts. Harris, 55, took a hit for being inconsistent regarding her vision for the role of private health insurers in the future. Warren, 70, was grilled for refusing to acknowledge middle-class taxes would increase under the framework. Sanders, however, has emerged unscathed by questions concerning its practicality.
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