The sales pitch for Medicare for all is appealing—universal coverage, free access to doctors and hospitals, and no insurance premiums, copayments or deductibles. But then come the tradeoffs: Everyone would be required to give up private health insurance, and taxes could double to finance $32 trillion in added government spending over the next decade. Washington bureaucrats would decide what services are covered and how much doctors and hospitals would be paid. Rationing and waiting lines are inevitable. The American people don’t want such a major upheaval. The right solution is to give people more choices of more affordable health coverage and have states, rather than the federal government, target resources to those who need help.
| Direct primary care (DPC) is fast becoming an accepted alternative to fee-for-service payment in the private market, but it has yet to find its way into Medicare. Over two-thirds of Medicare beneficiaries have two or more chronic conditions. This is a population that would benefit greatly from high quality primary care, but the program is still built on the fee-for-service model of payment, which creates barriers to low-cost, frequent communication between physicians and their patients.CMS could test ideas like DPC to see if they can deliver better care at a lower cost to the Medicare population. |
Medicare funds health-care services for 60 million elderly and disabled Americans. Of these, 39 million receive coverage through a plan known as “Traditional Medicare” or “Medicare Fee-for-Service” (MFFS) that the federal government administers directly. Increasing numbers of seniors—21 million in 2019—enroll in Medicare Advantage (MA), choosing from competing plans managed by private insurers. MA provides an incentive for plans to develop innovative care arrangements, but the rules under which MA plans operate can be restructured so that more of the efficiency gains can be passed on to beneficiaries.
| Two Republican congressmen introduced proposals Tuesday designed to fix America’s health care system through a variety of market-oriented reforms. Reps. Bruce Westerman (R-AK) and Jim Banks (R-IN) say their Fair Care Act of 2019 “addresses major drivers of health care costs as well as obstacles hindering individuals from obtaining health insurance coverage.” It proposes a bevy of changes to the health care market. Many of the bill’s provisions target availability of insurance to those who otherwise lack access. It also allows would put in statute short-term limited duration plans and association healthplans, which would increase competition. They worked closely with Avik Roy of the Foundation for Research on Equal Opportunity in developing the plan. |
As centrist Republicans contemplated an Obamacare repeal-and-replace plan, the CBO warned that doing so would boost the number of uninsured by 22 million. That scared enough Republicans away to kill the bill. The intrepid Philip Klein at the Washington Examiner noticed that, buried in a footnote, was a stunning rebuke of those CBO forecasts. Turns out, the CBO’s forecasts off by a factor of six. The report says that the mandate repeal will result in only 1.5 million dropping out of the individual insurance market, and 1 million from employer plans, with Medicaid enrollment unaffected. These forecasting errors don’t even rise to the “good enough for government work” level. But they were good enough to get Obamacare on the books, and then keep it there.
| Policymakers are debating whether Congress should enact a single-payer health care system or create a system based on personal choice and market competition. The fundamental question is whether government officials or individuals and families will make the key health care decisions. The adoption of a single-payer system requires major trade-offs: a loss of personal and economic freedom, the loss of existing health coverage, the imposition of unprecedented federal taxation, major payment reductions for doctors and medical professionals, long waiting lists, and care delays and denials. |
Health and Human Services Secretary Alex Azar sounded the alarm about Medicare-for-all during the Conservative Political Action conference on Thursday. “The threat is an immediate and complete takeover of healthcare,” Azar said. Secretary of Labor Alex Acosta and Small Business Administrator Linda McMahon joined Azar on the panel led by Grace-Marie Turner of the Galen Institute. Azar said that the new Democratic health care plan would dramatically crash the insurance industry in ways that President Barack Obama never dared to do politically. “They promised you that you could keep your insurance if you liked it,” he said. “This time they are not promising that.”
Price controls in health care could be one of the major policy issues of the 2020 Democratic primary and a key way of differentiating the most progressive candidates on the Left from others seeking the nomination, but Republicans are posing the question as well. It should come as no surprise to find the outspoken champion for an incremental approach to single-payer health care, Sen. Michael Bennet, (D-CO), promoting government-set rates, but the fact that a Republican, Sen. Bill Cassidy, (R-LA), is joining him in leading the charge should concern conservative and moderate Republicans alike.
Democrats defeated Republicans in the Obamacare repeal fight by warning that 22 million Americans would be thrown off their health insurance. They pointed to data leaked from the Congressional Budget Office.
Well, it turns out that data was completely wrong.
According to a report by the Centers for Medicare and Medicaid Services released Wednesday, the Congressional Budget Office wildly overestimated the number of people who would lose their health insurance with the repeal of the individual mandate penalty.
This is a special time of year in health policy nerd world — the arrival of another year of data on National Health Expenditures (NHE) from the Centers for Medicare and Medicaid Services (CMS). The journal Health Affairs published a preview on Wednesday, which the authors summarized thusly: “National health expenditures are projected to grow at an average annual rate of 5.5 percent for 2018–27 and represent 19.4 percent of gross domestic product in 2027.