He Plans To End Surprise Billing And Reform Pharmaceutical Drug Pricing
“Surprise” medical billing, or the process in which some insured individuals get charged from out-of-network providers , has left many Americans financially debilitated. A survey from the Kaiser Family Foundation, for example, found that one-third of adults struggling with medical bill issues are facing out-of-network charges. Additionally, a whopping seven out of 10 individuals struggling with such bills said that they didn’t know the provider was not covered in their insurance plan at the time of care.
Biden’s proposed solution to this pervasive type of billing is to prohibit health care providers from charging out-of-network rates in situations when patients have no control over who they can see, like in emergency hospitalizations. He also says that his administration will fight against market power concentration from a small pool of corporations, which contributes to hiked-up consumer prices, by exercising existing antitrust legislation.
A Boost To Low And Middle
The first great benefit of a single-player system as Bernie conceives it actually has nothing to do with healthcare. It is about poverty. A shift from employer-sponsored to government-sponsored health insurance would raise the pay of low- and middle-income workers.
To understand why, think about how health insurance looks from an employer’s perspective. A profit-seeking company will always look to cut costs, so it will compensate its workers as little as possible.
But while employers wish to lower the costs of employing a worker, they don’t care how those costs are distributed. For example, $30,000 in wages and $20,000 in health insurance benefits cost an employer just as much as $50,000 in wages. Unsurprisingly, a series of academic studies have found that employers fund their workers’ health insurance by docking their pay.
According to estimates from the Social Security Administration, this hurts low-wage workers the most. Due to the costs of employer-sponsored health insurance, pay is cut by 10% for workers in the bottom half of the wage distribution. For the richest 1 in 20 workers, pay falls by just 4%.
Single-payer systems, by contrast, boost the incomes of working-class people. Unlike employer-sponsored insurance, government-sponsored insurance can be funded through higher taxes on the incomes, estates, and spending of the rich.
The Fight That Will Mobilize The Nation
Democrats request, which the president agrees with, states that Medicare should have the power to negotiate with pharmaceutical companies and maintain the savings that would be achieved by such price negotiations up to $450 billion over a decade to pay for the improvements and expansions to Medicare. Sen. Bernie Sanders and 16 other Democratic senators write that their demands present an historic opportunity to make the most significant expansion of Medicare since it was signed into law.
Really? Democrats can make this a truly historic opportunity by doing everything they can to instead pass the Medicare for All Act of 2021, which would establish a national health insurance program for all U.S. residents from birth or residency cover all medically necessary services including inpatient, outpatient, prescription drugs, mental health and substance use services, reproductive health care, gender-affirming care, dental, vision, hearing, physical therapy and long-term care eliminate all premiums, deductibles, co-pays and co-insurance abolish obscene profit-making from our health care system reduce classism and racism by eliminating a means-tested program for the poor save over 68,000 lives every year eradicate medical bankruptcy and save $458 billion every year.
Passing H.R.1976, the Medicare for All Act of 2021, is the kind of history-making this country needs from Democrats right now. The pandemic is still here, and we cannot delay any longer.
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Weak Proposals Leave Much On The Table
Lowering the eligibility age to 60 sounds good. After all, it would add 23 million Americans to Medicare. However, of those, 75 percent already have private health insurance, 12 percent have Medicaid and 7.8 percent are uninsured. In other words, only 1.8 million individuals in this age group would gain health coverage that do not already have it. The proposal is even weaker than Hillary Clintons in 2016, when she offered to lower the age to 50 or 55evenwithout the presence of a global pandemic.
It is unclear what the bulk of the new beneficiaries, over 17 million individuals who have private health insurance through their employers, would choose to do. Do they buy supplemental coverage, or will they become cherry-picked by Medicare Advantage plans?
The Office of the Inspector General reported that private Medicare Advantage plans continue to inflate risk-adjustment payments, cheating tax payers out of billions of dollars every year. Medicare Advantage companies, ready to enroll a healthier, younger group, are watering at the mouth with yet another proposal to increase profits and continue to drain the Medicare Trust Fund.
Are Democrats using tax dollars to expand Medicare simply to increase profits of corporations? Is this the message they want to send to the public as we gear up for midterm elections?
Difficult Questions To Answer
They said among the unknowns are the length of immunity that vaccination provides, whether COVID will be a seasonal infection, and which other variants are in the pipeline.
“Part of this humility is recognizing that predictions are necessary but educated guesses, not mathematical certainty,” they said.
In their view, COVID cases, “vaccination rates, hospital capacity, tolerance for risk, and willingness to implement different interventions will vary geographically, and national recommendations will need to be adapted locally.”
They said there needed to be better data infrastructure to track the disease and more resources to “build and sustain an effective public health infrastructure.”
Better access to cheap and rapid testing are also required as are the faster development and better deployment of vaccines.
“The goal for the ‘new normal’ with COVID-19 does not include eradication or elimination,” the experts said. That’s at odds with Biden’s aim of bringing in measures to help end the pandemic “for good.”
They added that, “without a strategic plan for the ‘new normal’…more people in the U.S. will unnecessarily experience morbidity and mortality.”
Proposed vaccine requirements, such as those proposed by the Biden administration, “will be necessary to achieve levels of coverage to return to pre-COVID-19 life expectancy and social and economic vitality.”
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Bidens Lie: Medicare Goes Away As You Know It All The Medicare You Have Is Gone
Verdict: 100 Pinocchios
This is Bidens boldest and most duplicitous lie. Its also one that comes straight from a Donald Trump op-ed. Medicare for All, as its name suggests, will not eliminate Medicare but rather expand it to every US resident. The only parts of the program that will go away are the private supplemental plans seniors are currently forced to buy.
Medicare for All will instead make the public plan comprehensive by adding dental care, hearing aids, vision care, and more to its list of covered items and it will do this while eliminating all co-pays, premiums, and deductibles. BidenCare, on the other hand, will continue denying seniors needed coverage and charging them for care.
Bidens Lie: I Understand The Appeal Of Medicare For All But Folks Supporting It Should Be Clear That It Means Getting Rid Of Obamacare And Im Not For That
Verdict: 50 Pinocchios
Obamacare did a couple of very good things: it expanded Medicaid eligibility to millions more people and improved coverage by mandating a set of essential benefits. Medicare for All doesnt do away with either of these things. In fact, it improves upon them by bringing the entire country into a public insurance program that fully covers all medically necessary care.
Biden might as well be warning that winning a beautiful new car will mean getting rid of your busted 95 Taurus. Medicare for All is superior to Obamacare in every way. It will cover everyone, eliminate out-of-pocket costs, put an end to the phenomenon of Medicaid envy , and give patients total freedom of choice in doctor and hospital.
If anyone loves Obamacare, its because it gave them some small monetary reprieve or coverage that they lacked before. Medicare for All will help them even further by erasing all out-of-pocket costs and giving everyone comprehensive coverage.
Medicare for All doesnt get rid of Obamacare it replaces it with a far better system.
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Reimbursements For Doctors Could Fall
A shift of millions of people into Medicare would likely mean lower reimbursements for doctors. For example, the 13.4 million people aged 60 to 65 who would switch from employer-sponsored coverage to Medicare would be leaving some of the best-paying insurance plans, and their physicians would then be reimbursed at Medicare rates.
“Biden’s plan would lower payments to already cash-strapped doctors and hospitals, who have already seen a significant decrease in reimbursement over the past decade,” De Leon said. “He is trying to win the support of low-income voters by giving them lower healthcare prices, which doctors and hospitals would have to absorb.
“Yes, the US healthcare system is dysfunctional,” De Leon added, “but the basic system needs to be fixed before it is expanded to new groups of people.”
The American Association of Neurological Surgeons/Congress of Neurological Surgeons warns against Biden’s proposed government-run system. “We support expanding health insurance coverage, but the expansion should build on the existing employer-based system,” said Katie O. Orrico, director of the group’s Washington office. “We have consistently opposed a public option or Medicare for All.
“Shifting more Americans into government-sponsored healthcare will inevitably result in lower payments for physicians’ services,” Orrico added. “Reimbursement rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”
Bidens Lie: Bidencare Is The Best Way To Lower Costs And Cover Everyone
Verdict: 200 Pinocchios
This gets 200 Pinocchios because its actually two lies: that BidenCare is the best way to lower costs, and that its the best way to cover everyone.
The latter is Bidens funniest lie because it directly contradicts the details of his own plan. While every other Democrat is running on support for universal health care, Biden makes clear right on his website that his plan will only cover 97 percent of Americans.
Assuming that number is correct, nearly ten million people will remain uninsured and 125,000 will die due to lack of insurance in the first ten years. Its therefore a little audacious to say the plan will cover everyone.
BidenCare will lower costs somewhat for patients. It caps an employees premiums at 8.5 percent rather than 9.86 percent, while also making more people eligible for gold plans, meaning lower deductibles. But its important to understand that under BidenCare, people will continue to be saddled with thousands of dollars in out-of-pocket costs and regularly drained by expensive premiums. Only Medicare for All will get rid of these costs.
In terms of overall health care spending, BidenCare will cost $750 billion over a decade. This is on top of current spending, which is projected at $42.9 trillion over the next ten years. Medicare for All will cost trillions less.
Every Medicare for All supporter should stand up and join the conversation. There are too many lives at stake not to mention too many Pinocchios not to.
Joe Biden Explains Why Hes Against Medicare For All
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Bidens Health Care Proposals Still Cost A Lot Of Money And That Money Has To Come From Somewhere
Nobody knows for sure why Biden dropped the Medicare negotiations proposal from the American Families Plan, even as he called for lawmakers to pass it this year on a bipartisan basis an unlikely prospect in his first address to Congress. The reporting has been circumspect.
But we do know the pharma industry has a massive war chest, refilled every year by member fees, and has promised to deploy it if any major drug pricing reform started moving through Congress. Drug manufacturers also enjoy their best public approval in years after delivering Covid-19 vaccines in record time.
Why go after the very industry that basically is our lifeline out of the pandemic? Monk said.
This is how the trap closes: When health care must pay for health care, the health care industry must take a hit in order to cover more people. That is something the industrys immense lobbying apparatus usually wants to stop, and given its influence in the halls of Congress and in the White House, that can make anybodys health care plan whether it costs $800 billion or $32 trillion a nonstarter.
Biden avoided this problem with the initial two-year expansion of the ACA subsidies in the American Rescue Plan by mostly not paying for it. But even in this age of deficit doves, the $200 billion to make that expansion, or any other major health care expansion, permanent would need to be paid for. That presents a massive political problem, even for Bidens more modest proposals.
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Bidens Lie: How Many Of You Out There Have Had Someone Youve Lost To Cancer Or Cancer Yourself No Time We Cannot Have A Hiatus Of Six Months A Year Two Three To Get Something Done
Verdict: Really confusing. 80 Pinocchios
Biden is of course correct that we cannot have a hiatus of six months to three years during which cancer patients are unable to receive care. Fortunately, there will be no such hiatus with Medicare for All. Biden is pulling this idea out of thin air.
Sanderss Medicare for All bill has a four-year transition period during which nobody will lose coverage. The transition will add new age groups to Medicare until every US resident is on the program in the fourth year, and it will create a public option that people can join in the meantime. The programs list of covered items will expand in the very first year, ensuring that from the get-go people will have far better coverage than they ever would under BidenCare.
Appendix: Comparing Our Estimates To The Biden Campaigns Estimates
Excluding the effects of lowering the Medicare age, Vice President Biden has said his health care plan would cost $750 billion and that his revenue offsets would raise over $1.3 trillion.27The campaign has not clarified what is counted as its health plan or what budget window its estimates cover. A reasonable assumption would be that the campaigns $750 billion estimate incorporates all direct spending and revenue effects of its health coverage plan, but not its plans to expand long-term care or funding for rural health or mental health services. If so, the campaigns $750 billion cost estimate would fall between our low-cost estimate of $600 billion and our central estimate of $950 billion. The campaigns revenue figures are similar to our low-cost estimate.
1 See Melissa M. Favreault and Brenda C. Spillman, Tax Credits for Caregivers’ Out-of-Pocket Expenses and Respite Care Benefits: Design Considerations and Cost and Distributional Analyses, Urban Institute, January 2018, .
5 Actuarial value of 70 percent means that, on average, 70 percent of covered health costs would be paid by the insurer and 30 percent would be paid through deductibles, copayments, and coinsurance.
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The 5 Biggest Lies Joe Biden Is Telling About Medicare For All
Joe Biden keeps lying about Medicare for All and wont stop anytime soon he has to, to sell his own Bidencare plan. But Medicare for All will always win on the merits.
Joe Biden pauses as he speaks during the AARP and Des Moines Register Iowa Presidential Candidate Forum at Drake University on July 15, 2019 in Des Moines, Iowa.Justin Sullivan / Getty
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Ever since Joe Biden kicked off his 2020 presidential campaign by attending a big-dollar fundraiser with a major health insurance CEO, it was clear that he would define his health care platform in direct opposition to Medicare for All. The release of his underwhelming BidenCare plan brings no surprises on that front.
Rather than highlighting his plans policy specifics, Biden is spending the week of its launch attacking Bernie Sanderss Medicare for All bill. Parroting insurance industry talking points, Biden told a number of lies about the single-payer proposal in a campaign speech and in his BidenCare announcement video: he claimed Medicare for All will throw millions off of their insurance, scrap Obamacare, end Medicare as we know it, cause a hiatus in coverage, and cost more than his own plan.
In response, Sanderss campaign added a short quiz to their website asking visitors to attribute lies about Medicare for All to either Biden, Donald Trump, Mitch McConnell, or United Health CEO David Wichmann.