“Medicare-for-all” is quickly becoming a rallying cry for many Democratic White House hopefuls, but there are growing questions about how to pull off such a dramatic switch to a government-run health care system.
The debate over scrapping private insurers has heated up in recent days since Democratic Sen. Kamala Harris of California, a supporter of “Medicare-for-all,” told CNN’s Jake Tapper, “Who of us has not had that situation, where you’ve got to wait for approval, and the doctor says, well, I don’t know if your insurance company is going to cover this? Let’s eliminate all of that. Let’s move on.”
Two years ago this month, President Trump promised the American people that he would stop drug companies from “getting away with murder” with their annual ritual of price increases. Since then, his historic actions on drug pricing have produced historic results. One official measure of drug price inflation was actually negative in 2018, for the first time in almost 50 years.
We examined trends in per capita spending for Medicare beneficiaries ages sixty-five and older in the United States in the period 1999–2012 to determine why spending growth has been declining since around 2005. Decomposing spending by condition, we found that half of the spending slowdown was attributable to slower growth in spending for cardiovascular diseases. Spending growth also slowed for dementia, renal and genitourinary diseases, and aftercare for people with acute illnesses. Using estimates from the medical literature of the impact of pharmaceuticals on acute disease, we found that roughly half of the reduction in major cardiovascular events was attributable to medications controlling cardiovascular risk factors. Despite this substantial cost-saving improvement in cardiovascular health, additional opportunities remain to lower spending through disease prevention and control.
In 2010, CMS established the Hospital Readmissions Reduction Program under the ACA. Two years later, the government began fining hospitals with high rates of readmission within 30 days of a hospitalization for pneumonia, heart attack, or heart failure. But a study finds the program may have led to more patient deaths. “Why are policies that profoundly influence patient care not rigorously studied before widespread rollout?” the researchers ask. “[W]e remain uncertain about whether it has had unintentionally deadly consequences. That should be a bracing reminder that before we are seduced by promising but untried ideas, we need to first demand robust evidence that they will not harm patients.”
The president applauded the rollback of a key portion of the Affordable Care Act, which he has called a disaster. He called for protections for people with preexisting conditions, though his administration has worked against keeping them by trying to eliminate Obamacare. He pledged to bring down the price of prescription drugs and called for childhood cancer funding, earning some applause from Democrats. But Trump also called for halting the spread of HIV transmission before 2030 — even though his previous budgets have proposed slashing money from government initiatives in that area.
“Medicare-for-all’s” advocates promise a health care system that’s free at the point of service – no co-pays, no deductibles, no coinsurance.
They tend to be less upfront about how they’d pay for it. Independent estimates from both the right and the left peg “Medicare-for-all’s” cost at about $32 trillion over 10 years. Doubling what the federal government takes in individual and corporate income tax revenue wouldn’t be enough to cover that tab.
That’s assuming “Medicare-for-all” is able to implement its financing strategy. The bill proposes reimbursing doctors and hospitals at Medicare’s current rates, which are 40 percent below what private insurance pays.
Less than a month after Democrats—many of them running on “Medicare for All”—won back control of the House of Representatives in November, the top health policy aide to then-prospective House Speaker Nancy Pelosi met with Blue Cross Blue Shield executives and assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices, according to sources familiar with the meeting.
The pre-existing condition scare tactics continue.
I testified yesterday—as the sole witness called by the Republican minority—during a House Education and Labor Committee hearing on “Examining Threats to Workers with Preexisting Conditions.”
It was the first hearing of the new Congress under the new Chairman Bobby Scott, D-VA, and virtually all members on both sides of the aisle stayed to ask questions. (The hearing lasted for three and a half hours!)
Medicare’s costs for outpatient prescription drugs are rising quickly, and there is a growing sense that part of the problem lies in the incentives structure that Medicare Part D creates. Last week, the Trump Administration announced plans for a new, voluntary Part D payment model intended to lower Medicare expenditures on prescription drugs. The model’s basic idea is to increase plans’ liability for the part of the program where costs are rising the most, changing their incentives. These changes are a move in the right direction, but any benefits will likely be limited. More sweeping changes to the program’s structure, such as what AAF’s Team Health has proposed in the past, are needed to contain costs.
For decades, we’ve talked and talked and talked about the high cost of American health care. But we haven’t done anything about it. As the above chart shows, the problem has gotten so bad that, today, hospital spending reduces the average family’s take-home pay more than do federal taxes.
Overall, as a country, Americans spent $1.2 trillion on hospital care in 2018. That’s over $3,600 for every man, woman, and child in the U.S. The Centers for Medicare and Medicaid Services project that, by 2026, hospital spending will rise to $1.8 trillion: over $5,300 per person.