Instead of debating how to expand Medicare coverage, politicians should focus on fixing the fatal financial flaws in the existing program that threaten to bankrupt the nation.
Medicare spent 3.6% of gross domestic product in 2016, more than six times the share it consumed in 1967, the first full year it was implemented. The forecasts I have analyzed show that the share of GDP will rise to at least 9% within 75 years—and that’s the good-news scenario. Other plausible forecasts show that Medicare could spend more than twice that.
If any state can serve as the poster child for the problems associated with ObamaCare’s Medicaid expansion, it’s Louisiana, which joined the expansion in 2016, after Democrat John Bel Edwards became governor. An audit released last year exposed ineligible Medicaid beneficiaries, including at least 1,672 people who made more than $100,000. But Louisiana’s Medicaid expansion has revealed another waste of taxpayer funds, both in the Pelican State and nationwide: the money spent providing coverage to people who already had health insurance.
Transparency, though essential, is not sufficient to bring down health care costs. Nor does it always need to be legislated. Laws aren’t required to force sellers of food, computers or clothing to post prices. That information is driven by consumers who actively seek value for their money. The most compelling motivation for doctors and hospitals to post prices would be the awareness that they’re competing for price-conscious patients.
Nine years after Democrats passed the Affordable Care Act and more than a year after Republicans failed in their effort to repeal it, health care promises once again to be a major issue in the 2020 elections.
Drug costs are rising, as are insurance premiums. Rural hospitals are closing. Even as an estimated 20 million people have gained coverage under the ACA, widely known as Obamacare, nearly 30 million people remain uninsured. Surveys consistently find that Americans see the health-care system as broken.
Americans cited health care as the top issue for the federal government to address, ahead of the economy, immigration, national security and other issues, Wall Street Journal/NBC News polling found this month.
The financial burden of health care was of particular concern for American families, according to a new Gallup poll released last week, trumping worries linked to wages, college expenses, housing and taxes.
| Connecticut Gov. Ned Lamont and fellow Democratic lawmakers reached an agreement Thursday to create a public option that will allow individuals and small businesses to purchase health insurance through the state. The proposal also calls for re-establishing the individual mandate—a centerpiece of the ACA that required people to have health insurance or pay a penalty—that has since been eliminated at the federal level by Congress. The bill would also have the state seek permission from the federal government to buy prescription drugs from Canada and calls for taxing opioid manufacturers. [As if Connecticut didn’t have enough problems with crippling taxes and regulations, now this…] |
| California lawmakers are headed for a showdown over how many illegal immigrants should qualify for government-subsidized health care. Democratic Gov. Gavin Newsom has proposed allowing unauthorized immigrants under age 26 to enroll in Medi-Cal, the state’s Medicaid program. Some members of the legislature, which is dominated by Democrats, have proposed that low-income people of all ages should be eligible, regardless of their immigration status. Both would be first-in-the-nation expansions and represent another step by California to enact economic and social policies in defiance of the Trump administration, including more financial support for those in the country illegally. |
The latest liberal policy idea would effectively end all private health care for many Americans. The proposal, the Medicare for America Act, first appeared as a 2018 paper by the Center for American Progress. It’s been called “the Democratic establishment’s alternative” to Sen. Bernie Sanders’s single-payer scheme and has been framed as a moderate proposal. But the bill is anything but moderate. When Rep. Rosa DeLauro (D-CT) reintroduced Medicare for America legislation on May 1, she included a new, radical provision. The revised bill prohibits any medical provider “from entering into a private contract with an individual enrolled under Medicare for America for any item or service coverable under Medicare for America.” Essentially, this would bar program enrollees from paying for health care with their own money.
The Trump administration has been working behind the scenes for months on a strategy to force greater price disclosure across much of the $3.5 trillion health-care industry. The push relies on existing administrative tools, according to people familiar with the discussions. Those include Labor Department powers under the law setting minimum standards for private-industry health plans and current hospital-payment rules under Medicare. The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services, the people said. The requirement could affect insurers providing coverage in the private-employer market.
Democrats asked CBO to lay out some parameters of how to set up single-payer, hoping to elude analysis of any one bill in Congress. The latter would carry political accountability—and a price tag. Instead CBO walks through “key design components and considerations” in a report that aims to bore and deploys the word “could” 209 times. Yet even this limited analysis is instructive about the “major undertaking” of single payer, as CBO puts it in hilarious understatement. CBO acknowledges, for example, that a transition that includes moving 160 million people from employer-sponsored coverage to single payer would be “complicated, challenging, and potentially disruptive” to health care and the economy. You don’t say.
The GOP must narrow the Democratic health-care advantage. Too many people are too ready to believe that whatever Democrats offer on that front is better for the country. The GOP’s message for 2020 should emphasize the party’s strengths: taxes, jobs, regulatory relief, defense, energy and judges. But winning will also require Republicans to improve on health care. Unless Republicans make their case confidently and forcefully, the health-care issue could cost them victory in 2020.