Category Archives: Bernie Sanders

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!

Yes, Medicare for All is expensive. That’s not the point but who loses?

37913774_1639263202869999_2457300851903954944_nI’m more confused as I read more and more about Medicare for All. Who is telling the truth? Diane Archer, founder and former president of the Medicare Rights Center and president of JustCareUSA.org. recently wrote that something interesting is happening in the age of Trump: 63 percent of Americans support a national health insurance plan, or Medicare for All, in which the federal government would guarantee health insurance for everyone in the country.

Mounting support for Medicare for All has left conservatives hyperventilating. Commercial insurers and their Republican allies are working overtime to convince Congress and the electorate that we simply can’t “afford” Medicare for All. A report by the Mercatus Center’s Charles Blahous, who spearheaded President George W. Bush’s attempt to privatize Social Security, is the latest entry in this fuzzy math sweepstakes.

Happily, for those of us who seek health-care security for all Americans, Blahous and his friends miss the point. Our commercial health insurance system is crazy and unsustainable, and Medicare for All is the only realistic path to reduce national health spending and improve the quality of our health-care system.

Sen. Bernie Sanders’s Medicare for All proposal improves and expands the current Medicare program, replacing commercial health insurance with federally administered coverage for all Americans. The proposal eliminates premiums, deductibles, and co-pays, and includes new coverage for vision, hearing and dental care. It allows everyone to use the doctors and hospitals they know and trust, anywhere in the country, without the restrictive networks, arbitrary denials and high out-of-pocket costs that go hand in hand with commercial insurance.

Medicare for All, like Social Security, is social insurance, designed to pool and broadly distribute the costs of care across the entire population. At its core, Medicare for All gives doctors and hospitals the freedom to compete for patients without insurers getting in the way.

Blahous writes that Medicare for All is expensive. That’s correct, but it’s the wrong starting point. The current commercial health insurance system is much more expensive than Medicare for All and is unsustainable by any measure.

We spend more than $3.3 trillion a year on health care — about 18 percent of the gross domestic product. That’s twice as much per capita on health care as the average of other high-income countries. In return, we get health-care outcomes that rank dead last among our peers. Health-care costs in this country are projected to increase by 5.5 percent a year over the next eight years. You do the math: The status quo doesn’t work. Period.

Medicare for All, by contrast, provides a compelling path to keeping health-care costs in check. To begin with, Medicare for All would eliminate the administrative waste and profit margins created by the commercial insurance system with hundreds of insurers negotiating different agreements with thousands of health-care providers. Total annual savings on administrative costs under Medicare for All are estimated as high as $500 billion a year (far more than Blahous estimates in his report).

Most important, Medicare for All would empower the federal government to use the collective bargaining power of 330 million Americans to reduce the cost of health care, something that commercial insurers have been unable to do. Blahous himself estimates that the extension of current Medicare rates to all health-care services coupled with lower prescription drug prices under Medicare for All would eliminate $445 billion in annual costs in 2022.

In all, Blahous concedes that Medicare for All would reduce national health spending by $2 trillion over 10 years; even after accounting for the cost of guaranteeing everyone coverage and offering better benefits. (And again, many health economists would say Medicare for All would drive far greater savings.)

Blahous’s concern is that Medicare for All will transfer the rest of the cost of health care from the private sector to the federal government. Okay. So how will we pay for Medicare for All? The same way we pay for the defense budget and everything else: through taxes. Does that mean that ordinary Americans will pay more under Medicare for All that they pay for healthcare today? No.

Think about it. Today, the typical family of four spends more than $28,000 on health care a year. Individuals pay that cost indirectly through lower wages (which fund the employer’s share of health insurance) and directly through out-of-pocket costs. Under Medicare for All, the typical family will see higher wages and lower expenses and spend much less on health care than it does today.

To be sure, the transition to Medicare for All will disrupt the health-care marketplace. Insurers will wind down. Pharmaceutical companies and medical device manufacturers likely will see their profits drop. Hospitals and doctors will need to work smarter and more efficiently; they will see an overall reduction in their rates, but they will save on administrative costs and their bills will all be paid.

There are always winners and losers in policy reform. Today, commercial insurers and other corporate interests in the health-care industry are the winners, and the American people are the losers. Medicare for All flips that paradigm. We can’t afford to live without it.

But at what cost to patient and caregiver?

Bernie Sanders Supporters Admit His Socialized Medicine Plan Will Ration Care

If Bernie Sanders wants to take a ‘victory lap’ for a study arguing that millions of health workers will receive the same amount of money for more work, I have four words: Good luck with that.

Christopher Jacobs noted that the move to enact single-payer health care in the United States always suffered from major math problems. This week, it revived another: Common sense.

On Monday, the Mercatus Center published an analysis of single-payer legislation like that promoted by socialist Sen. Bernie Sanders (I-VT). While conservatives highlighted the estimated $32.6 trillion price tag for the legislation, liberals rejoiced.

Sanders even released a video thanking Mercatus for its study, claiming that it showed how his bill would reduce overall national health expenditures by $2 trillion. In other words, Sanders claims his bill will provide more health care coverage to more Americans, and at less cost.

Riiiiiigggggggghhhhhhhhhttttt. As the old saying goes, if something sounds too good to be true, it usually is. Given that even single-payer supporters have now admitted that the plan will lead to rationing of health care, the public shouldn’t just walk away from Sanders’ plan—they should run.

National Versus Federal Health Spending

Sanders’ claim arises because of two different terms the Mercatus paper uses. While Mercatus emphasized the way the bill would increase federal health spending, Sanders chose to focus on the study’s estimates about national health spending.

Essentially, the $32.6 trillion figure—the amount of taxes that a single-payer bill must raise over its first decade—represents the cost of bringing the entire health-care system on to the federal government’s books. While bringing the health-care system on-budget will obviously require massive tax increases, the Mercatus paper assumes that doing so will cause overall national health spending to drop slightly.

Although it sounds large in absolute terms, the Mercatus paper assumes only a slight drop in health spending in relative terms. It estimates a total of $2.05 trillion in lower national health expenditures over a decade from single-payer. But national health expenditures would total $59.7 trillion over the same time span—meaning that, if Mercatus’ assumptions prove correct, single-payer would reduce national health expenditures by roughly 3.4 percent.

Four Favorable Assumptions Skew the Results

However, to arrive at their estimate that single-payer would reduce overall health spending, the Mercatus paper relies on four highly favorable assumptions. Removing any one of these assumptions could mean that instead of lowering health care spending, the single-payer legislation would instead raise it.

First, Mercatus adjusted projected health spending upward, to reflect that single-payer health care would cover all Americans. Because the Sanders plan would also abolish deductibles and co-payments for most procedures, study author Chuck Blahous added an additional factor reflecting induced demand by the currently insured, because patients will see the doctor more when they face no co-payments for doing so.

But the Mercatus study did not consider whether providing completely free health care to all U.S. residents will induce additional migration, adding even more costs to the system. As Hillary Clinton testified before Congress in 1993: “We do not think the comprehensive health care benefits should be extended to those who are undocumented workers and illegal aliens. We do not want to do anything to encourage more illegal immigration into this country. We know now that too many people come in for medical care, as it is.”

Second, the Mercatus study assumes that a single-payer plan can successfully use Medicare reimbursement rates. However, the non-partisan Medicare actuary has concluded that those rates already will cause half of the hospitals to have overall negative total facility margins by 2040, jeopardizing access to care for seniors.

Expanding these lower payment rates to all patients would jeopardize even more hospitals’ financial solvency. But paying doctors and hospitals market-level reimbursement rates for patients would raise the cost of a single-payer system by $5.4 trillion over ten years—more than wiping away any supposed “savings” from the bill.

Third, by its own admission, Mercatus assumes “virtually perfect success” for a single-payer system in replacing brand-name drug usage with generics. If the government cannot achieve “virtually perfect success” in increasing generic drug utilization—and a cynic might ask whether the government has achieved even imperfect success in anything—or greater government “negotiating” power has little effect in jawboning down prices, then the estimated costs of single-payer will rise.

Finally, the Mercatus paper “assumes substantial administrative cost savings,” relying on “an aggressive estimate” that replacing private insurance with one single-payer system will lower health spending. Mercatus made such an assumption even though spending on administrative costs increased by nearly $26 billion, or more than 12.3 percent, in 2014, Obamacare’s first year of full implementation.

Likewise, government programs, unlike private insurance, have less incentive to fight fraud, as only the latter face financial ruin from it. The $60 billion problem of fraud in Medicare provides more than enough reason to doubt many administrative savings from a single-payer system.

Apply the Common Sense Test

But put all the technical arguments aside for a moment. As I noted above, whether a single-payer health-care system will reduce overall health expenses rests on a relatively simple question: Will doctors and hospitals agree to provide more care to more patients for the same amount of money?

Whether single-payer will lead to less paperwork for doctors remains an open question. Given the amount of time people spend filing their taxes every year, I have my doubts that a fully government-run system would generate major improvements.

But regardless of whether providers get any paperwork relief from single-payer, the additional patients will come to their doors seeking care, and existing patients will demand more services once the government provides them for “free.” Yet doctors and hospitals won’t get paid any more for providing those additional services. The Mercatus study estimates that spending reductions due to the application of Medicare’s price controls to the entire population will all but wipe out the increase in spending from new patient demand.

If Sanders wants to take a “victory lap” for a study arguing that millions of health care workers will receive the same amount of money for doing more work, I have four words for him: Good luck with that.

Also, consider the health care workers, especially the physicians.                        Libertarian think tank: Providers would pay for Medicare for All                     Susannah Luthi reviewed libertarian take on the Medicare for All concept further and found that the Medicare for All plan backed by Sen. Bernie Sanders would put the brunt of the proposals costs on provider pay cuts.
In a white paper released Monday by the Mercatus Center of George Mason University, senior research strategist Charles Blahous claimed healthcare spending constraints laid out in the plan from the Vermont independent senator fall almost totally on providers. The plan could save the U.S. more than $2 trillion over 10 years in national health care spending but could increase the federal government’s costs to nearly $33 trillion above current levels, according to Blahous’ calculations.
Nearly all the savings for national health spending come from across-the-board Medicare rate cuts, which Blahous projects would reduce provider payments by $384 billion in the first year, and by nearly $660 billion in 2030.
This analysis will likely push single-payer advocates to hone their message on healthcare pricing to make their proposal viable, said Benedict Ippolito, a health economist with the right-leaning American Enterprise Institute.
“Provider payment cuts are doing a lot of heavy lifting here,” Ippolito said. “Changes to provider payments, whether you love them or not, have real consequences. And those real consequences extend beyond a budgetary score.”
While the U.S. healthcare system does need to grapple with the “right price to pay for healthcare,” Ippolito said, proponents of the Sanders plan and others like it need to determine what the right rate could be and how it will impact provider behavior, which determines major components of the healthcare system—investments in equipment and buildings, patient access and health outcomes.
“It’s easy to think about prices as one piece of a broader market, but the thing that’s special about prices is that it’s the key that unlocks the whole thing,” he added. “Whatever price you set will be highly consequential for the entire market. The decision you make for good or bad is extremely consequential, and you can’t get around that.”
Single-payer advocates lauded the paper’s findings that the projected provider cuts would roughly pay for universal coverage. The Mercatus analysis also estimated the health care system would save billions every year on drug spending since the Sanders Medicare for All plan allows the HHS secretary to negotiate prescription drug prices with the manufacturers—and presumably refuse to buy certain high-priced drugs.
But Blahous warned that the Sanders blueprint for coverage would likely lead to a huge spike in overall healthcare utilization, not only because more people would automatically be covered for services like dental and vision care but also because it bans any co-pays or deductibles.
“As a general rule, the greater the percentage of an individual’s health care that is paid by insurance … the more healthcare services an individual tends to buy,” Blahous wrote.
Blahous maintained that the jury is still out on whether MACRA effectively reins in provider costs, warning that the Medicare for All transition could disrupt access to health care as universal coverage goes into effect. He also noted that while some Medicaid-dependent providers would see a pay boost in the early years as their traditionally much-lower Medicaid reimbursements would rise to Medicare rates, they would start losing money soon after.
To back up his warning, Blahous cited the CMS’ Office of the Actuary’s projections that current payments would lead to negative operating margins for nearly half of hospitals by 2040. By 2019, over 80% of hospitals will lose money treating Medicare patients. A dramatic structural change to reimbursement structure could shutter many provider doors, Blahous wrote.
The paper acknowledged that phasing out employer-sponsored health care would translate into a huge increase in taxable wages, as it would free individuals, families, and employers from hefty healthcare spending. States would also no longer have to fund Medicaid, consistently their largest budget item.
“These offsetting effects should be considered when weighing the implications of requiring federal taxpayers to finance the enormous federal expenditure increases under M4A,” Blahous wrote. “These estimates should be understood as projecting the added federal cost commitments under M4A, as distinct from its net effect on the federal deficit. To the extent that the cost of M4A is financed by new payroll taxes, premium collections, or other revenue increases, the net effect on the federal budget deficit would be substantially less.”
The picture the Mercatus study paints for utilization in the healthcare system runs counter to the latest House Republican push to leverage health savings accounts to cut spending on superfluous services.
Last week, the House passed a packet of bills originally projected to cost more than $90 billion to expand the use of HSAs. In a subsequent speech before the conservative Heritage Foundation, HHS Secretary Alex Azar praised HSAs as a way to lower unnecessary spending, saying that from his own behavior when he had an HSA he was much more cautious about the number and manner of services on which he was willing to spend a limited number of dollars.
The Democratic Party at large is keeping Sanders’ Medicare for All plan at arm’s length, but its principles are gaining traction within the party. Prominent Democratic senators including Elizabeth Warren of Massachusetts, Kamala Harris of California and New Jersey’s Cory Booker have signed onto Sanders’ bill.
In the House, progressive Washington Democrat Pramila Jayapal founded a Medicare for All caucus to try to hammer out a comprehensive, streamlined platform over the next conference. More than 60 House Democrats have joined Jayapal’s group.
But Ippolito said the new paper highlights that single-payer proponents will need to acknowledge the political fight on their hands.
“In my time of listening to these single-payer proposals, a lot of emphases is on administrative savings—they appeal to that because they don’t rile up constituencies,” he said. “But going after provider payment rates means taking on one of the most well-organized constituencies in domestic policy. When I read this, it struck me as: this really wants to pick a fight. It promises the moon, but it does set up, surely, that something’s got to give here.”                                                                                                                                Health Care Rationing Ahead                                                                                                       I’ll give the last word too, of all things, a “socialist perspective.” One blog post yesterday actually claimed the Mercatus study underestimated the potential savings under single-payer: “[The study] assumes utilization of health services will increase by 11 percent, but aggregate health service utilization is ultimately dependent on the capacity to provide services, meaning utilization could hit a hard limit below the level [it] projects” (emphasis mine).                                                                                                                                 In other words, spending will fall because so many will demand “free” health care that the government will have to ration it. To socialists who yearningly long to exercise such power over their fellow citizens, such rationing sounds like their utopian dream. But therein lies their logic problem, for any American with common sense.

More to follow next week as we get closer to the truth.

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.