Category Archives: Affordable Care Act

The Effects of Socialism on Healthcare and Healthcare Reform

39975971_1685066984956287_3032019853234929664_nIn the current discussions, a single word — “socialism” — seems to have triggered the most emotional responses, needlessly so.

As more and more of the Democrats campaigning for the Mid-Term elections tout Socialism I wonder if they have any idea of what socialism means and more importantly how it would impact health care. David Nash and Richard Jacoby, both physicians wrote in MedPage Today back in 2009 that the health care reform debate is, all too often, confusing. The subject is multifaceted and is generally not presented in a logical, orderly fashion.

One reason is that, when we approach an issue as large as health care reform, we tend to focus on the segments about which we have strong personal feelings. Emotions come into play, often vigorously, making objective discussion difficult or impossible.

Often, the basis for these strongly held beliefs is rooted in the misunderstanding of a principle, a definition, or how things work in the real world. Such understanding is fundamental to a logical debate.

In the current health care reform discussions, a single word — “socialism” — seems to have triggered the most emotional responses. It is used almost pejoratively as if it is the worst thing that could possibly happen in America.

Socialism is most commonly invoked when the healthcare reform discussion turns to whether or not we should have a government-funded public insurance option.

Simple definitions can help here. In capitalism, individuals own the means of production of goods and services. In socialism, the government owns them. Let’s look a bit more at what socialism really is. Look at Venezuela and their currency, the Bolivar, which has been devalued to 0.0000040 of the U.S, dollar! Wow!

Kimberly Amadeo stated at the beginning of the month that Socialism is an economic system where everyone in the society equally owns the factors of production. The ownership is acquired through a democratically elected government. It could also be a cooperative or a public corporation where everyone owns shares. The four factors of production are labor, entrepreneurship, capital goods, and natural resources.

Socialism’s mantra is, “From each according to his ability, to each according to his contribution.” Everyone in society receives a share of the production based on how much each has contributed.

That motivates them to work long hours if they want to receive more.

Workers receive their share after a percentage has been deducted for the common good. Examples are transportation, defense, and education. Some also define the common good as caring for those who can’t directly contribute to production. Examples include the elderly, children, and their caretakers.

Socialism assumes that the basic nature of people is cooperative. That nature hasn’t yet emerged in full because capitalism or feudalism has forced people to be competitive. Therefore, a basic tenet of socialism is that the economic system must support this basic human nature for these qualities to emerge.

These factors are valued for their usefulness to people. This includes individual needs and greater social needs. That might include preservation of natural resources, education, or health care. That requires most economic decisions to be made by central planning, as in a command economy.

Advantages:

Workers are no longer exploited since they own the means of production. All profits are spread equitably among all workers, according to his or her contribution. The cooperative system realizes that even those who can’t work must have their basic needs met, for the good of the whole.

The system eliminates poverty. Everyone has equal access to health care and education. No one is discriminated against.  Everyone works at what one is best at and what one enjoys. If society needs jobs to be done that no one wants, it offers higher compensation to make it worthwhile.

Natural resources are preserved for the good of the whole.

Disadvantages:

The biggest disadvantage of socialism is that it relies on the cooperative nature of humans to work. It negates those within society who are competitive, not cooperative. Competitive people tend to seek ways to overthrow and disrupt society for their own gain.

A secondly related criticism is that it doesn’t reward people for being entrepreneurial and competitive. As such, it won’t be as innovative as a capitalistic society.

A third possibility is that the government set up to represent the masses may abuse its position and claim power for itself.

Difference Between Socialism, Capitalism, Communism, and Fascism

Untitled.Differences between Socialism,Some say socialism’s advantages mean it is the next obvious step for any capitalistic society. They see income inequality as a sign of late-stage capitalism. They argue that capitalism’s flaws mean it has evolved past its usefulness to society. They don’t realize that capitalism’s flaws are endemic to the system, regardless of the phase it is in.

America’s Founding Fathers included promotion of the general welfare in the Constitution to balance these flaws. It instructed the government to protect the rights of all to pursue their idea of happiness as outlined in the American Dream. It’s the government’s role to create a level playing field to allow that to happen. That can happen without throwing out capitalism in favor of another system.

Examples of Socialist Countries:

There are no countries that are 100 percent socialist, according to the Socialist Party of the United Kingdom. Most have mixed economies that incorporate socialism with capitalism, communism, or both.

The following countries have a strong socialist system.

Norway, Sweden, and Denmark: The state provides health care, education, and pensions. But these countries also have successful capitalists. The top 10 percent of each nation’s people hold more than 65 percent of the wealth. That’s because most people don’t feel the need to accumulate wealth since the government provides a great quality of life.

Cuba, China, Vietnam, Russia, and North Korea: These countries incorporate characteristics of both socialism and communism.

Algeria, Angola, Bangladesh, Guyana, India, Mozambique, Portugal, Sri Lanka, and Tanzania: These countries all expressly state they are socialist in their constitutions. Their governments run their economies. All have democratically elected governments.

Belarus, Laos, Syria, Turkmenistan, Venezuela, and Zambia: These countries all have very strong aspects of governance, ranging from healthcare, the media, or social programs run by the government.

Many other countries, such as Ireland, France, Great Britain, Netherlands, New Zealand, and Belgium, have strong socialist parties and a high level of social support provided by the government. But most businesses are privately owned. This makes them essentially capitalist.

Many traditional economies use socialism, although many still use private ownership. There are eight types of socialism. They differ on how capitalism can best be turned into socialism. They also emphasize different aspects of socialism. Here are a few of the major branches, according to “Socialism by Branch,” in The Basics of Philosophy.

Democratic Socialism: a democratically elected government manages the factors of production. Central planning distributes common goods, such as mass transit, housing, and energy, while the free market is allowed to distribute consumer goods.

Curiously, socialism is rarely used to describe Medicare, Medicaid, and the various other government-sponsored plans that account for roughly half of the healthcare dollars spent in this country and that are bona fide examples of socialist services.

It should be clear to any objective observer that the U.S. is not a purely capitalist country. We have many government-run services — the military, highways, public education, the Postal Service, Social Security, and Medicare to name a few.

Thus, the U.S. exhibits elements of both capitalism and socialism — a so-called mixed economy.

As has become abundantly clear through the recent financial crisis and subsequent government-sponsored rescue of the financial system, government spending shortened what otherwise would have been an extended economic downturn — when the private sector could not or would not do so.

So, a little government (read “socialism”) mixed in with our capitalism can be a good thing. Students of economics embrace “capitalism” because it has proven unparalleled in raising living standards for vast numbers of people and for fostering innovation. But, the conventional wisdom about capitalism is rooted in flawed logic that assumes free markets are inherently self-correcting. They are not. A capitalist system does not guarantee a good outcome.

What are the prospects for “market forces” to reshape our current health care system in a fashion that decreases cost and increases quality? For a market to work its magic, transparency about costs (which allows comparison shopping by patients) and information about quality (public reporting of quality measures in a standardized format) need to be widely available so that value can be assessed and delivered.

Clearly, these elements are not present in our current system and are not likely to be present for some time. Further, our current payment structures give patients little incentive to engage in “comparison shopping” or for providers to be efficient in delivering services. Indeed, providers are rewarded on the basis of quantity rather than quality or value of the services they provide.

The U.S. occupies the 37th place in the World Health Organization’s ranking of health care quality in industrialized nations. This, coupled with the fact that we pay almost twice as much as other countries for that level of care, suggests that our “capitalistic” healthcare system could use some “socialistic” guidance.

Who will provide guidance toward better outcomes in healthcare?

Historically, the government (in the form of the Centers for Medicare and Medicaid Services) has led the way to cost and quality reform through various demonstration projects and programs involving “Value-Based Purchasing.” Private insurers have followed the government’s lead.

The premise of health insurance is that a risk pool with a large number of people reduces the cost of protecting any one individual from the consequences of a serious health problem. The larger the pool, the broader the risk is spread, and the lower the cost.

A federally provided public insurance option covering all Americans would spread the risk as broadly as possible. In fact, many Medicare services are administered currently by Blue Shield and other private insurance companies.

Combining a single large insurance pool with the private administration is a nice mixed economic insurance solution. Certainly, this is not as crazy a scheme as the status quo.

Why is Socialized Health Care Is Unjust?

Hadley Heath Manning looked more critically and healthcare in a socialized system. As she states, when the government runs hospitals, clinics, and other healthcare institutions, people get worse care for more money. Sen. Bernie Sanders’s presidential campaign is exceeding expectations and drawing large support from young and blue-collar voters. At the center of his policy platform is a plan to completely socialize the U.S. healthcare system, turning it into a “single-payer” program, or a single government fund that pays for all citizens’ health costs.

The argument for this kind of system is simple. Supporters say it will enable everyone to access health care and cost less than our current mix of private and public health expenditures. Most of all, they argue this system would be morally superior to others.

All of those claims are dubious, but the last is the biggest whopper. In fact, socialized medicine is immoral. It relies on coercion and results in shortages and long wait times, which means worse care. It is rife with inequality and inefficiency, leading to serious harms.

This Would Ratchet Up the Doctor Squeeze!                                                                 Consider how a socialized system would cut costs. Single-payer advocates brag that having one, the national fund for health costs would allow the government to “negotiate” health-care prices down because it would essentially have prevented everyone else from bidding to pay for them. In other words, the government would have control of an entire industry and be able to dictate the terms of work and trade for everyone within it. How is this morally superior to allowing free people to negotiate arrangements on their own?

We already see the bullying of providers in the single-payer systems that exist in the United States.

Unfortunately, America hasn’t had a truly free, market-based health system for decades. Many people feel the outsized power of insurance companies has allowed them to dominate and unfairly control doctors and hospitals. This is true: Insurance companies, thanks in large part to regulations from the Affordable Care Act, are consolidating and using their growing market shares to bargain, and perhaps bully, health-care providers and dictate the terms for everyone.

We already see the bullying of providers in the single-payer systems that exist in the United States, including Medicare. Doctors consistently complain about the ways Medicare makes practicing medicine hard, from bureaucratic paperwork and compliance burdens to low pay.

Socialism Means Force and Force Are Wrong!

In fact, each year more and more physicians opt out of the Medicare program altogether. It’s become so bad in Hawaii that legislators have proposed a bill that would force providers to accept Medicare or else lose their medical licenses! This is always the end of government-controlled health care: coercion.

As Dr. Jim Geddes, a trauma surgeon near Denver, CO, recently told Medscape.com, “The only way physicians can afford to participate in Medicare is that they get higher payment from commercial insurers. Single-payer advocates talk about ‘Medicare for all,’ but if Medicare were standing alone, it would fall flat.”

But at least some choice remains: Doctors today can still choose not to participate in certain plans or programs.

But at least some choice remains: Doctors today can still choose not to participate in certain plans or programs. If single-payer were the law of the land, no health-care provider could engage in his profession without having to bill the government, as the government would be the only payer for these services in most cases.

Health-care providers would be forced to accept a government-set price for their services. This would inevitably harm the quality of care we receive by locking in current ways of doing things instead of allowing people to try new ones and discourage people from pursuing grueling expensively learned work in the medical field because of low pay and bad working conditions.

We’ve seen how a similar standardized compensation system has worked for public-school teachers. It effectively punishes excellent teachers and rewards mediocre ones. It’s helped create a bifurcated education system, with private schools delivering higher quality to families that can afford to pay tuition on top of taxes, while too many families are left to attend low-quality public schools.

The same phenomena would take place in medicine. Under a government-dominated system, excellent health-care providers wouldn’t be rewarded and would suffer new burdens, while mediocre and even poor providers would receive the same payments as those that provide high-quality care.

Socialized Style Health Care Means Rationing and Shortages.

Patients too would suffer at the hands of a single payer, due to the rationing and shortages that always result when a government sets prices. That is, of course, unless you are wealthy and can find a concierge medical practice to sell you some special service. Single-payer systems always unravel, giving the rich a chance to buy superior care, and thus creating tremendous economic inequities in the system.

Single-payer results in implicit rationing, which manifests in long waiting lists for the desired service or treatment.

In fact, it may shock some single-payer advocates to hear, but the National Bureau of Economic Research has found that health outcomes are more strongly tied to income in Canada (already a single-payer system) than in the United States.

Single-payer would also lead to waste and great inefficiency, which can have serious health consequences. If the government sets a price for a certain service that is too high, providers may over-prescribe it and patients may over-consume it. If the government sets a price for a certain service that is too low, then too few providers will offer it, and there will be a shortage.

In a market system, higher prices signal shortages and give providers an incentive to adapt to meet people’s actual needs. In a government-based system like single-payer, patients always face the same price—zero—so the government has to limit what services are available to whom based on data. This is straight-up rationing.

But single-payer also results in implicit rationing, which manifests in long waiting lists for the desired service or treatment. Long waits, common in other countries with government-controlled health-care systems, can lead to inferior health outcomes. To be blunt, this means more pain and suffering. In some cases, this even means more death.

That was the case for Laura Hiller, an 18-year-old Canadian with leukemia who died in January for lack of a hospital bed. Numerous bone marrow donors were ready and willing to assist her, but because her hospital could only perform about five transplants per month, Laura died while waiting for her turn. Stories like this are not uncommon in countries with single-payer health-care systems.

So, a Better Idea: A Medical Free Market!

Surely there is nothing moral about this. Americans shouldn’t accept that either insurers or government must dominate the health-care market or set the prices and payments for everyone. Rather, we should reform our health-care system to give individuals more power and choice. Market competition would drive prices down without the need for coercion.

Patients should pay providers directly for any services that are routine and not catastrophic, and patients could carry low-cost insurance policies to protect them in the event of catastrophic health-care costs. This is how it works for house and auto insurance, which almost everyone can afford even though cars and houses are frequently as expensive as many medical services.

A direct-pay model would create an incentive for providers to offer more pricing information, and to compete with one another on price. Market competition would drive prices down without the need for coercion. Quality would go up, prices would go down, and, just as importantly, this would be a morally superior system free of the coercion and domination implicit in a government-run socialized system.                                                The level of freedom in research and medical commercialization matters greatly. It is a very large determinant of the speed with which future medicine arrives – and especially medical technologies capable of reversing the age-related cellular damage that lies at the root of frailty, degeneration, and death. At the moment, right this instant, the system is broken. The very fact that we have “a system” is a breakage; that entrepreneurs are held back from investment by rules and political whims that are now held to be of greater importance than any number of lives. Those decisions about your health and ability to obtain medicine are made in a centralized manner, by people with neither the incentives nor the ability to do well.

As is always the case, the greatest cost of socialism in medicine lies in what we do not see. It lies in the many billions of dollars presently not invested in medical research and development, or invested wastefully, because regulations – and the people behind them, supporting and manipulating a political system for their own short-term gain – make it unprofitable to invest well. Investment is the fuel of progress, and it is driven away by self-interested political cartels.

The situation is grim; the greatest engines of progress in medicine – the research communities of the US and other Western-style countries – are moving forward very much despite the ball and chain of regulation that drags them down. In the fight against the age-related disease, and aging itself, how much further ahead would we be if we cut those chains and restored freedom to research, manufacture, review and quality assurance of medicine?

Sadly, I do not see this happening in the near future; a long, but a hard battle lies ahead for advocates of freedom and faster progress in any field. We live in an era of creeping socialism, economic ignorance, and blind acceptance thereof. It’s almost as though no lesson was learned from the megadeaths, poverty, and suffering of the Soviet experience, and now as I pointed out what is happening in other countries like Greece and now Venezuela as we step a little at a time in that direction once more.

Free tuition for all NYU medical students – a $55,018-a-year surprise but a Possible Solution!

38940385_1662028083926844_2145790176754925568_nSo, finally, medical schools, or really one medical school, is looking at one important aspect of the cost of healthcare and an impediment to a sustainable single-payer system, affordable healthcare or whatever you may want to call health care for all and now with the midterm elections around the corner.

Joel Shannon of USA TODAY wrote that all current and future students enrolled in New York University School of Medicine’s MD degree program will receive full-tuition scholarships, the school announced Thursday.

The scholarships are granted independently of merit or financial need for all enrolled students, the university said. Sticker price for tuition at the school is $55,018 a year.

The school has an acceptance rate of 6 percent, according to Princeton Review.

Students will still be responsible for books, fees, housing and other costs. The school estimates those education and living-related expenses will total about $27,000 for a 10-month term.

“No more tuition … The day they get their diploma, they owe nobody nothing,” said Kenneth G. Langone, the board of trustees chairman for NYU Langone Medical Center. The center is named for Langone and his wife, Elaine.

“(Students) walk out of here unencumbered, looking at a future where they can do what their passion tells them.” The school announced the news in a surprise end to its White Coat Ceremony, where new students receive lab coats. NYU Langone says Thursday’s announcement comes as the medical community reckons with the moral impact of higher education costs.

Medical students who face debt burdens that can reach well into six figures may be more likely to pick lucrative specialties, which may not be in the public’s interest, a release from NYU Langone says. The cost can also discourage some students from pursuing a career in the medical field at all.

The increasing cost of higher education has sparked action from employers, politicians, and schools around the country. Often those efforts are focused on financial need, as in the case of a “debt-free graduation” program announced by Columbia University’s Vagelos College of Physicians and Surgeons in April.

The move—which it said was financed by the generosity of the university’s “trustees, alumni, and friends,” amounts to a reduction of $55,018 in annual fees, regardless of financial needs or academic merit. It does not cover living and administrative costs averaging $27,000 a year. So, it isn’t entirely free!!

“A population as diverse as ours is best served by doctors from all walks of life, we believe, and aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt,” said Dr. Robert Grossman, dean of the NYU School of Medicine.

In its statement, NYU also pointed out that high student debt was putting graduates off pursuing less lucrative specializations including pediatrics and obstetrics and gynecology.

According to the Association of American Medical Colleges, the median debt of a graduating medical student in the US is $202,000—while 21 percent of doctors who graduate from a private school such as NYU face over $300,000.

“Our hope—and expectation—is that by making medical school accessible to a broader range of applicants, we will be a catalyst for transforming medical education nationwide,” said Kenneth Langone, chair of the Board of Trustees of NYU Langone Health.

Thursday’s announcement came as a surprise ending to the school’s annual white coat ceremony, which marks the start of first-year students’ medical careers. Those 93 students will benefit from the scholarship, along with 350 others enrolled further along in the program.

NYU said it is the only top 10-ranked medical school in the US to offer such an initiative and I believe that their acceptance rate is 6% of applicants!!!

Rising higher education costs have led some to question the value of college broadly. More than half of undergrads do not think the “value of a college education has kept up with the cost,” a July Ascent Student Loans study found.

5 Key Questions About NYU’s Tuition-Free Policy for Medical School

Beckie Supiano in the consideration of free tuition at NYU Medical School added with pertinent questions. In these days of near-universal concern about tuition prices and student-loan debt, colleges promote new affordability efforts pretty frequently. But when New York University announced on Thursday that it would offer full-tuition scholarships to “all current and future students” in its doctor-of-medicine program “regardless of need or merit,” it left college-pricing experts a bit stunned.

“It’s hard to fathom how you go from charging this high price to zero,” said Sandy Baum, a nonresident fellow in the Education Policy Program at the Urban Institute, who wondered if the program would even, be sustainable. NYU has said it would raise $600 million to endow the effort, which it estimates will cost $24 million a year.

Announcing that a program will be tuition-free is guaranteed to make a splash, said Lucie Lapovsky, a principal of Lapovsky Consulting and a former college president. “It’s a much clearer message,” she said, than a price cut or waiving tuition for particular students. “It’s a bold move.”

In its announcement, the medical school — among the top-ranked in the country — cast going tuition-free as a way to address two concerns: the lack of socioeconomic diversity among medical students, and their tendency to choose prestigious and well-paid specialties that don’t align with the need to provide basic health care in large swaths of the country.

Could NYU’s program move the needle on those problems? And what lessons might it offer higher ed more generally? Let’s consider some key questions.

Why don’t more institutions do something like this?

Plenty of commenters on social media wanted to know why other medical schools — or colleges generally — don’t stop charging tuition. The short answer? “If enough money drops out of a helicopter, they can,” said Robert Kelchen, an assistant professor of higher education at Seton Hall University. Few of the country’s colleges, he pointed out, have institutional endowments as large as the $600 million that NYU is raising just for this effort and my question is it sustainable in the future?

Few colleges have the same fund-raising opportunities, either, said Amy Li, an assistant professor of higher education at the University of Northern Colorado. The alumni base of an elite private university’s medical school has unusually deep pockets.

Another reason most colleges won’t waive tuition: They need this revenue to keep the lights on. Among the many data points, the federal government collects in its Integrated Postsecondary Education Data System is one that looks at how much of an institution’s core revenue comes from tuition. Not many colleges could feasibly abandon that income stream, said Jon Boeckenstedt, associate vice president for enrollment management and marketing at DePaul University, who has analyzed those data.

“Harvard could,” Baum said. “It would sound great, but it wouldn’t be socially beneficial.”

Even the Harvards of the world use the tuition revenue they bring in, and they spend it on things that presumably make the educational experience they provide worthwhile to the many families that can and do pay full price to attend. They also offer significant financial aid to support their less-advantaged undergraduates. At such colleges, this category refers to family incomes that reach into the six figures.

But even a student paying full freight at Harvard is receiving a subsidy from the endowment, said Donald Hossler, a senior scholar at the Center for Enrollment Research Policy at the University of Southern California’s education school. Their tuition is expensive, but it doesn’t cover what the university is spending to educate them.

Endowments also come with strings, Boeckenstedt said: “People think of endowments as a big pool of money you can use to do whatever you want,” but most of the funds are set aside for specific purposes.

Could NYU’s announcement pressure other institutions to try something similar? Higher education is a competitive industry, so other top medical schools no doubt have taken notice. While they are likely to do something in response, that doesn’t necessarily mean they’ll try to replicate the program, experts said.

While elite medical schools are already out there asking for donations, NYU’s announcement might push them to consider raising money for an affordability initiative — which is bound to receive lots of favorable buzz — instead of launching yet another cancer-research center, said Boeckenstedt.

“It’ll be interesting to see if other schools jump on the bandwagon,” said Lapovsky, who suspects that other med schools will be inclined to show that they, too, are doing something to promote affordability.

The financial pressures of becoming a doctor weigh disproportionately on women and underrepresented minorities, she said. And those are two populations that medical schools may be especially keen to attract.

NYU’s program is expensive and hard to replicate, Baum said. If it had instead reduced the price for low-income students, the idea would stand a better chance of being adopted by more medical schools, much the way “no loan” financial-aid policies, in which loans are not included in the aid packages of some or all undergraduates, have become ubiquitous among elite colleges.

Colleges will probably also discuss the possibility of an undergraduate version of the program, Hossler said. But he doesn’t expect that to result in the birth of “no tuition” programs at the undergraduate level. A boost in financial aid, he thought, is more likely.

Is this the best way to spend $600 million? Baum, for one, was struck by the fact that, out of all the students it educates, NYU had decided to raise this much money to support medical students — a group that’s disproportionately likely to both come from and ends up in the high end of the income spectrum. After all, she pointed out, NYU often finds itself in the news for the significant loan burden faced by its undergraduates.

A $600-million effort could go a long way, she said, toward making their education more affordable. “You have to ask, from a university perspective, what their priorities are.”

Even if the goal were to help medical students, in particular, Baum said, NYU’s program is untargeted. There’s no requirement that students be low-income to have their tuition waived. An effort that raised $600 million for scholarships that low-income students could use at the medical school of their choice, she said, would do a great deal more to improve the profession’s diversity.

But it’s not as if the university got to decide its donors’ intentions, Lapovsky said. Given the apparent interest of big donors in supporting medical-school affordability, she said, this was “an exciting way to do it.”

When policymakers design a program that will use tax dollars, it makes sense to ask whether they’re using those dollars as efficiently as possible, said Beth Akers, a senior fellow with the Manhattan Institute. But that concern is not as pressing when private donors are putting their own money toward something they value.

Will this make the NYU medical school’s student body more diverse?

One medical school getting rid of tuition might not much change the socioeconomic diversity of the country’s doctors. Still, diversity is an important goal in its own right: Colleges argue that all students receive a better education when their classmates come from varied backgrounds.

But would NYU’s new scholarships make the med school itself more diverse? It could go either way. Going tuition-free could make diversity harder for NYU’s medical school to achieve, Hossler said. The school is bound to see an increase in applications and to receive applications from even more of the country’s top applicants. Whatever other factors its admissions process might consider, it’s not easy to turn away applicants with top grades and test scores, Hossler said. And for a host of reasons that may have little to do with ability, students from financially privileged backgrounds are more likely to have those.

Kelchen is more optimistic. With a larger pool of students to choose from and no revenue expectations, NYU’s medical school would have more power to shape its class as it sees fit. If it wanted to become more diverse, he thinks, it could.

A parallel can be found in elite colleges’ “no loan” policies. They come in two main flavors, said Kelly Rosinger, an assistant professor of education-policy studies at Pennsylvania State University, who has studied them.

Some colleges stopped packaging loans for all students, while others designed their programs for students with family incomes up to a certain cap. In neither case, Rosinger and her co-authors found did the programs do much to increase the enrollment of low-income students.

The universal programs, however, did bring in more middle and upper-middle income students. “I sort of worry,” Rosinger said, “about the same thing happening at the graduate level.” Enrollment at graduate and professional schools is already less socioeconomically diverse than at the undergraduate level, Rosinger said. “The barriers to elite education,” she said, “aren’t just financial.”

Perhaps NYU’s program could chip away at some of those other barriers, Lapovsky said. The university is now in a position to be able to tell younger students who assumed that medical school was financially out of reach that it need not be.

Will the decision change the career choices of NYU’s medical graduates? One thing NYU’s program does is send a signal that the medical school has an interest in its graduates’ paths beyond their prestige or earnings potential, Akers said. “Society can value things in a different way than the market values them.”

In its news release, NYU cited sobering statistics about medical students’ debt: 75 percent of them graduate in debt, with a median burden of more than $200,000. Such debt loads, some in the profession worry, push graduates into high-paid specializations at the expense of general practice.

NYU’s medical school is not the first entity to worry that starting out in that kind of hole might shape students’ career choices. “The federal government already has a program that’s supposed to help doctors go into general practice,” Kelchen said. “It’s called income-driven repayment.”

Indeed, Baum said, because of their high debt levels, many doctors will see a significant portion of their loans forgiven under the government’s income-driven repayment and public-service loan-forgiveness programs. Besides, she said, while $200,000 sounds like a lot of money, it’s dwarfed by the earnings difference between, say, pediatricians and neurosurgeons. Money is probably a factor in doctors’ decisions of what to specialize in, but education loans are just a small piece of that financial equation.

Our doctors are too educated. Should We Reform Our Education System?

Dr. Akhilesh Pathipati at Massachusetts Eye and Ear related his feeling on the education of our doctors. I had just finished an eye examination for one of my patients and swiveled around to the computer. It was clear that he needed cataract surgery; he was nearly blind despite his Coke-bottle glasses. But even before I logged in to the scheduling system, I knew what I was going to find: He wouldn’t be able to get an appointment with an ophthalmologist for more than three months. Everyone’s schedule was full.

Moments like these are far too common in medicine. An aging population with numerous health needs and a declining physician workforce has combined to create a physician shortage — the Association of American Medical Colleges projects a shortfall of up to 100,000 doctors by 2030.

Policymakers have proposed many solutions, from telemedicine to increasing the scope of nurse practitioners. But I can think of another: Let students complete school and see patients earlier. U.S. physicians average 14 years of higher education (four years of college, four years of medical school and three to eight years to specialize in a residency or fellowship). That’s much longer than in other developed countries, where students typically study for 10 years. It also translates to millions of dollars and hours spent by U.S. medical students listening to lectures on topics they already know, doing clinical electives in fields they will not pursue and publishing papers no one will read.

Decreasing the length of training would immediately add thousands of physicians to the workforce. At the same time, it would save money that could be reinvested in creating more positions in medical schools and residencies. It would also allow more students to go into lower-paying fields such as primary care, where the need is greatest.

These changes wouldn’t decrease the quality of our education. Medical education has many inefficiencies, but two opportunities for reform stand out. First, we should consolidate medical school curriculums. The traditional model consists of two years of classroom-based learning on the science of medicine (the preclinical years), followed by two years of clinical rotations, during which we work in hospitals.

Both phases could be shortened. In my experience, close to half of the preclinical content was redundant. Between college and medical school, I learned the Krebs cycle (a process that cells use to generate energy) six times. Making college premedical courses more relevant to medicine could condense training considerably.

Meanwhile, the second clinical year is primarily electives and free time. I recently spoke with a friend going into radiology who did a dermatology elective. While he enjoyed learning about rashes, we concluded it did little for his education.

In the past decade, several schools have shown the four-year model can be cut to three. For instance, New York University offers an accelerated medical degree with early, conditional admission into its residency programs. The model remains controversial. Critics contend that three years is not enough time to learn medicine. Yet a review of eight medical schools with three-year programs suggests graduates have similar test scores and clinical performance to those who take more time.

Finally, we can reform required research projects. Research has long been intertwined with medical training. Nearly every medical school offers student projects, and more than one-third require them. Many residencies do as well. Students have responded: The number pursuing nondegree research years doubled between 2000 and 2014, and four-year graduation rates reached a record low. Rather than shortening training, U.S. medical education is becoming longer. The additional years aren’t even spent on patient care.

Done right, this could still be a valuable investment. Intellectual curiosity and inquiry drive scientific progress. But that’s not why most students take research years. I conducted a study showing that less than a quarter do so because of an interest in the subject matter. The most common reason was instead to increase their competitiveness for residency applications.

And because having more research published represents greater achievement in academic medicine, students are presented with a bad incentive to publish a large amount of low-quality research. Many of my peers have recognized this, producing more papers than many faculty members. It’s no surprise that there has been an exponential increase in student publications in the past few decades, even though a majority are never cited.

Medical schools need to realign incentives. This starts with the recognition that students can do valuable work even if it doesn’t end up in a journal. It’s time we get them out of school and in front of patients.

Another  Suggestion-Training U.S. doctors faster by cutting out college                                                                                                                               Abdullah Nasser, a neurobiology degree candidate at Harvard University related something the most foreign schools have found that the U.S.A. education for physicians is flawed. Consider two young people, similar in many respects. Both were outstanding secondary school students. Both wanted to help others. Both dreamed of becoming doctors and worked very hard to achieve that goal.

One took his SATs in high school and was accepted by his state university. He fulfilled his premedical requirements while pursuing a liberal arts degree in biology. After four years, he took the Medical College Admission Test and, following graduation, spent a year volunteering in rural Kenya to improve his odds of getting into medical school. He then applied and was accepted, matriculating as a first-year medical student at age 25.                                                 By that time, the second young person had already earned the right to have the letters MD after her name. In fact, she had graduated from medical school two years earlier and was well on her way to opening her own clinic. Over her lifetime, she can expect to practice medicine for four to five more years than her peer.    The only difference between them? The first person is American, while the second is British. Their stories are not the exception; they are the norm in their respective countries.

Medical degrees in the United States are being issued to older and older students. Data compiled by the Association of American Medical Colleges show that the percentage of first-year medical school students who are age 24 or younger has gone from 75 percent in 2001 to 50 percent last year. The average age of these first-year students in 2011 was 23 for women and 24 for men, a whopping five to six years older than our British friends — and most of the rest of the world.

A majority of the world’s countries, including Brazil, China, and Denmark, considers an MD to be an undergraduate degree. Five to six years after receiving their high school diplomas (or their national equivalent), students in these countries are seeing real patients while their U.S. counterparts are still struggling with verbal-comprehension passages on the MCAT. It is time for the United States to recognize the traditional pre-med path for what it is: a colossal waste of time and potential that is costing this nation millions, if not billions, of dollars.

Proponents of the status quo often argue that U.S.-educated doctors are renowned for their excellence and professionalism, but there is little evidence that earning an undergraduate degree before medical school produces better or more mature doctors. Put another way, there is no reason to believe that U.S. doctors are “better” than French, Finnish or German doctors — all of whom enrolled in medical programs straight out of high school. But there is some evidence that U.S. doctors may be worse. An international study in 2007 estimated the rate of medical errors in the United States to be higher than that in the six other countries examined: Australia, Britain, Canada, Germany, the Netherlands and New Zealand.

Others might argue that U.S. high school graduates are not prepared for the international approach to medical training. But performance on Advanced Placement tests suggests a growing minority would be able to handle the medical school course load.

A reasonable, and relatively cheap, way to address the issue is to allow a two-stream medical education system: one stream — similar to what we have now — for college-graduate entry into medical school; and one that is slightly longer for students straight out of high school (say, five or six years). This sort of model has been shown to work in several countries, including Australia and Britain.

Some U.S. medical schools, notably including New York University’s, are revamping their curriculums and offering shorter paths to graduation. This is a change in the right direction. The hybrid approach too would allow the United States to catch up with the rest of the world and reduce the critical demand for doctors without increasing our reliance on doctors with degrees from other countries or pushing our medical schools to their limit and would decrease the cost of medical education. How important is that? Consider that when Bernie Sanders suggests that Medicare for All can be financed partially by reducing salaries to our practicing physicians!!

My prediction is that NYU, as well as other medical schools that adopt a tuition-free policy will not have the sustainable endowment for future classes and the state government, will be forced to shoulder the burden. And there go our taxes!!

 

Five Doctors and Surgeons Tell Us What They Really Think About Medicare-for-all and the Trump Administration Continues to Change the Present Medicare System!

38631154_1656169364512716_8196802800739418112_nSome doctors support single-payer health care — even if that means a lower salary. I’m wondering more and more, about who is Cookoo, Cookoo today?? I know that Bernie, Nancy and many of our politicians are crazy or Cookoo, but educated physicians?

Remember last week when I discussed the explanation that if we adopt Medicare for All that one of the outcomes of this system would be a reduction in physician salaries. Dylan Scott reviewed the feedback regarding the Medicare for All plan as he reported from the muscle of the health industry lobby — pharma, health plans, doctors, and hospitals — some of which is gathering to stop proposed single-payer systems.

The Hill’s Peter Sullivan had the report on Friday morning. The industry’s influence can’t be underestimated: It stopped Clintoncare. And, for better or worse, it was a boon for passing Obamacare that the industry mostly supported the legislation.

The industry’s disparate interests fight over a lot of issues, but Medicare-for-all unites them. That is going to be a factor if we get to 2021 with a Democratic Congress and president, and they decide to pursue single-payer health care.

That moment really might come. A sign times are changing: A Republican health care lobbyist called me recently to ask whether all-payer rate setting would be a better alternative to single payer, by causing less disruption. (I quibbled that you would need some kind of coverage component, given the moral urgency that is animating the left on health care.)

Still, a Republican almost endorsing price controls. That is a pretty strong indicator of where our health care debate seems to be heading.

Payment cuts for health care providers, if we eliminate private insurance and move everybody to Medicare rates, are going to come up a lot in this debate.

Those cuts are an easy thing for industry lobbyists to target and for Republicans to run ads on. Cuts could be overstated, depending on how much legitimate waste single payer can actually eliminate by consolidating the administration of health care, but the projections for Medicare for All plans are going to anticipate big cuts.

That explains the industry’s lobbying position. But the reality on the ground is more complicated than that. There are absolutely health care providers who support single payer. Quite a few of them sent me emails after I asked for their thoughts last week.

Here are some of the most interesting responses. From a registered Republican working at a next-gen gene sequencing company:

Medicare is, without question, the most reliable, most predictable payer that we deal with. And for somebody like me, it would be a dream to only have to deal with them. Yes, they are pretty heavily regulated. And yes, they have pretty strict guidelines for who to cover. But unlike other payers, who make life virtually impossible for smaller providers because they’re in the for-profit game (the not paying for care game), Medicare at least adheres to a clear set of rules. Other payers put up an endless set of traps against reimbursement, contracting, and other parts of the revenue lifecycle that add substantial cost to services and thus increase the cost to the consumer. I can say with near certainty that parties in my industry would provide services at a materially lower price and with more predictable out of pocket costs if every payer was as reliable and consistent as Medicare.

As such, I’m now, despite growing up a conservative afraid of such government largesse as “Medicare for all,” convinced that a single public payer, either as rate setter or as a true single-payer, is needed. In contrast, I remain a staunch defender of private medical care, where companies such as my own and our competitors do battle to increase quality and lower patient cost.

So I guess you could count me as pro-Medicare for all, a sentence I never thought I’d write 15 years ago.

From a retired neurosurgeon, who had also thought of himself as a Republican:

I practiced neurosurgery in Texas and retired 20 years ago. I started out as a pretty solid, but non-thinking, Republican, opposing perceived intrusions of Medicare into my practice. I read Himmelstein and Woolhandler’s NEJM articles and thought they were Harvard hippie Communists. Over time, I came to see that they were right, that we really need a universal health care system, as so many of my patients weren’t getting needed care. I was a bit embarrassed making as much money as I did and would have done it for half of that.

From a radiation oncologist of more than 20 years, in Chicago and for the military:

I left full-time medicine a few years ago after getting fed up with continuously fighting insurance companies for pre-authorization and for the right to practice medicine the way I was trained within the standard published guidelines. I now work part-time seeing primarily uninsured and Medicaid patients.

A 2011 Health Affairs study found that the average US physician spends nearly $83,000 a year interacting with insurance plans. And a 2010 American Medical Association Study found the average doctor spent 20 hours a week on pre-authorization activities. This has only gotten more expensive and much worse. Under a single-payer plan, this would be much easier and far less expensive.

In addition, we know that the major cost of malpractice coverage is for the continued medical care of the patient that was harmed. A single-payer system would ensure that any such patient would be covered for the rest of their lives and as a result, malpractice coverage would also be dramatically lower.

While reimbursement under a single payer plan most likely would be less, so would the headaches and administrative hassles and costs. And I would be able to see far more patients instead of being on the phone fighting with a case manager, while my office and malpractice coverage costs would be far less.

From a Texas oncologist still early in their career:

My general view of Medicare-for-all is that it would moderately contribute to remedying our health care spending problem, but by no means fix it.

My understanding is that the biggest savings would come from getting rid of the huge administrative dead weight in our private insurance system. However, that in and of itself would not fix the fact that billing rates are through the roof here in the US. Saving a few percents on overhead would be great, but MRIs and appendectomies are still going to cost 2x-4x here than in other OECD countries.

I am definitely heterodox among physicians in believing that our salaries (mainly among specialists such as myself) ought to be significantly lower. The greater bargaining power than a single, government payer might have could potentially rein in some of that.

On the other side, from an anesthesiologist intern in Chicago, fiscally liberal but socially conservative, who has some concerns about how single payer would handle Catholic hospitals:

The one part of a more single-payer system that worries me relates to the socially conservative opinions I have. I’m sure you have seen the series FiveThirtyEight has had the past week on the effects of Catholic hospitals coming to predominate in more rural areas and even some cities. (As someone who grew up in a small town, I can say the main healthcare provider in the area is a Catholic hospital.) I don’t fear a single-payer system would result in individual providers being required to provide services they individually oppose for religious beliefs.

However, I do worry about whether or not there would be requirements for Catholic hospitals to provide services contrary to Catholic teaching, generally surrounding abortion or end of life care, in order to be eligible for billing Medicare. I do presume a Medicare-for-All system would pass on a party-line vote with only Democrat support and could see them trying to expand abortion coverage–either directly in a law or through regulation like many abortion coverage issues have been changed–at the same time since that issue has also grown much more partisan in the past decade.

Again I believe that even these physicians fail to see reality. My question is are you willing to accept Medicare for All as the new health care system including the lower reimbursements and lower salaries, and when will it stop? Will the salaries see continual reductions to make the huge debt to continue the program? And how will the newly trained physicians pay off their loans and pay for their required malpractice insurance?

The real problem here is that these experts touting the Medicare for All programs is that they don’t realize that in order to make a universal health care/ single payer health care program to work tort reform and the cost of education of health care workers has to be part of the solution. If not the new program, whatever it is, will fail or become so expensive and expand out of control.

The solution to the health care crisis is not one factor but an equation that needs to have a solution to each factor!

And Trump continues to change the present system. Consider this article in USA TODAY:

Trump administration takes aim at the Obama-era Medicare program for 10.5 million seniors

Ken Alltucker of USA TODAY published a recent article of President’s Trump’s continued attack on Obama’s modification of the Medicare program.

The Trump administration on Thursday moved to tighten controls over an Obama-era health program by making doctors and hospitals take on greater financial risk for 10.5 million Medicare patients.

Seema Verma, the Centers for Medicare and Medicaid Services administrator who has been critical of the Affordable Care Act, said the changes are necessary because the Medicare program had “weak incentives” for health-care providers to slow spiraling costs.

Under proposed changes, hospitals and doctors would adhere to a more aggressive timetable to save money while maintaining the quality of care. Medicare, the federal health program mainly for adults who are 65 and over, projects the changes would save the federal government $2.2 billion over 10 years.

Untitled.Trump and Medicare changes

“Pathways to Success” shortens the maximum amount of time ACOs are not subject to performance-based risk to 2 years or 1 year for existing shared savings only ACOs.

“After six years of experience, we feel we know what works and what doesn’t,” Verma said. “We want to focus on delivering value for patients and taxpayers.”

Verma said, without changes, that the nation is on pace to spend $1 out of every $5 on health care by 2026, an unsustainable path that will harm families, businesses and the economy.

The Obama program, part of the Affordable Care Act, encouraged hospitals and doctors to band together as “accountable care organizations” to coordinate medical care and cut down on unnecessary tests and procedures. The idea is that if these organizations could deliver care at a lower-than-projected cost, they could collect bonus payments from the federal government.

However, CMS said that 82 percent of 561 accountable-care organizations chose a risk-free version of the program that provided little incentive to reduce spending. These organizations recouped savings if they cost Medicare less than projected, but they faced no financial penalty if they billed more than expected.

The upshot: Congressional Budget Office projections that the Obama-era program would save Medicare $5 billion through 2019 never materialized.

Under Verma’s changes, participants would be limited to two years in the risk-free version of the program. The current regulations allow these organizations to stay for 6 years.

The likely result will be hospitals and doctors dropping from the program.

CMS projects that nearly 20 percent of participants will drop out of the voluntary program due to the more aggressive timetable. However, an industry organization called the National Association of ACO’s predicts 71 percent will drop from the program.

The American Hospital Association said the proposed changes “ignores the reality” that hospitals are at a different point in transiting to this type of “value-based care.”

“The proposed rule fails to account for the fact that building a successful ACO, let alone one that is able to take on financial risk, is no small task,” the hospital group said in a statement. “It requires significant investments of time, effort, and finances.”

Verma also will require doctors and hospitals to notify Medicare patients if they are enrolled in such a program. Medicare recipients also could earn bonuses, such as gift cards, if they meet preventive care milestones, Verma said.

And now:

Well, this Fox & Friends Twitter poll on “Medicare for All” didn’t go as planned

Christopher Zara reported that in today’s edition of “Ask and Ye Shall Receive,” here’s more evidence that support for universal health care isn’t going away.

The Twitter account for Fox & Friends this week ran a poll in which it asked people if the benefits of Bernie Sanders’s “Medicare for All” plan would outweigh the costs. The poll cites an estimated cost of $32.6 trillion. Hilariously, 73% of respondents said yes, it’s still worth it—which is not exactly the answer you’d expect from fans of the Trump-friendly talk show.

Granted, this is just a Twitter poll, which means it’s not scientific and was almost certainly skewed by retweets from Twitter users looking to achieve this result.

At the same time, it’s not that far off from actual polling around the issue. In March, a Kaiser Health tracking poll revealed that 6 in 10 Americans are in favor of a national health care system in which all Americans would get health insurance from a single government plan. Other polls have put the number at less than 50% support but trending upward.

More on Medicare for All!

Trump’s Top Medicare Official Slams ‘Medicare for All’ and Another Cost Estimation of the Plan!

37743878_1632665590196427_5036079386281902080_nI was away on vacation and arrived home from a long flight and long shuttle ride through the beautiful mountains of Colorado, but the delay allowed me to view an article updating the cost of the Medicare for All plan, with which I will end this post.          Ricardo Alonso-Zaldivarof the Associated Press reported that the Trump administration’s Medicare chief on Wednesday slammed Sen. Bernie Sanders’ call for a national health plan, saying “Medicare for All” would undermine care for seniors and become “Medicare for None.”

The broadside from Medicare and Medicaid administrator Seema Verma came in a San Francisco speech that coincides with a focus on health care in contentious midterm congressional elections. Sanders, a Vermont independent, fired back at Trump’s Medicare chief in a statement that chastised her for trying to “throw” millions of people off their health insurance during the administration’s failed effort to repeal the Affordable Care Act. Verma’s made her comments toward the end of a lengthy speech before the Commonwealth Club of California, during which she delved into arcane details of Medicare payment policies.

Denouncing what she called the “drumbeat” for “government-run socialized health care,” Verma said “Medicare for All” would “only serve to hurt and divert focus from seniors.” “You are giving the government complete control over decisions pertaining to your care, or whether you receive care at all,” she added.

“In essence, Medicare for All would become Medicare for None,” she said. Verma also said she disapproved of efforts in California to set up a state-run health care system, which would require her agency’s blessing.

In his response, Sanders said, “Medicare is, by far, the most cost-effective, efficient and popular health care program in America. He added: “Medicare has worked extremely well for our nation’s seniors and will work equally well for all Americans.”

The Sanders proposal would add benefits for Medicare beneficiaries, coverage for eyeglasses, most dental care, and hearing aids. It would also eliminate deductibles and copayments that Medicare and private insurance plans currently require.

Independent analyses of the Sanders plan have focused on the enormous tax increases that would be needed to finance it, not on concern about any potential harm to seniors currently enrolled in Medicare. I will review another cost estimation at the end of this post.

But so-called “Mediscare” tactics have been an effective political tool for both parties in recent years, dating back to Republican Sarah Palin’s widely debunked “death panels” to an opposition to President Barack Obama’s health care overhaul. Democrats returned the favor after Republicans won control of the House in 2010 and tried to promote a Medicare privatization plan.

Democrats clearly believe supporting “Medicare for All” will give them an edge in this year’s midterm elections. More than 60 House Democrats recently launched a “Medicare for All” caucus, trying to tap activists’ fervor for universal health care that helped propel Sanders’ unexpectedly strong challenge to Hillary Clinton for the 2016 Democratic presidential nomination. Just a few years ago, Sanders could not find co-sponsors for his legislation.

A survey earlier this year by the Kaiser Family Foundation and The Washington Post found that 51 percent of Americans would support a national health plan, while 43 percent opposed it. Nearly 3 out of 4 Democrats backed the idea, as did 54 percent of independents. But only 16 percent of Republicans supported the Sanders approach.

Early in his career as a political figure, President Donald Trump spoke approvingly of Canada’s single-payer health care system, roughly analogous to Sanders’ approach. But by the 2016 presidential campaign, Trump had long abandoned that view.                                                                                                                                             Bernie Sanders Medicare-for-all plan is all wrong for America          It would be senseless to replace employer-based coverage with an expensive one-size-fits-all system that couldn’t handle treatments of the future.

Sanders unveils ‘Medicare For All’ bill

Sen. Bernie Sanders is proposing legislation that would let Americans get health coverage simply by showing a new government-issued card. And they’d no longer owe out-of-pocket expenses like deductibles. (Sept. 13)

My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits-all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen.

Single-payer is the ultimate one-size-fits-all health care promise. Consider Canada, our single-payer neighbor to the north. One of my patients was visiting Toronto several years ago when he developed worsening angina requiring a cardiac stent. He was placed on a several-week waiting line before giving up and returning home for the procedure. The waiting-your-turn problem has only gotten worse since then. In 2016, the Fraser Institute found a median 20-week wait in Canada between a generalist’s referral and the time the patient actually received a definitive test or treatment/procedure from a specialist.

Americans already face a wasteful health care system with inadequate access to care. The Commonwealth Fund ranked us last among 11 wealthy nations this summer. But unlike Canada, we will never tolerate such long waiting lines, which is one of the reasons single-payer will never work here.

Despite growing problems in access and cost, most Americans don’t want change to jeopardize what works. A 2016 Gallup Poll revealed that 65% of Americans are happy with the way the healthcare system works for them. The backbone of our system is employer-based health insurance. Some 170 million Americans rely on coverage at their job, and employers receive an incentive to offer it in the form of a tax deduction.

More than 55 million Americans are covered by Medicare at a cost to the taxpayer of around $650 billion a year. Medicaid covers more than 70 million, at a cost of $532 billion.

Medicare-for-all would be far more expensive, especially given the rising cost of healthcare technologies. Last year the Urban Institute estimated that the Sanders plan would cost a whopping $32 trillion between 2017 and 2026, a completely unworkable number.

POLICING THE USA: A look at race, justice, media

Both Medicare and Medicaid are already struggling to find doctors who still want to work with them. About 30% of doctors wouldn’t see new Medicaid patients, close to the same as the share of primary care doctors over the age of 55 who won’t see new Medicare patients. This inherent doctor shortage will only worsen if government-run health insurance is expanded.

Finally, the health insurance lobby, quite powerful in Congress, will never allow single-payer to pass, as it would significantly erode its client base. Major health insurers spend millions of dollars lobbying each year to ensure their survival. They were crucial players in the construction of the highly regulated policies of Obamacare, which provide millions of more clients paying high premiums. Single-payer represents a big threat, and insurers are far too entrenched in Congress to lose the battle.

Single-payer isn’t the answer to providing health care in an exciting future where cancer and other treatments are genetic-based and personalized. For instance, CAR-T involves removing a patient’s immune cells and genetically engineering and reinserting them to fight cancer. Single-payer will never be able to justify paying for a $500,000 technology on a patient-by-patient basis.

Food and Drug Administration commissioner Dr. Scott Gottlieb told me recently that the insurance model isn’t necessarily prepared to cover the latest treatments where “a one-time administration of a drug could potentially cure a disease.” He added, “I worry about access to therapies, particularly effective new therapies so it would be concerning if we had really impressive new treatments and patients couldn’t get access to them because the models weren’t right or patients were uninsured or underinsured for the medicines that they use.”

Bernie Sanders’ bloated Medicare-for-all insurance may be extensive, but it is not designed for the personalized cures of the near future. It is also definitely not the kind of national catastrophic national health insurance that Theodore Roosevelt had in mind during his 1912 “Bull Moose” presidential campaign or Richard Nixon’s comprehensive coverage plan that built on the existing employer-based system (proposed in 1974 but soon eclipsed by Watergate).

It makes a lot of sense for all patients and hospitals to be covered in the event of a sudden health catastrophe so that neither they nor the hospital that saves them goes bankrupt. But it makes little sense for single-payer to threaten an employer-based market that’s already working.

And now the newest Democrat contender joins Bernie Sanders in touting Medicare for All. In Thursday’s episode of “The Daily Show,” host Trevor Noah grilled Alexandria Ocasio-Cortez ― the democratic socialist candidate who recently toppled Rep. Joe Crowley in the Democratic primary for New York’s 14th Congressional District ― on what she calls her “idealist” views.

While discussing major points of political contention like health care and education, Noah asked the 28-year-old Latina to explain democratic socialism and what that label means to her. “I don’t knock on a person’s door and is like, ‘Hey! Let me tell you about socialism!’ Like, that’s not how I campaign,” Ocasio-Cortez said. “And I also think that I don’t knock on a person’s door and say, ‘Hey, let me tell you about being a Democrat.’”

“I don’t say that. I speak to people’s needs,” she went on. “And, you know, if Fox News and if media want to continue using this word, they’re gonna use the word. I think by me saying, ‘Oh, no, I’m not this, that and the other,’ it just becomes a distraction.”

Ocasio-Cortez told Noah that democratic socialists want to talk about “wages and education” as well as “saving our planet.”

“We’re here to talk about people paying their fair share, and we’re here to talk about saving the country, frankly,” she said.

Noah then pivoted, making the argument that while many would agree with the ideas she has in mind, it’s not clear how she plans to fund the causes she’s aiming to overhaul.

“Those ideas, I think most people would agree on, especially if they don’t know the label that they are attached to, you know?” Noah said. “But then, the pragmatic side of it comes in, as you said. How do you pay for these?”

“You know, you always see people coming in with economic arguments, and they say, look, these numbers don’t really add up,” he continued. “You know, in order to get health care for everybody, this is what it would cost. That’s going to be troubling. Even if you reverse the Republican tax deal, that’s only going to make up 5 percent of what we need to pay for Medicare for all. How do you pay for education for all ― how do you pay for all of these ideas?”

Ocasio-Cortez called that an “excellent, excellent question.” She told Noah she recently sat down with a “Nobel Prize economist” to talk policy ― “I can’t believe I can say that, it’s really weird” ― and noted that the extremely wealthy, like Warren Buffett, could be paying a 15 percent tax rate. With that and a corporate tax rate of 28 percent, plus some closed loopholes, she said, there would be “$2 trillion in 10 years” to put toward transitioning the U.S. to a fully renewable-energy economy. “One of the wide estimates is that it’s going to take $3 to $4 trillion” to do that, she said.

“A lot of what we need to do is reprioritize what we want to accomplish as a nation,” Ocasio-Cortez said. “Really, what this is about is saying, health care is important enough for us to put first. Education is important enough for us to put first. And that is a decision that requires political and moral courage, from both parts of the aisle. Period.” This lady and I use this term carefully is a true idiot, but one can see how she might get a long list of followers.                                                                                                                                      And look what is happening in the state of Maryland.                                                            The question was what would we get if we moved to ‘Medicare for all’?                   Pete Marovich for The Post recently wrote an article for The Post Reporting that “Jealous, Hogan clash on health care” exposed the missing link in our state (and national) debate on health care: It is about cost, not care. It is about quantity, not quality. “Single-payer” is by its nature-socialized health care. Okay. But I know socialized medicine, as a common soldier in the Army and as a U.S. diplomat who used a “VIP” clinic in a socialist country. Socialized medicine? No, thank you. Would socialized medicine be different here? Is it worth taking into consideration when debating the pros and cons of a “single-payer” health system what you would get with government’s trickle-down health care? “Medicare for all” is wishful thinking. It would be “Medicaid for all.”

The article mentioned that a University of Massachusetts at Amherst study concluded that California’s single-payer proposal “could provide decent health care for all California residents while still reducing net overall costs. ” What does “decent” mean? Does England have decent health care? It certainly is not enviable. Does Canada contribute significantly to the discovery of new advances in medicine and lifesaving drugs? Or does its enviable health-care system depend upon American contributions in the field of medicine? Who would determine the value of health care in terms of it being “adequate” or “decent”? Why the government would make this judgment. Taking in cost savings, of course. By the way, how’s the Trump administration doing on health care? Cost, not care. Quantity, not quality.

And back to the latest cost estimation of Medicare for All. Brooke Singman reporting for Fox News wrote recently that The “Medicare for All” plan, which we all know was and still is being pushed by Sen. Bernie Sanders and endorsed by a host of Democratic congressional and presidential hopefuls would increase government health care spending by $32.6 trillion over 10 years, according to a new study. So I was off by a few Trillion $$. What’s a few trillion between “friends” or taxpayers??

The Vermont senator has avoided conducting his own cost analysis, and those supporting the plan have at times struggled to explain how they could pay for it. The study, released Monday by the Mercatus Center at George Mason University, showed the plan would require historic tax increases. The hikes would allow the government to replace what employers and consumers currently pay for healthcare — delivering significant savings on administration and drug costs, but increased demand for care that would drive up spending, according to the report.

According to the report, the legislation’s federal health care commitments would reach approximately 10.7 of GDP by 2022, and rise to nearly 12.7 percent of GDP by 2031. But the study, conducted by senior research strategist Charles Blahous, said that those estimates were on the “conservative” side.

Sanders’ plan builds on Medicare, the insurance program for seniors. The proposal would require all U.S. residents to be covered with no copays and deductibles for medical services. The insurance industry would be regulated to play a minor role in the system.

Sanders is far from the only liberal lawmaker pushing the program. 2020 hopefuls like Sen. Kamala Harris, D-Calif., and Sen. Elizabeth Warren, D-Mass., endorsed a “Medicare for all” program last year.

Political newcomer Alexandria Ocasio-Cortez, who beat House Democratic Caucus Chairman Joe Crowley, D-N.Y., in a recent upset primary and instantly became a prominent face of the democratic socialist movement, also is promoting a “Medicare for all” platform and now she is pounding the campaign trails with Bernie Sanders pushing Medicare for All as well as other liberal programs that are going to cost the taxpayers.

“Enacting something like ‘Medicare for all’ would be a transformative change in the size of the federal government,” Blahous, who was a senior economic adviser to former President George W. Bush and a public trustee of Social Security and Medicare during the Obama administration, said.

Blahous’ study also found that “a doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.”

But Sanders blasted the analysis as “grossly misleading and biased,” noting that the Mercatus Center receives funding from the conservative Koch brothers. Koch Industries CEO Charles Koch is on the center’s board.

“If every major country on earth can guarantee health care to all, and achieve better health outcomes while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States cannot do the same,” Sanders said in a statement. “This grossly misleading and biased report is the Koch brothers’ response to the growing support in our country for a ‘Medicare for all’ program.”

A spokesman for Sanders said that the senator’s office has not done a cost analysis on the new plan, however, the estimates in the latest report are within the range for other cost projections for Sanders’ 2016 plan.

Sanders’ staff found an error in an original version of the Mercatus report, which counted a long-term care program that was in the 2016 proposal but not the current one. Blahous corrected it, reducing his estimate by about $3 trillion over 10 years. Blahous says the report is his own work, not the Koch brothers’.

Also called “single-payer” over the years, “Medicare for all” reflects a long-time wish among liberals for a government-run system that covers all Americans.

The idea won broad rank-and-file support after Sanders ran on it in the 2016 Democratic presidential primaries. Looking ahead to the 2020 election, Democrats are debating whether single-payer should be a “litmus test” for national candidates.

The Mercatus analysis estimated the 10-year cost of “Medicare for all” from 2022 to 2031, after an initial phase-in. Its findings are similar to those of several independent studies of Sanders’ 2016 plan. Those studies found increases in federal spending over 10 years that ranged from $24.7 trillion to $34.7 trillion.

The Mercatus study takes issue with a key cost-saving feature of the plan — that hospitals and doctors will accept payment based on lower Medicare rates for all their patients.

The study found that the plan would reap substantial savings from lower prescription costs — $846 billion over 10 years — since the government would deal directly with drug makers. Savings from the streamlined administration would be even greater, nearly $1.6 trillion.

But other provisions of the plan are also expected to drive up spending, with coverage for nearly 30 million uninsured Americans, no copays and no deductibles and improved benefits on dental, vision and hearing.

The study estimated that doubling all federal individual and corporate income taxes would not fully cover the additional costs.

So where do we get all the additional money to pay for this program or are there other options such as what will the restrictions on coverage look like?

More to follow!!!

What Are the Pros and Cons of Bernie Sanders’ Proposed Medicare for All Single-Payer National HealthCare Plans?

 

insurance639We will now take a look at the pros and cons of having this plan in place come next year (i.e. if Bernie Sanders win the presidential race or if the Democrats get control of the Senate and House)

Single Payer Health Care Pros

Single payer health care was introduced together with several pros. Here are some of those:

  • Guaranteed Health Care

Single payer guarantees high-quality health care services regardless of who you are or what you are into. Everybody is treated equally so social and economic status is never a hindrance for you to receive this insurance. All the legal residents of the United System will get coverage. The single-payer health care system ensures that people get health care to the full extent, which is required by their health.

  • Non-Complex Billing

Submission of complex billing statements that usually requires some office personnel or any staff is eliminated. Thus, physicians and doctors can freely practice medicine at any time.

  • Recognition

Physicians who give out great health care quality can be rewarded for such good doing in providing preventive care. In some countries, most doctors and physicians can receive bonuses after giving their patients a truly remarkable health care. These vary though depending on what country you are in.

  • Reduce Cost / Lower Cost

Because this is a non-profit organization, the cost of providing health care is substantially reduced. No corporate executives are employed so there is no reason to aim for a higher profit since no bonuses or extreme salaries are to be given out to the staffs. There will be a significant reduction in the amount you pay for health insurance each year.

  • No-Limitations

No one will ever be denied on receiving these health care services because this is open to all citizens. Single payer health insurance covers everything regardless of individual differences and even though you have or pre-existing medical conditions or not.

  • No Insurance Premiums

Insurance premiums are eliminated. This means it does not exist. Thus, taxpayers can have a significant reduction in the taxes they are paying compared to those who acquire costly health insurance from private organizations.

  • Reduce Amount of Paperwork

There are lots of paperwork that doctors and nurses have to deal with under the current healthcare plan. Introduction of single-payer health care plan would reduce it to a significant extent.

  • No More Private Health Insurance (Only One Buyer Required)

The cost of medications will be significantly reduced since now there will be only one buyer which is the government.

Arguments Against Single Payer Health Care (Cons)

As a single-payer health care system expands its benefits for many people, many critics still debated the effectiveness of this system and cited many cons. Here are some of those:

  • Increased Bureaucracy

Government bureaucracy is increased because this is needed to administer the program. This is basically just like Medicare but was expanded its coverage. Anything run by the government usually takes a lot of time. A single payer system will see an increase in the queue in hospital and time required before a patient can be able to receive care. 

  • Physicians Became Government Employees/Government Controlled

The government will be the one paying your medical expenses. Thus, this looks like the physicians became government employees as they were receiving salaries from the government. This is not totally a con then, since some may also consider this as pros depending on how you view things. Single payer system will automatically turn all doctors, nurses, research universities and other health workers and medical equipment manufacturers into employees of the government.

  • Uses Socialized Medicine

The use of socialized medicine is considered evil things since this is against what America stands for. This is because it can lead one’s nation to become a communist dictatorship nation.

This comment is a bit over the top but decisions are made for the benefit of the community and not for the individual patient.

  • Socialism

Many people do not understand the real meaning of socialism and they cannot even understand that single payer is associated with this.

  • Waiting Times

One common issue exhibited by this single-payer health care system is in the waiting time one needs to get the fund processed by the government. Thus, you have the sole responsibility to evaluate public option vs single payer and single payer vs universal health care to find what is best for you.

  • Reduce Development

This system has a strong tendency to reduce creativity since there is no more financial incentive for people to carry out research and develop new medicines.

  • Increase Government Burden

The single-payer health care system will automatically increase the size and burden of government since more personnel will be required to administer the financial activities that are involved in this system.

Bernie Sanders proposal is still a long shot, the senator brought up this proposal two years ago. He knows that currently, he has no co-sponsors, however, he is determined to garner support that will see the bill passed into law if elected even that is still a long shot as many insurance companies, pharmaceutical companies, and other powerful lobby group are posed to stop it as implementation of this system will automatically closed down their businesses. The single payer plan system can either be good or bad and this solely depends on how you view things on your own perspective.

The next question is whether Medicare for All is the only single-payer system to be considered and whether there is a single payer system that will work.

Medicare for all is a winner for Democrats, as Ocasio-Cortez and others have shown

Erica Payne reported that Ocasio-Cortez and other Democrats have shown that ‘Medicare for all’ is a winning issue with voters. That’s the future of health care, not Obamacare.

Last month’s upset primary victory by Alexandria Ocasio-Cortez, who beat 10-term incumbent Joe Crowley in a New York City district, was decisive proof: the Democrats’ path to victory requires exciting their base with a bold, fearless agenda that includes Medicare for all.

We have seen this strategy prove successful not just for Ocasio-Cortez, but also for Ben Jealous, who won a competitive primary for Maryland governor, and candidates like Kara Eastman, who won her primary against a former congressman in Nebraska.

The merits of Medicare for all have been touted by medical professionals, business leaders, and health care economists for a variety of reasons: it would help drive down costs, eliminate administrative waste, increase transparency, bring down rising drug costs, and ease the costly burden of health insurance from businesses and individuals.

And, beyond the benefits of the policy, it’s a winning political strategy.

It’s not enough to fix ACA

Despite Democrats’ attempts to salvage the Affordable Care Act — a crucial law for millions of Americans — sabotage by the Trump administration and Republicans has proved highly effective. They’ve cut advertising budgets aimed at getting more young people into the insurance pool, repealed the individual mandate which helped balance out healthy and sick people, announced they won’t defend protections against price gouging for people with pre-existing conditions, and just froze billions of dollars in payments meant to help insurers cover sicker policyholders.

As a result, the uninsured rate rose last year for the first time since the bill was enacted in 2010 — 12.2% of Americans are now uninsured. While the ACA has managed to slow the rate of premium increases, they are still rising faster than wages and the inflation rate.

To win, Democrats need to do more than just point fingers at Republicans and claim they’re destroying the ACA. Candidates need to take it one step further: Make Medicare for all a central part of their platform.

This message draws a clear line in the sand: Republicans want to strip you of your health insurance, while Democrats want to offer low-cost, universal coverage. It’s an endorsement of universal health care that doesn’t waffle and isn’t complicated.

Unlike the Affordable Care Act, Medicare for all is not difficult to understand and sells itself on its merits. It appeals to patients drowning in medical debt, doctors and medical professionals buried in paperwork, workers who are shouldering more of their premium costs, and business owners who year after year are forced to devote more resources to keeping their employees insured.

It excites a group that Democrats desperately need to get to the polls — younger voters, who strongly support it. And it shows that a candidate is willing to take on special interests on behalf of their constituents.

Medicare for all is a better insurance system

Voters want to hear a positive message about health care: recent polling data revealed that preserving health care is the top voting issue for Americans.  Democrats can be the party offering a bold and viable solution.

They need to tell voters how they’re going to make things better, how they’re going to defend health care as a basic right, and how they’re going to create a new system that better serves the needs of patients, workers, small and mid-sized businesses, and the economy. They need to really differentiate themselves from the Republicans and show that they speak for people first, not the insurance and pharmaceutical industries.

Medicare for All is more than just the right thing to do, and it’s more than just good policy. It’s good politics.

Choking on the Cost of ‘Medicare for All’

My wife was confused when watching the Maryland primaries, especially the Democrat’s Governor race. Mr. Jealous wants to solve the healthcare crisis by adopting Medicare For All in Maryland. Really? Does he and all those others realize that Medicare is a Federal program and states just can’t change a federal program? Also, do they realize how much it really costs?

Sally Pipes and Erica Payne reported that last month, Alexandria Ocasio-Cortez, an outspoken socialist, beat 10-term Congressman Joe Crowley, the fourth-highest-ranking House Democrat, in the primary election for New York’s 14th congressional district.

Ocasio-Cortez is a member of the Democratic Socialists of America and a former organizer for Sen. Bernie Sanders’ presidential campaign. She’s also a vocal advocate of “Medicare for All” — a government takeover of America’s healthcare system. Support for single-payer health care is now a requirement for securing many Democrats’ votes.

But candidates who advocate single-payer on the campaign trail are increasingly balking once they actually get their hands on the levers of power. That’s because single-payer is cost-prohibitive. Even the most dyed-in-the-wool leftists admit as much after they take office and have to figure out how to pay for their campaign promises.

Single-payer’s champions generally paint a lovely picture of healthcare utopia. Patients go to see the doctor of their choice whenever they like, get treatment, and leave the clinic without paying a cent. No copays, no deductibles, no cost-sharing, and no referrals — health care is “free” at the point of service.

In reality, health care doesn’t magically become free; people just pay for it outside the doctor’s office, in the form of higher taxes.

Many Democrats have walked back their enthusiasm for single-payer after getting a look at the just how much public money they’d have to come up with.

Last month in North Carolina, Democratic State Representative Verla Insko moved to kill her own pro-single-payer bill. An assessment from the state legislature’s Fiscal Research Division pegged the cost of single-payer at $70 billion, $42 billion of which would have to come from the state. That latter figure is almost twice the state budget.

Sanders’ last ‘Medicare for all’ plan cost nearly $1.4 trillion

Tami Luhby put things in perspective in her article last year. Vermont Senator Bernie Sanders is not giving up on his desire to extend Medicare to all Americans. He is set to unveil legislation on Wednesday that would likely jettison private health insurance and create a government-run program.

Bernie Sanders has long pushed for the United States to adopt a single-payer system, similar to those found in Canada and Europe. The most recent iteration came in amid his unexpectedly strong bid for the Democratic presidential nomination last year. But that proposal came with an eye-popping price tag and a slew of new taxes.

Though Sanders has yet to reveal the details of his current plan, it will be unveiled with at least a half-dozen Democratic senators, including some potential 2020 presidential hopefuls, as cosponsors. Here’s what he outlined during the 2016 campaign:

Under the ‘Medicare for all’ initiative, Americans would have comprehensive coverage, which would include doctors’ visits, hospital stays, preventative care, mental health services and prescription drugs. It would also pay for vision, dental, long-term care, and hospice needs. All doctors would be in the network.

What’s more, patients would no longer have to pay private insurance premiums, deductibles or co-pays.

How much would all this cost? Nearly $1.4 trillion a year. Gulp!! That is per year. Remember what our National debt is already. How do we pay for it??

To pay for it, all Americans and employers would see a tax hike. Sanders called for a new 2.2% income tax on all Americans and a 6.2% levy on employers. He would also increase taxes on the wealthy.

But, he argues, people would save money since they would no longer have to pay monthly premiums or deductibles. A family of four earning $50,000 would save more than $5,800 each year.

“As a patient, all you need to do is go to the doctor and show your insurance card,” his campaign proposal said.

Businesses, meanwhile, would save more than $9,400 annually since they would no longer have to pick up their share of workers’ health insurance premiums.

Sanders’ plan relies on more than $6 trillion in savings over the next decade — largely stemming from lowering the rates paid to doctors, hospitals, and drug manufacturers. He maintains that simplifying the payment structure and eliminating private insurers will make it easier for providers to absorb the cuts.

The senator has yet to provide details on just how the nation would shift to ‘Medicare for all’ and how the program would actually work. Among the unanswered questions are whether providers would accept steep cuts in payments and how medical costs would be contained if more people have access to health care.

‘Medicare for all’ faces some steep hurdles, but the idea is gaining traction among the public. Some 53% of Americans support a national health care plan, according to a June poll by the Kaiser Family Foundation. That’s up from 50% last year and from 40% between 1998 and 2000.

Is there a difference in a Medicare for All and other Single Payer systems? And can a Medicare for All health care system work and have Republican backing? More to come.

 

Is Statewide Single-Payer Feasible, or Is It Just ‘California Dreamin’?

15826113_1072477266215265_6530794931196981565_nLast week we were treated to the future with the Democrats having the new candidate and even worse, a socialist getting involved in the future of our country and especially health care, immigration, and even more. Be careful! After her victory in Tuesday’s primary election, a lot of political commentators scrambled to figure out how a young socialist like Alexandria Ocasio-Cortez managed to unseat 10-year incumbent Joe Crowley. While there are some obvious explanations, like her campaign was strong and her ideas are good, the upset has also inspired dismissiveness and hand-wringing, with Nancy Pelosi brushing off the win as just “one district” and op-eds proclaiming that “Democrats can kiss swing voters goodbye with the progressive ballot.”

But Ocasio-Cortez is aware of those critiques—in fact, she had them in mind throughout her campaign.

This may be as good an electoral policy as the Democrats have had in a long time. For decades the Democratic playbook has been to try to peel off moderate Republican voters rather than energize a working class and left-wing base, and while that could, debatably, be a sound strategy in purple districts, it doesn’t make sense in a reliably blue territory. On top of that, the insistence on always playing to the middle while the Republican Party swings further into full-blown authoritarianism has produced a huge imagination deficit among the Democrats. There have been precious few big ideas coming out of the Democratic Party, particularly ideas that voters care about, and in that vacuum, the central policies of Ocasio-Cortez’s campaign, like Medicare for all and abolishing ICE, are concrete and exciting.

And on top of that, Ocasio-Cortez’s success has shown that her policies are popular. So popular that mainstream Democrats are quickly getting on board with things like abolishing ICE: this past week both Kamala Harris and Kirsten Gillibrand have publicly endorsed the position. It shouldn’t have taken a blowout election for establishment Democrats to come out against agencies literally throwing kids in cages, but it’s a big step forward from the previously most mainstream solution of throwing kids in cages along with their parents.

Ocasio-Cortez’s campaign is evidence that big solutions aren’t just fantasies. As long as Democrats are too afraid or just unwilling to take stands on the deepening crises happening on fronts across the country, they have little hope of regaining real political power and even less of actually accomplishing anything.

Rich Pedroncelli wrote that California’s leading progressives are currently debating — amicably, for the moment — when the right time will arrive to destroy the state’s healthcare system.

The frontrunner in the race for the governor’s mansion, current Lieutenant Governor Gavin Newsom, has long championed single-payer health care. But he recently softened his support. “[Single-payer] is not an act that would occur by the signature of the next governor,” he recently said. “There’s a lot of mythology about that.”

His most progressive allies — including the California Nurses Association, which has led the charge for single-payer — appear to be in more of a hurry. “To get there, state leaders must have the political will,” said Stephanie Roberson, a legislative advocate for the Association.

This debate — over when to implement single-payer — misses the point. Any single-payer system would be a disaster for California taxpayers and patients, whether it’s established tomorrow or in ten years.

California’s most recent dalliance with single-payer originated last June when the State Senate passed SB 562, the Healthy California Act. The bill would consolidate all public insurance programs — including Medicare and Medi-Cal — into a single state-run health plan. That plan would also gobble up uninsured Californians, those who buy insurance through Covered California, and the millions who currently have coverage through work.

Like most single-payer schemes, the proposed system would effectively outlaw private insurance. Public officials would determine which drugs, procedures, and services the one-size-fits-all system covers. Care would be free at the point of service. Californians would pay no premiums, deductibles, or co-pays, and referrals to specialists would not be necessary.

Assembly Speaker Anthony Rendon ultimately rejected SB 562 as “woefully incomplete,” since it included no funding mechanism. But to pacify progressives, he formed a special commission, grandly titled the “Assembly Select Committee on Health Care Delivery Systems and Universal Coverage,” to further study single-payer.

The Committee heard more than 30 hours of testimony before releasing a report authored by an independent healthcare consultant and professors from the University of California, San Francisco, and the University of California, San Diego. That report essentially concluded that implementing single-payer would be impossible in the short term.

Among the reasons? It’d cost about $400 billion. That’s more than double California’s entire annual budget.

In theory, the state could cover about half that total by poaching federal funding from existing public insurance programs, such as Medicare and Medi-Cal. But as the report points out, that would require a federal waiver — one the Trump administration almost certainly wouldn’t grant.

Even if Democrats retake the White House in 2020 and grant California a waiver, the state would still have to come up with $200 billion to fund the single-payer system. Senate leaders have floated a 15 percent payroll tax.

A study conducted by the University of Massachusetts, Amherst, economist Robert Pollin on behalf of the California Nurses Association claims that the state would only need to raise an additional $106 billion in revenue.

And even if those wildly optimistic projections are correct, California would still have to raise taxes significantly. The nurses’ study suggests an additional 2.3 percent sales tax — on top of the existing 7.25 percent levy — and an equivalent tax on business revenue.

Such enormous tax increases would drive businesses out of California. As the tax base continually shrinks, lawmakers would be forced to raise tax rates higher and higher to offset the lost revenue.

On the other side of the equation, single-payer advocates’ rosy revenue projections are predicated upon wresting significant savings out of the healthcare status quo. Practically, that means paying doctors and hospitals less — rates likely tied to Medicare or Medi-Cal, which are much lower than those paid by private insurers.

Many doctors would respond to such pay cuts by retiring early or moving to other states. Meanwhile, the best and brightest medical students would think twice about coming to California to practice. These twin outcomes would exacerbate the Golden State’s existing shortage of physicians, particularly in high-need areas.

Publicly funded health care for all sure sounds good. But the math behind single-payer doesn’t add up. And all the political will in the world can’t overcome that fact.

Canadians are one in a million — while waiting for medical treatment

Sally Pipes wrote that Canada’s single-payer healthcare system forced over 1 million patients to wait for necessary medical treatments last year. That’s an all-time record.

Those long wait times were more than just a nuisance; they cost patients $1.9 billion in lost wages, according to a new report by the Fraser Institute, a Vancouver-based think-tank.

Lengthy treatment delays are the norm in Canada and other single-payer nations, which ration care to keep costs down. Yet more and more Democratic leaders are pushing for a single-payer system — and more and more voters are clamoring for one.

Indeed, three in four Americans now support a national health plan — and a new NBC/Wall Street Journal poll finds that health care is the most important issue for voters in the coming election.

The leading proponent of transitioning the United States to a single-payer system is Sen. Bernie Sanders, Vermont’s firebrand independent. If Sanders and his allies succeed, Americans will face the same delays and low-quality care as their neighbors to the north.

By his own admission, Sen. Sanders’ “Medicare for All” bill is modeled on Canada’s healthcare system. On a fact-finding trip to Canada last fall, Sanders praised the country for “guaranteeing health care to all people,” noting that “there is so much to be learned” from the Canadian system.

The only thing Canadian patients are “guaranteed” is a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.

All told, nearly 3 percent of Canada’s population was waiting for some kind of medical care at the end of last year.

Those delays were excruciatingly long. After receiving a referral from a general practitioner, the typical patient waited more than 21 weeks to receive treatment from a specialist. That was the longest average waiting period on record — and more than double the median wait in 1993.

Rural patients faced even longer delays. For instance, the average Canadian in need of orthopedic surgery waited almost 24 weeks for treatment — but the typical patient in rural Nova Scotia waited nearly 39 weeks for the same procedure.

One Ontario woman, Judy Congdon, learned that she needed a hip replacement in 2016, according to the Toronto Sun. Doctors initially scheduled the procedure for September 2017 — almost a year later. The surgery never happened on schedule. The hospital ran over budget, forcing physicians to postpone the operation for another year.

In the United States, suffering for a year or more before receiving a joint replacement is unheard of. In Canada, it’s normal.

Canadians lose a lot of money waiting for their “free” socialized medicine. On average, patients forfeit over $1,800 in lost wages. And that’s only counting the working hours they miss due to pain and immobility.

The Fraser Institute researchers also calculated the value of all the waking hours that patients lost because they couldn’t fully function. The toll was staggering — almost $5,600 per patient, totaling $5.8 billion nationally. And those calculations ignore the value of uncompensated care provided by family members, who often take time off work or quit their jobs to help ill loved ones.

Canada isn’t an anomaly. Every nation that offers government-funded, universal coverage features long wait times. When the government makes health care “free,” consumers’ demand for medical services surges. Patients have no incentive to limit their doctor visits or choose more cost-efficient providers.

To prevent expenses from ballooning, the government sets strict budget caps that only enable hospitals to hire a limited number of staff and purchase a meager amount of equipment. Demand inevitably outstrips supply. Shortages result.

Just look at the United Kingdom’s government enterprise, the National Health Service, which turns 70 this July. Today, British hospitals are so overcrowded that doctors regularly treat patients in hallways. The agency recently canceled tens of thousands of surgeries, including urgent cancer procedures, because of severe resource shortages. And this winter, nearly 17,000 patients waited in the backs of their ambulances — many for an hour or more — before hospital staff could clear space for them in the emergency room.

Most Americans would look at these conditions in horror. Yet Sen. Sanders and his fellow travelers continue to treat the healthcare systems in Canada and the UK as paragons to which America should aspire.

Sen. Sanders’s “Medicare for All” proposal would effectively ban private insurance and force all Americans into a single, government-funded healthcare plan. According to Sen. Sanders, this new insurance scheme would cover everything from regular check-ups to prescription drugs and specialty care, no referral needed — all at no charge to patients.

Americans shouldn’t fall for these rosy promises. As Canadians know all too well, when the government foots the bill for healthcare, patients are the ones who pay the biggest price.

Most Californians support single-payer unless they have to pay for it

Maybe Californians really are tired of paying so much in taxes. But Sal Rodriquez found that according to a recent survey from the Public Policy Institute of California, 53 percent of likely voters support the idea of a single-payer health care system in California, but support falls to just 41 percent if single-payer would require new taxes, which it will.

About two-thirds of Democrats support the idea of a single-payer system even if it means higher taxes – because to be a Democrat in California is apparently to firmly believe that the inept government in Sacramento deserves more of everyone’s hard-earned money.

Only 11 percent of (very confused) Republicans 31 percent of independents share that view.

According to the survey, the Bay Area is the only region in the state where a majority of likely voters support a single-payer system even if it means higher taxes, but even then it’s just 55 percent of them. Majorities of likely voters in the Central Valley and Orange/San Diego Counties outright oppose a single-payer plan, and almost half (47 percent) of Inland Empire likely voters also oppose the idea.

It should be absolutely clear that a single-payer plan will necessarily entail higher taxes and there’s no way around it.

A California Senate Rules Committee analysis of SB562, a single-payer bill which remarkably passed the state Senate despite not actually offering an actual plan, noted that “about $200 billion in additional tax revenues would be needed to pay for the remainder of the total program cost.”

For context, total estimated general fund revenues for 2018-19 for state government is just over $140 billion.

So, yeah, single-payer will require enormous tax hikes. Considering that most Californians already believe they pay more in taxes than they should and that the state can barely manage everything it does now, single-payer is a fanciful idea that shouldn’t be seriously contemplated at this time.

Bernie Sanders: Starbucks CEO ‘dead wrong’ on government-run health care

Kimberly Leonard of the Washington Examiner reported that outgoing Starbucks CEO Howard Schultz has been criticized by Sen. Bernie Sanders, I-Vt., over his comments on a healthcare system fully funded by the government.  (Reuters)

Liberal Sen. Bernie Sanders says outgoing Starbucks CEO Howard Schultz is “dead wrong” for saying that moving to a health care system fully funded by the government isn’t realistic.

The Vermont independent, who has been pressing for the U.S. to move toward socialized medicine, was asked to respond to comments Schultz made about the plan in another interview.

Schultz recently announced that he would be leaving Starbucks and said he was considering “public service.” He said on CNBC he was concerned about the way “so many voices within the Democratic Party are going so far to the left.”

Sen. Bernie Sanders said Medicare-for-all is a “cost-effective” program.  (AP)

“And I ask myself, how are we going to pay for all these things? In terms of things like single-payer or people espousing the fact that the government is going to give everyone a job, I don’t think that’s realistic,” he said.

CNN’s Chris Cuomo asked Sanders about the possibility of Schultz running as “the Left’s Trump” who may go up against the current president in 2020.

Sanders said he didn’t know Schultz but his comment was “dead wrong.”

“You have a guy who thinks that the United States apparently should remain the only major country on earth not to guarantee health care to all people,” Sanders said. “The truth of the matter is that I think study after study has indicated that Medicare for All is a much more cost-effective approach toward health care than our current, dysfunctional health care system, which is far and away the most expensive system per capita than any system on Earth.”

I think the Bernie is a nut socialist but he may be correct in this situation. However, Medicare for All is also questionable and I can’t believe these candidates suggesting that they as governors can change a federal law or system. And also remember what free borders for illegal immigrants mean to a health care system. Who is going to pay for all those illegal immigrants needing health care? Be careful what you wish for!!

And finally on to the discussion of Medicare for All!!

Politics are Ruining Our Future and Will Keep Us in Purgatory!! Obamacare Is A Political Nightmare That’s Not Going Anywhere. Is there A Solution?

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Some conservatives are unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back the Obamacare regime.

I was disgusted last week speaking with a friend who is a very powerful strategist in the Democratic Party. She agreed with me when I suggested to her that the Democrats would Never sign off on either an immigration or health care plan until after the midterm election. I sensed this after the President signed an Executive Order reversing the separation of illegal immigrant children from their illegal parents as the Democrats, especially Ms. Pelosi and Mr. Schummer asked him to “pen”.

How can we make any progress at all when there is no cooperation between the parties and the administration? I am truly frustrated and wonder when we all are going to wake up and make these Senators and Representatives to “do their job”! They all only care about their own reelection models…. and impeaching the President. How have we sunk so low, so far??

Congress is still wading through the swampy waters of Obamacare. Congressional Republicans, who ran against Obamacare through four election cycles, have spent most of the past year running away from it. But they are finding the law hard to escape.

Democrats who once shied away from Obamacare now can’t stop talking about it. They are blaming Republicans for the next round of premium increases that will become finalized in the weeks leading up to the November elections.

Republicans will justifiably respond that Obamacare is a mess they didn’t make. Voters may nevertheless hold them accountable for not cleaning up that mess, despite years of campaign promises.

Congress should keep those promises, according to a group of conservative policy analysts, state-based think tanks, grassroots organizations, and GOP governors and state legislators. Tuesday, a group of them announced support for the Health Care Choices Act, a proposal that would repeal Obamacare entitlements and replace them with grants to states to finance consumer-centered reform.

The plan is innovative and bold. The ill-fated bills Congress considered last year kept the federal structure of Obamacare with relatively minor modifications. For example, those proposals modified the federal tax credits that are at Obamacare’s core; the Health Care Choices Act would repeal them. And while last year’s bills would have reduced federal spending on Medicaid coverage of able-bodied adults, the Health Care Choices Act would scuttle the Medicaid expansion policy entirely.

The proposal resembles the successful welfare reform of the 1990s, which repealed the individual entitlement to cash benefits and replaced it with grants to states to assist the needy. The Health Care Choices Act does the same thing with health care, but on a much grander scale. It would repeal an open-ended federal entitlement program expected to cost $1.6 trillion over the next decade and replace it with a block grant. It is welfare reform on steroids.

Block grants are not blank checks. Like welfare reform, which required states to implement policies to encourage work and reduce dependency, the Health Care Choices Act would require states to pursue two important goals: reducing costs and increasing health care choices.

States would be required to spend a portion of their federal allotments on meeting the medical needs of the sick without saddling the healthy with exorbitant premiums. Other stipulations would prevent states from using the money to expand Medicaid or to warehouse the poor in state-contracted managed care plans. States would have to provide low-income people assisted through the through the block grant, as well as Medicaid and State Child Health Insurance (CHIP) recipients, the option of applying the value of their assistance to the plan of their choice. Think of it as school choice for health care.

The new money would be provided through the CHIP statute, which, unlike Obamacare, includes permanent restrictions on the use of funds for abortion. Within those broad guidelines, states would design their own programs, determining who is eligible for assistance and what they’re eligible for. They would be released from Obamacare regulations on essential health benefits, age-related premium variation, and the requirement that insurers enroll the sick and healthy in the same insurance pools. Repealing these regulations would allow states to repair or ameliorate much of the market dislocation Obamacare produced.

In short, the Health Care Choices Act would dismantle two of Obamacare’s pillars and weaken the third: Obamacare’s individual entitlement would be abolished, the employer mandate (like the individual mandate) would be repealed, and federal insurance rules would be diluted.

Some conservatives look at the proposal’s health care reform donut and complain about the hole. They have particularly faulted the plan for not repealing Obamacare’s pre-existing condition rules.

A Republican reaction to last week’s Justice Department motion in a lawsuit that seeks to invalidate these rules is instructive. Democrats attacked the Trump administration – and Congressional Republicans – for opposing pre-existing condition protections.

To stanch the political bleeding, Senate Majority Leader Mitch McConnell declared, “Everybody I know in the Senate – everybody – is in favor of maintaining coverage for pre-existing conditions.”

McConnell’s colleagues pointedly did not race to the microphones to distance themselves from their leader. Nor are scores of House and Senate conservative incumbents campaigning on a promise to repeal the popular pre-existing condition requirements.

The message is clear: repealing that requirement does not enjoy anything like majority support even in a GOP Congress. For some conservatives, that is reason enough to leave Obamacare in place. If Congress can’t pass a perfect bill, they argue, then it shouldn’t pass anything at all.

A growing cadre of conservatives is unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back an Obamacare regime that continues to raise costs and constrict health care choices.

They view the Health Care Choices Act’s repeal of Obamacare’s entitlements and devolution of power from Washington to the states not as the final word on health care reform, but as an essential component of a broader effort. Expanding health savings accounts is part of that effort. Promoting innovative approaches like health-sharing ministries and direct primary care is another. Trump administration regulatory proposals to allow small businesses and independent contractors form health insurance purchasing groups across state lines also are part of it, as is its plan to expand the sale and renewal of short-term, limited duration policies.

Conservatives who back the Health Care Choices Act prefer real progress to theoretical perfection and the inaction it induces.  They also argue that it is politically better for Republicans to confront Obamacare than to be blamed for its failures.

Republicans are stuck in a Nash equilibrium on Obamacare repeal. Conservative firebrands, Republican moderates, and congressional leadership – each for very different reasons – are content to make Obamacare repeal the new balanced budget, something they talk about to mine money and votes from their base, but never seriously pursue.

The millions of families and thousands of small businesses suffering under Obamacare deserve better.

Obamacare Faces New Life-threatening Conditions

Opponents of the Affordable Care Act have been busy. In the midst of several headline-making events on other issues, the Trump administration has instigated two major efforts to effectively do what Congress could not do earlier this year — repeal Obamacare.

The result is a laundry list of warnings for all health care consumers, not just those who buy insurance on the ACA exchanges. Here’s a closer look at the latest changes to the health insurance marketplace:

Expanding association health plans

The administration issued new rules on Tuesday that expand the use of what’s known as association health plans. They allow small businesses and self-employed individuals to buy health insurance collectively through what’s loosely defined as an industry association. By pooling together, members can buy insurance for less expensive group rates, the way employees of large corporations do.

Association plans have been around for a long time, but under the ACA they were restricted. The new rules loosen some of these restrictions and expand the reach of these plans. At the same time, these plans are exempt from many of the protections under the ACA, including coverage of the 10 essential health benefits such as maternity and mental health services, hospitalization and prescription drugs.

In addition, the new rules allow association plans to sell insurance across state lines. States regulate health insurers, and for the most part, insurers must adhere to each state’s regulations for the consumers they serve in those states. But under the new rules, association plans can choose which state they want as their regulatory jurisdiction. That means they could conceivably choose a loosely regulated state as their home base.

Association plans have seen their share of scandals in the past, largely due to this state regulatory confusion.

The new rules aren’t a surprise. The Trump administration has been calling for the expansion of association health plans as a way of offering more options outside of Obamacare and a way for small businesses and individuals to have access to more affordable group insurance.

But advocates worry that the move is a return to the bad old days before insurers had to adhere to standard regulations that protected consumers from paying insurance premiums, only to find coverage wasn’t there when they needed it.

“The new rule will allow groups of businesses to band together to buy insurance across state lines, which will be bad for small firms and their employees because it will lead to higher premiums, unbalanced risk pools and lower-quality insurance,” said John Arensmeyer, founder, and CEO of Small Business Majority.

In addition, the provision may encourage a new batch of healthier people who can get by with skimpier coverage to sign up for association plans instead of the ACA exchange plans. That could leave more sick people in the exchanges without the benefit of younger, healthier people balancing the risk pool. According to the Congressional Budget Office, 6 million people are expected to enroll in expanded association health plans.

If you’re considering one of these plans, many of which are expected to be available in September just before the 2019 ACA open-enrollment period, be sure to read everything you can get your hands about the plan as carefully as you can. You’ll want to be sure you understand any limitations in coverage so you can determine if the plan is right for you.

A threat to preexisting condition coverage — and more

Tuesday’s announcement comes on the heels of another potentially devastating blow to the ACA. Earlier this month the Justice Department announced it would not defend the law against a lawsuit brought by the attorneys general of Texas and 19 other states.

The suit claims that because the newly enacted tax law eliminates penalties associated with the individual mandate, the ACA requirement that most Americans carry health insurance is no longer constitutional. In addition, the suit contends that consumer insurance protections under the law also aren’t valid.

Since then an outcry has been heard from health care advocates, insurers, congressional Republicans and most recently a group of bipartisan governors from nine states. The protest is focused on the provision in the ACA that requires insurers to provide equal coverage and the same premium rates to people with pre-existing conditions as they provide to people without previous health problems.

The requirement applies to all insurers, not just those in the exchanges, and polls show most Americans — including many who don’t support Obamacare overall — want to preserve it. Even Senate Majority leader Mitch McConnell famously said, “Everybody I know in the Senate, everybody, is in favor of maintaining coverage for preexisting conditions.”

Still, the Texas court case would potentially eliminate many more ACA provisions, including the premium subsidies so many exchange customers rely on, essential health benefits and Medicaid expansion, said Eliot Fishman, senior director of health policy at Families USA. That said, Fishman believes the court case will take time, so consumers who are planning on signing up for exchange coverage for 2019 at the end of this year should not be dissuaded from doing so.

Health warning-Obamacare is in legal peril once again! Many legal scholars are dismissing a new case. Don’t listen to them.

Noah Feldman wrote that one shouldn’t turn your back.  Could key portions of the Affordable Care Act be declared unconstitutional – years after the Supreme Court upheld them? The Trump administration’s Department of Justice has just filed a brief saying so in a suit by several states that aims to take down the whole program.

Most mainstream legal commentators think the government’s arguments are unconvincing. But it’s crucial to remember that this was exactly the reaction of the same set of people in 2010 when the original argument was made against the individual mandate by libertarian law professor Randy Barnett. Just two years later, five justices of the Supreme Court embraced Barnett’s argument.

Given the excitement for judicial activism building among conservatives, the Trump administration may have more than a 50 percent chance of success.

Just in case you haven’t thought much about the individual mandate and the Constitution in the last six years, let me provide an update and a brief refresher. The update is that, in 2017, Congress passed the Tax Cuts and Jobs Act. In the law, Congress repealed the tax penalty associated with the individual mandate that everyone has health insurance.

In other words, the ACA still says you have to have insurance. But if you don’t, nothing happens to you. You may remember that the Obama team was worried about the interaction between the individual mandate and the popular ACA provisions that say insurance companies can’t refuse to cover anybody because of pre-existing conditions and can’t charge you more if you are already sick.

The theory went something like this: If you aren’t compelled to buy insurance when you’re healthy, but you’re allowed to buy it when you find out you are sick, then only sick people would buy health insurance. That, in turn, would create a “death spiral” for insurance under the ACA, as insurance costs went up.

Crucially, President Barack Obama’s Department of Justice relied on this argument in trying to convince the Supreme Court to uphold the individual mandate. This death spiral doesn’t seem to have happened yet, however.

Now comes the new constitutional challenge to the ACA, filed by a group of states led by Texas. Their argument begins with the fact that, when the Supreme Court upheld the individual mandate, it did so in a very strange way. The five conservative justices all agreed that, under the commerce clause of the Constitution, Congress did not have the authority to make people buy insurance.

Their reasoning was borrowed from Prof. Barnett, who had proposed in his article that while the Congress has the power to regulate existing commercial activities, it can’t force people to undertake a commercial activity they are not already engaged in. This was the famous broccoli hypothetical: the conservatives argued that the commerce clause wouldn’t allow Congress to pass a law requiring everyone to buy and eat broccoli, even though Congress could lawfully regulate broccoli prices.

Despite this conclusion about the commerce clause, however, Chief Justice John Roberts joined the four liberals to uphold the individual mandate on the ground that it was a tax and therefore fell within Congress’s separate taxing power. The other four conservatives were clearly frustrated with Roberts, but his vote carried the day.

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place. The Supreme Court already excludes the commerce clause, and now the tax rationale is gone. Trump’s Department of Justice has agreed with this claim.

The states say that without the individual mandate, the whole ACA should be struck down as unconstitutional. Trump’s Justice Department didn’t go quite that far. But it did say that the ACA provisions on pre-existing conditions are so linked to the individual mandate that it should now be struck down.

Legal observers are pretty upset about this — but not all for the reason you’d think. Some are focused on the strange circumstance that Justice is arguing that the law is unconstitutional. It’s not supposed to work that way. The executive branch is supposed to argue in favor of the constitutionality of laws currently on the books.

That’s bad, without a doubt. But it seems less worrisome than the possibility that courts, including the Supreme Court, might actually adopt the Trump administration’s view and strike down the ACA provisions on pre-existing conditions.

Legally, I don’t think that would be the right decision. I don’t think that the repeal of the penalty means that the no-penalty individual mandate is necessarily unconstitutional, since there is no sanction for violating it, so it isn’t really much of a law at all.

And even if the no-penalty mandate were unconstitutional, it doesn’t follow that the mandatory coverage provisions need to go. They are logically separate from the individual mandate. The mandate may have been thought been necessary to make those provisions work in practice, but it turns out that, so far at least, they are operating without it, and the death spiral hasn’t happened.

But it is entirely possible that five justices would follow the chain of formal logic laid out by the states and adopted by the Justice Department. The best argument in favor of that position is that the Obama Department of Justice told the Supreme Court years back that these provisions were interlinked – “inseverable” in legal jargon.

There is, therefore, a real and indeed significant chance that the most popular part of the ACA could be struck down. You may have thought that the whole ACA-and the-courts topic was over. But as it turns out, it keeps coming back, like a figure from a horror movie. Don’t turn your back.

And look at all of the campaign “idiots” who are experts on health care and declare that their State will have better healthcare by adopting Medicare for All. Don’t they know that Medicare is a Federal program that States can’t themselves change? And how are they going to pay for it if the prediction that Medicare and Social Security programs will be out of money by 2026-2034?

Let’s talk more about Medicare for All!