The core appeal of the 2020 Democratic presidential candidate’s Medicare for All proposals, whether it’s optional buy-ins floated by moderate Democrats or Sen. Bernie Sanders’s comprehensive single-payer reforms, is the notion that enormous savings could be generated by dispensing with private insurance. Advocates claim that that insurer profits, as well as costs associated with managing risk and advertising plans, could be dispensed with, and that hospital fees could be greatly reduced by imposing Medicare rates, which are 40% lower under the M4All plans.Yet, it is notable that no such savings ever have materialized—even under the most propitious of circumstances.
Creating a single-payer health–care system in the U.S. would be a “major undertaking that would involve substantial changes” to medical coverage, according to a report issued by the Congressional Budget Office. The nonpartisan agency that evaluates the potential budgetary, economic and other effects of legislative proposals didn’t assess any specific bill or estimate costs. “The transition toward a single-payer system could be complicated, challenging and potentially disruptive,” the CBO said on Wednesday.
More than 100 House Democrats have endorsed Rep. Jayapal’s Medicare for All Act of 2019. Fourteen Democratic senators have co-sponsored a similar bill from Sen. Bernie Sanders (I-VT). The title is deeply misleading. It implies that the current Medicare system would be extended to all Americans. In fact, Medicare for All differs from Medicare in fundamental ways. While America needs a debate about health care, it should be based on an accurate description of the alternatives.
Americans are frustrated with the current health care system. Care costs far too much. Millions are priced out of the insurance market, and even those with insurance say premiums and deductibles are so high they might as well be uninsured. But when government officials make decisions about what services will be covered, how much providers will be paid, and how much citizens must pay in mandatory federal taxes, consumers will have even fewer choices and less control than they do today. M4All will reduce access to new technologies, stifle innovation, and result in a near-doubling of the tax burden. The Left is undaunted with its promises of free virtually unlimited health care for everyone and has an answer for everything. The House Rules Committee hearing on Tuesday, where Chuck Blahous and I testified, showed what we are up against.
“Medicare for All” sounds good until you see its high price tag and consider the implications it would have on the quality and access to health care. The House Rules Committee held its first ever hearing Tuesday on the Democrats’ Medicare for All bill introduced by Rep. Pramila Jayapal (D-WA). The bill would implement a government takeover of health care coverage, where all medically necessary services would be paid for by the federal government and all private insurance that duplicates government coverage would be prohibited. Grace-Marie Turner, president of the Galen Institute and a witness testifying against the bill, argued that it’s hard to see how patients would be more empowered when dealing with a single government payer for health care: “In a country that values diversity, will one program with one list of benefits and set of rules work for everyone?”
Kansas’ new law allowing the sale of health plans that can turn away people with pre-existing medical conditions has heightened concerns that more states may move to allow leaner, cheaper plans that don’t comply with ACA rules. So far, three states have passed laws allowing their Farm Bureaus to bypass ACA rules and sell health plans that are free from any state insurance regulation. Kansas became the latest last week. The state’s Democratic governor let the bill become law without her signature in the hope of winning GOP support for a bill to expand Medicaid to low-income adults, though that remains uncertain.
Federal health officials on Monday unveiled a new primary care experiment that seeks to pay doctors for providing stepped-up services that keep patients healthy and out of the hospital, an effort they say will transform basic medical services for tens of millions of American patients. The initiative, called CMS Primary Cares, includes five new payment options for small and large providers, allowing them to take varying levels of financial responsibility for improving care and lowering costs. It broadly seeks to change how primary care is delivered in the U.S. by rewarding doctors for improving management of patients with chronic illnesses such as diabetes and high blood pressure and averting expensive trips to the hospital.
The CMS is inviting state Medicaid agencies to pursue new ways of integrating care for patients eligible for both Medicare and Medicaid—a population that has complex health needs and accounts for a big portion of spending in both public health programs. In a letter to state Medicaid directors, CMS Administrator Seema Verma described three new ways states can test approaches to integrating care for dual-eligible patients with the goal of improving the quality of their care and reducing costs for federal and state governments. “Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems,” Verma said. “This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all.”
The number of uninsured climbed by 1.4 million from 2016 to 2018, according to a report out last week from the Congressional Budget Office. Naturally, this led those on the left to blame the Trump administration for its Obamacare “sabotage.” But the data in that report—which was released on the same day the Mueller report came out and largely ignored—tell an entirely different story. All of the increase in the uninsured over the past two years—all of it—is the result of the massive rate increases that Obamacare’s mandates and regulations caused. According to the Health and Human Services Dept., premiums in the individual insurance market doubled from 2013 to 2017. They shot up again in 2018.
As I listened to the Town Hall where Democratic Presidential candidate Bernie Sanders proclaimed his dream of Medicare for All, I realized that he was speaking in vague generalities that were void of realism. Medical care would be “free at the point of service with no co-pays.” Would there be any brakes on the over-utilization of services? He had no answer. He thus needs to understand that the demand for medical services is limitless when other people are paying the bill. The suggestion that “Medicare for all” would save money is surely an example of a pipe dream.