Category Archives: Mayor Pete Buttigieg

Warren’s $52T ‘Medicare-for-all’ plan revealed: Campaign still claims no middle-class tax hikes needed and SNL

74798250_2323921837737462_2762717535395643392_nFinally, we got a view of the cost of Medicare for All plan for health care for all of us. It was so interesting that Saturday Night Live featured it on T.V. With the remarkably versatile Kate McKinnon at the helm, this weekend’s “Saturday Night Live” cold open took aim at Sen. Elizabeth Warren’s $52 trillion “Medicare-for-all” health care plan.

“I am in my natural habitat – a public school on a weekend,” McKinnon’s excitable Warren quipped at an Iowa town hall, complete with fist pumps, some “whoos” and the senator’s signature raspy voice.

She also took a moment to give former Rep. Beto O’Rourke a sendoff after he dropped out of the race last week.

“Let me know how my dust tastes,” she said.

After mentioning that she pays taxes in every state “out of principle,” she took questions from cast members playing ambivalent voters.

Asked why it took her so long to release her health care plan, McKinnon’s Warren answered, “When Bernie [Sanders] was talking ‘Medicare-for-all’, everybody was like, ‘Oh cool,’ and then they turned to me and said, ‘Fix it, Mom.’”

She added that her plan “compares favorably” to former Vice President Joe Biden’s “in that it exists.”

“No one asks how we’re going to pay for ‘Remember Obama,” she said, referring to Biden’s tendency to frequently cozy up to the former president.

She then answered a question about estimates of how much her plan would cost.

“We’re talking trillions,” she answered. “When the numbers are this big they’re just pretending.”

Warren has surged in polls recently as Biden has faded and is in the lead in a new Iowa poll.

Democratic presidential candidate Elizabeth Warren’s long-awaited “Medicare-for-all” funding plan projects the government-run health care system would cost a staggering sum of “just under $52 trillion” over the next decade, with the campaign proposing a host of new tax increases to pay for it while still claiming the middle class would not face any additional burden.

“We don’t need to raise taxes on the middle class by one penny to finance Medicare for All,” Sen. Warren, D-Mass., said in her plan — a copy of which was obtained by Fox News in advance of its release Friday.

In a tweet posted after this report was first published, Warren reiterated that pledge while asserting she can return $11 trillion to American families.

Today, I’m releasing my plan to pay for ‪#MedicareForAll. Here’s the headline: My plan won’t raise taxes one penny on middle-class families. In fact, we’ll return about $11 TRILLION to the American people. That’s bigger than the biggest tax cut in our history. Here’s how:

Some of Warren’s rivals for the nomination are unlikely to buy that claim, after having repeatedly challenged her assertions that the middle class would not be hit by tax hikes and suggested she has not been upfront with voters.

Indeed, the Joe Biden campaign said the “unrealistic plan” would leave only two options: “even further increase taxes on the middle class or break her commitment to these promised benefits.”

“The mathematical gymnastics in this plan are all geared towards hiding a simple truth from voters: it’s impossible to pay for Medicare for All without middle-class tax increases,” Deputy Campaign Manager Kate Bedingfield said in a statement.

The Warren campaign’s detailed Medicare-for-all proposal, however, insists that the costs can be covered by a combination of existing federal and state spending on Medicare and other health care — as well as myriad taxes on employers, financial transactions, the ultra-wealthy and large corporations and some savings elsewhere. Those measures are meant to pay for a projected $20.5 trillion in new federal spending. Notably, they include what is essentially a payroll tax increase on employers, something economists generally say can hit workers in the form of reduced wages.

Like Medicare-for-all’s chief Senate champion, fellow candidate Bernie Sanders, the Warren campaign argues that many of these costs already are being spent in the existing health care system by governments, employers and individuals in the form of premiums, deductibles, and other expenses.

However, unlike Sanders’ plan, Warren’s projects no new tax burden for the middle class. The Warren campaign claims those $11 trillion in individual costs would drop to “practically zero,” while the plan maintains and boosts a funding pipeline from other sources. The plan also carries a total price tag of “just under $52 trillion” over the next 10 years, or slightly less than cost projections for the current system. That factors in current and additional spending; new spending alone would be in the $20 trillion range, compared with roughly $32 trillion for Sanders’ plan.

So how would she pay for it?

Among other proposals, Warren calls for bringing in nearly $9 trillion in new Medicare taxes on employers over the next 10 years, arguing this would essentially replace what they’re already paying for employee health insurance. Further, Warren’s campaign says if they are at risk of falling short of the revenue target, they could impose a “Supplemental Employer Medicare Contribution” for big companies with “extremely high executive compensation and stock buyback rates.”

Whether some of those costs, however, still could be passed on to middle-class employees – as economists argue payroll tax costs often are – remains to be seen. As the Tax Policy Center has noted, it is assumed the “employee bears the burden of both the employer and employee portions of payroll taxes.”

Bedingfield pointed to that component in alleging the plan “would place a new tax of nearly $9 trillion that will fall on American workers.”

Warren also proposes even more taxes on the ultra-rich, expanding on her previously announced signature wealth tax, to tax more of anyone’s net worth over $1 billion (estimated to raise another $1 trillion). Warren also calls for raising capital gains tax rates for the wealthy, taxing more foreign earnings and imposing a tax on financial transactions to generate $800 billion in revenue.

Aside from those and other taxes, the campaign claims they can scrounge up $2.3 trillion with better tax enforcement and policies, as well as additional funds by reining in defense spending.

“When fully implemented, my approach to Medicare for All would mark one of the greatest federal expansions of middle-class wealth in our history,” Warren said in her plan. “And if Medicare for All can be financed without any new taxes on the middle class, and instead by asking giant corporations, the wealthy, and the well-connected to pay their fair share, that’s exactly what we should do.”

Warren has been teasing this plan for weeks, especially after some of her rivals hammered her campaign on the financing issue during the last primary debate.

“Your signature, senator, is to have a plan for everything except this,” South Bend, Ind., Mayor Pete Buttigieg memorably said during last month’s Democratic primary debate.

“No plan has been laid out to explain how a multitrillion-dollar hole in this Medicare-for-all plan that Senator Warren is putting forward is supposed to get filled in,” he charged.

Sen. Amy Klobuchar, D-Minn., also slammed Warren during that debate, saying “at least Bernie’s being honest here in saying how he’s going to pay for this and that taxes will go up. And I’m sorry, Elizabeth, but you have not said that and I think we owe it to the American people to tell them where we’re going to send the invoice.”

Sanders has openly said taxes will increase “for virtually everybody” but argued the system will ultimately cost less than what workers currently pay for premiums and other expenses.

The Warren campaign’s insistence that the middle class will be spared any such costs is likely to face sustained skepticism in the Democratic primary field.

Buttigieg reprised his criticism this week, telling Fox News that his concern about Warren’s plan “is not just the multi-trillion-dollar hole, but also the fact that most Americans would prefer not to be told that they have to abandon their private plan.”

Trump campaign communications director Tim Murtaugh also blasted Warren’s plan Friday as a “total disaster.”

“There are 52 trillion reasons why this plan is a total disaster,” Murtaugh told Fox News. “Best of luck to the fact-checkers who now have to clean up the mess.”

One Emory University health care expert recently told The Washington Post “there’s no question” a Medicare-for-all plan “hits the middle class” in some way. A new study released by the bipartisan Committee for a Responsible Federal Budget also noted it would be “impossible” to finance any such plan using only taxes on the wealthiest Americans.

Aside from the cost issues, Warren did appear to acknowledge this week that Medicare-for-all could result in substantial job losses, calling it “part of the cost issue” when confronted with an estimate that nearly 2 million jobs could be shed.

During that same interview with New Hampshire Public Radio, Warren vowed that she would “not sign any legislation into law for which costs for middle-class families do not go down.”

UPDATE 6-Democrat Warren: Medicare for All would not raise U.S. middle-class taxes ‘one penny’

As we just heard and Reuters published a report noted, Democratic U.S. presidential candidate Elizabeth Warren on Friday proposed a $20.5 trillion Medicare for All plan that she said would not require raising middle-class taxes “one penny,” answering critics who had attacked her for failing to explain how she would pay for the sweeping healthcare system overhaul.

Warren said her plan would save American households $11 trillion in out-of-pocket healthcare spending over the next decade while imposing significant new taxes on corporations and the wealthy to help finance it.

“Healthcare is a human right, and we need a system that reflects our values,” Warren wrote in a 20-page essay outlining her plan. “That system is Medicare for All.”

The proposal to remake the U.S. healthcare system will face scrutiny from Warren’s more moderate Democratic opponents, who have questioned Medicare for All’s practicality.

Warren’s proposal also calls for cuts in defense spending and passing immigration reform to increase tax revenue from newly legal Americans, two steps that would face an uphill battle in Congress. The $20.5 trillion in new spending over 10 years would increase the entire federal budget by a third.

Warren, a U.S. senator from Massachusetts, is one of 17 Democrats vying for the party’s nomination to take on Republican President Donald Trump in the November 2020 election. She is near the front of the pack in opinion polls, having closed in on former Vice President Joe Biden, the early front-runner.

Medicare for All would replace private health insurance, including employer-sponsored plans, with full government-sponsored coverage, and individuals would no longer have to pay premiums, deductibles, co-pays or other out-of-pocket costs.

It would extend Medicare, the U.S. government’s health insurance program for people 65 years and older and the disabled, to cover all Americans, including the roughly 27.5 million – 8.5% of the population – who are currently uninsured.

Warren, a former law professor, has become known for a bevy of detailed policy proposals. But she had faced criticism for not detailing how she would pay for a Medicare for All plan she backs, which was introduced in the Senate by rival Democratic candidate Bernie Sanders of Vermont.

At recent debates, Warren had refused to answer directly when asked whether she would be forced to raise middle-class taxes to cover the costs, even as Sanders acknowledged he would.

More moderate 2020 candidates such as Biden and South Bend, Indiana, Mayor Pete Buttigieg have said Medicare for All would be too disruptive and favor a more incremental approach.

‘MATHEMATICAL GYMNASTICS’

On Friday, Biden’s campaign questioned Warren’s calculations, calling them “double talk” and “mathematical gymnastics” and asserting that middle-class taxes would rise despite her vow.

“It’s impossible to pay for Medicare for All without middle-class tax increases,” said Kate Bedingfield, Biden’s deputy campaign manager. “To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else.”

Warren, speaking to reporters in Iowa on Friday, said she was “just not sure where he (Biden) is going,” adding that her proposal and its costs were authenticated by outside experts.

“Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant drug companies and the giant insurance companies,” Warren said.

House of Representatives Speaker Nancy Pelosi also questioned the feasibility of enacting Medicare for All, saying in an interview with Bloomberg on Friday that Democrats should focus on expanding the Affordable Care Act, commonly known as Obamacare.

Critics like Warren note that the current U.S. healthcare system – a patchwork of private insurance often provided by employers or obtained through Obamacare marketplaces and public programs covering the poor, elderly and disabled – is the most costly in the world despite leaving tens of millions uncovered.

Medicare for All legislation stands little chance of passing Congress, where Democrats control the House and Republicans control the Senate.

The plan relies on aggressive ways of lowering healthcare costs, including major cuts in prescription drug prices and significant reductions in administrative costs by eliminating private insurers.

“She makes some assumptions about how effectively healthcare costs could be contained that may not pan out,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation.

Employers would be asked to repurpose the money they currently spend on workers’ healthcare into Medicare contributions, while billionaires, high-earning investors, and corporations would face trillions of dollars in higher taxes.

In an effort to appease union leaders, some of whom have expressed skepticism about giving up hard-fought healthcare plans, Warren said employers that already offer benefits under a collective bargaining agreement could reduce their contributions if they pass the savings along to workers.

Warren released two letters supporting her calculations from several experts, including Simon Johnson, the former chief economist for the International Monetary Fund; Donald Berwick, who oversaw Medicare in the Obama administration; and Mark Zandi, the chief economist at Moody’s Analytics.

An online calculator launched by Warren’s campaign showed an average family of four with employer-provided insurance would save $12,378 per year.

Warren said with her Medicare for All plan in place, projected total healthcare costs in the United States over 10 years would be just under $52 trillion – slightly less than maintaining the current system.

Here’s How Warren Finds $20.5 Trillion To Pay For ‘Medicare For All’

Danielle Kurtslenben reported that Sen. Elizabeth Warren says paying for “Medicare for All” would require $20.5 trillion in new federal spending over a decade. That spending includes higher taxes on the wealthy but no new taxes on the middle class.

The Democratic presidential candidate released her plan to pay for Medicare for All on Friday after being dogged for months by questions of how she would finance such a sweeping overhaul of the health care system. That pressure has been intensified by the fact that Warren has made detailed proposals a central part of her brand as a candidate.

Medicare for All is a single-payer health care proposal introduced by Sen. Bernie Sanders and co-sponsored by multiple candidates in the presidential race, including Warren. It would virtually eliminate private insurance, including employer-sponsored coverage.

It also represents a political risk, as multiple polls show that introducing a public option for health insurance coverage is more popular than a Medicare for All plan that almost entirely does away with private insurance.

Here’s a look at what Warren has laid out to provide single-payer health care, including proposals to cut costs, where new revenue would come from, where funds would not be taken from and what comes next.

How Warren wants to reduce spending

Warren bases her plan off of a recent analysis from the Urban Institute, which estimated that under current law, Americans would spend $52 trillion over the next decade on health care — that includes many types of spending, from employers, individuals and all levels of government.

In that analysis, the Urban Institute calculated that under a single-payer plan that looks a lot like Medicare for All, costs would total not $52 trillion but $59 trillion over a decade, which would require $34 trillion in new federal spending.

Warren’s plan estimates that total health costs could be held to $52 trillion and that $20.5 trillion in new federal spending would be necessary.

Like Urban, Warren’s plan assumes that Medicare for All would pay doctors what Medicare pays them right now. It would also pay hospitals 110 percent of what Medicare pays right now — slightly less than Urban’s 115 percent assumption.

This question — what to pay hospitals and doctors — is a big part of what determines how much Medicare for All would cost. That’s because Medicare pays doctors and hospitals much less than private insurance.

“This plan aggressively constrains the price of health care, paying doctors, hospitals and drug companies much less,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “There would be a lot of adjustment required from hospitals and doctors as their incomes go down.” ( And I will say more about this at the end of this blog post).

Just how seismic such a shift would be would depend in part on how fast the transition is, he added.

“I think how quickly she proposes to transition to this new system will be really important because it would be very disruptive to the health care system,” Levitt said. “You know, a quick transition would be hard and potentially result in shortages or increased wait times for health care.”

Sanders calls for a four-year transition to Medicare for All — a pace that Levitt characterized as “quite quick.” In a Friday blog post spelling out her proposal, Warren said she plans to unveil her transition plan “in the weeks ahead.”

A letter from economists supporting the plan, provided by Warren’s team, argued that these payment rates would work in part because doctors and hospitals would save substantially on administrative costs. Warren’s team also says there would be ways to ensure that vulnerable hospitals, like those in rural areas, would get paid more, so they could stay in business.

Her proposal also establishes savings by projecting that Medicare for All could substantially slow medical cost growth. Warren also stipulates that state and local governments would redirect the more than $6 trillion they currently spend on Medicaid and the Children’s Health Insurance Program (CHIP) to the federal government.

Where the money would not come from

One thing that’s notable about this plan is where the revenue doesn’t come from. Warren had promised at a recent debate that she would not sign a bill that raises health care costs for the middle class.

This plan goes further: Middle-class Americans would no longer pay health premiums or copays and would also not pay new taxes to replace those costs. They would, however, pay taxes on whatever additional take-home pay they would receive from this plan. That would add $1.4 trillion in revenue, her team estimates.

This is a departure from Bernie Sanders’ ideas about how to fund Medicare for All. One of his options is a 4% tax on families earning more than $29,000. At the Democrats’ October debate, he explained that taxes would go up for many Americans under his plan.

“At the end of the day, the overwhelming majority of people will save money on their health care bills. But I do think it is appropriate to acknowledge that taxes will go up,” he said. “They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less — substantially less than what they were paying for premiums and out-of-pocket expenses.”

Where the $20.5 trillion comes from

Employers are one of the main sources of revenue in this proposal. Warren says she would raise nearly $9 trillion here, a figure that comes from the roughly $9 trillion private employers are projected to spend over the next decade on health insurance. The idea here is that instead of contributing to employees’ health insurance, employers would pay virtually all of that money to the government.

In addition, she will boost her proposed 3% wealth tax on people with over a billion dollars to 6% and also boost taxes on large corporations. Altogether, she believes, taxes on the rich and on corporations would raise an estimated $6 trillion. An additional $2.3 trillion would come from improving tax enforcement.

But there are lingering questions about how much revenue some of these taxes would bring in or how easy it would be to impose a wealth tax in particular.

“Something like half of the wealth of the wealthiest people in America is held in privately held corporations, privately held businesses,” said Howard Gleckman, a senior fellow at the Urban-Brookings Tax Policy Center. “And it’s really hard to value those assets for tax purposes.”

Warren also includes comprehensive immigration reform as part of her plan. Giving more people a path to citizenship would mean more taxpayers, which would mean more tax revenue.

Political ramifications

While Medicare for All is Sanders’ plan, his bill does not include set methods to pay for the plan. Rather, Sanders has included “options” to pay for his health care plan. In a recent interview with CNBC, he said “we’ll have that debate” over how exactly to finance the plan.

As the candidate with “a plan for that,” as one of her slogans goes, Warren has been asked repeatedly whether her health care overhaul plan would raise taxes on the middle class. Warren repeatedly said in response that she would not raise costs for the middle class.

This proposal gives Warren an answer for the next time she is asked how she would pay for Medicare for All, and it means she can say that she wouldn’t impose new taxes on middle-class Americans.

But it also gives her opponents potential new fodder for attacks. Former Vice President Joe Biden has already come out swinging, accusing Warren of fuzzy math. In addition, his team argues that that nearly $9 trillion that employers would pay the government would ultimately hurt workers.

“To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else,” said Biden deputy campaign manager Kate Bedingfield in a statement released Friday.

In fact, another study by a number of economists estimates the true cost of almost $70 trillion over a decade. Wow, what a spending plan and what is our national debt now? About $21 trillion and now we are going to add more and more. When does it end? And remember all the doctors and hospitals, especially rural hospitals, will be paid based on the discounted rates of Medicare. How do doctors then pay for the education debts, their overhead expenses, and their malpractice insurance fees? Interesting! Who then will be taking care of our patients?

Again I ask, where is Obamacare when we need it and how do we pay for it in the future?

 

Whistleblower Alleges Fraud At A Large Medicare Advantage Plan In Seattle and on and on about the last Democrat Debate and more on Medicare for All

72488737_2301802426616070_6529440653267435520_nWhat a unique world we live in. Bernie Sanders, a man running for the position of President, ignores his symptoms of heart disease, has a heart attack, needs stents for his coronary arteries which are obstructed and a few weeks later is back on the difficult road to running for President. What a jerk who I am sure is ignoring his doctor’s advice, who I’m sure has discussed his post-procedure heart disease restrictions including taking stress, etc. easy for at least 6 weeks, or that what is what I would tell my patient. And this is the man who is telling us all how we should all be deciding our health care system. Unbelievable!! Now, with all the whistleblowers coming out of the woodworks, Fred Schulte points out another whistleblower. Group Health Cooperative in Seattle, one of the United States’ oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming that some patients were sicker than they were or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit.

Ross filed suit in federal court in Buffalo, N.Y., in 2012, but the suit remained under a court seal until July and is in its initial stages. The suit also names as defendants two medical coding consultants — consulting firm DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y. All denied wrongdoing in separate court motions filed late Wednesday to dismiss the suit.

The Justice Department has thus far declined to take over the case but said in a June 21 court filing that “an active investigation is ongoing.”

The whistleblower suit is one of at least 18 such cases documented by Kaiser Health News that accuses Medicare Advantage managed care plans of ripping off the government by exaggerating how sick their patients were. The whistleblower cases have emerged as a primary tool for clawing back overpayments. While many of the cases are pending in courts, five have recovered a total of nearly $360 million.

“The fraudulent practices described in this complaint are a product of the belief, common among [Medicare Advantage] organizations, that the law can be violated without meaningful consequence,” Ross alleges.

Medicare Advantage plans are a privately run alternative to traditional Medicare that often offers extra benefits such as dental and vision coverage but limits the choice of medical providers. They have exploded in popularity in recent years, enrolling more than 22 million people, just over 1 in 3 of those eligible for Medicare.

Word of another whistleblower alleging Medicare Advantage billing fraud comes as the White House is pushing to expand enrollment in the plans. On Oct. 3, President Trump issued an executive order that permits the plans to offer a range of new benefits to attract patients. One, for instance, is partly covering the cost of Apple watches as an inducement.

Group Health opened for business more than seven decades ago and was among the first managed care plans to contract with Medicare. Formed by a coalition of unions, farmers and local activists, the HMO grew from just a few hundred families to more than 600,000 patients before its members agreed to join California-based Kaiser Permanente. That happened in early 2017, and the plan is now called the Kaiser Foundation Health Plan of Washington. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In an emailed statement, a Kaiser Permanente spokesperson said: “We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government, which has not intervened in the case at this time.” Ross nods to the plan’s history, saying it has “traditionally catered to the public interest, often highlighting its efforts to support low-income patients and provide affordable, quality care.”

The insurer’s Medicare Advantage plans “have also traditionally been well regarded, receiving accolades from industry groups and Medicare itself,” according to the suit.

But Ross, who worked at Group Health for more than 14 years in jobs involving billing and coding, says that from 2008 through 2010, the company “went from an operating income of almost $57 million to an operating loss of $60 million.” Ross says the losses were “due largely to poor business decisions by company management.”

The lawsuit alleges that the insurer manipulated a Medicare billing formula known as a risk score. The formula is supposed to pay health plans higher rates for sicker patients, but Medicare estimates that overpayments triggered by inflated risk scores have cost taxpayers $30 billion over the past three years alone.

According to Ross, a Group Health executive in 2011 attended a meeting of the Alliance of Community Health Plans, where he heard from a colleague at Independent Health about an “exciting opportunity” to increase risk scores and revenue. The colleague said Independent Health “had made a lot of money” using its consulting company, which specializes in combing patient charts to find overlooked diseases that health plans can bill for retroactively.

In November 2011, Group Health hired the firm DxID to review medical charts for 2010. The review resulted in $12 million in new claims, according to the suit. Under the deal, DxID took a percentage of the claims revenue it generated, which came to about $1.5 million that year, the suit says.

Ross says she and a doctor who later reviewed the charts found “systematic” problems with the firm’s coding practices. In one case, the plan billed for “major depression” in a patient described by his doctor as having an “amazingly sunny disposition.” Overall, about three-quarters of its claims for higher charges in 2010 were not justified, according to the suit. Ross estimated that the consultants submitted some $35 million in new claims to Medicare on behalf of Group Health for 2010 and 2011.

In its motion to dismiss Ross’ case, Group Health called the matter a “difference of opinion between her allegedly ‘conservative’ method for evaluating the underlying documentation for certain medical conditions and her perception of an ‘aggressive’ approach taken by Defendants.”

Independent Health and the DxID consultants took a similar position in their court motion, arguing that Ross “seeks to manufacture a fraud case out of an honest disagreement about the meaning and applicability of unclear, complex, and often conflicting industry-wide coding criteria.”

In a statement, Independent Health spokesman Frank Sava added: “We believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately.”

Whistleblowers sue on behalf of the federal government and can share in any money recovered. Typically, the cases remain under a court seal for years while the Justice Department investigates.

How would Warren pay for ‘Medicare for All’? Enough evasion, it’s past time for answers.

Chris Truax points out that the last 2 months al anyone who watches the politicians suggesting that Medicare for all is the solution to the healthcare crisis has bombarded the news. Medicare for All will create winners and losers. It’s all very well to say you can’t make an omelet without breaking some eggs unless you’re the egg.

When it comes to doing things, Elizabeth Warren has a plan for everything — and she’s happy to tell you all about it. But when it comes to paying for things, I’m sorry to say, the Massachusetts senator dodges and deflects like a Donald Trump defender.

It’s estimated that “Medicare for All” will cost the federal government an extra $3 trillion a year. That’s more than $9,000 annually from every man, woman, and child in America. Despite being asked, again and again, Warren refuses to acknowledge that paying for this is going to require an across-the-board tax increase — and a pretty massive one, at that. Instead, she keeps talking about how “costs” will go down before she changes the subject to how stressful it is to have your insurance canceled when you get sick or when you have to cope with your mom having diabetes. That’s very true, I’m sure. But we’re talking fiscal policy here.

Warren To Release Plan To Pay For ‘Medicare For All’

Yuval Rosenberg of The Fiscal Times noted that now, just last week Massachusetts Sen. Elizabeth Warren said Sunday she will roll out a plan to pay for an expansive single-payer health care system in the coming weeks, promising the plan would decrease overall costs for the middle class.

“I plan over the next few weeks to put out a plan that talks, specifically, about the cost of ‘Medicare for All’ and how we pay for it,” Warren said at the end of a town hall here at Simpson College. “I will not sign a bill into law that does not reduce the cost of health care for middle-class families.”

Warren’s aides have long suggested she was studying ways to pay for the health care plan originally backed by Vermont Sen. Bernie Sanders, one of her leading rivals for the 2020 Democratic presidential nomination. In recent days, Warren has faced criticism from lower-profile candidates in the race — especially South Bend, Indiana, Mayor Pete Buttigieg and Minnesota Sen. Amy Klobuchar — for her failure to explain how she would pay for the ambitious plan, which would replace private health insurance with generous, universal coverage paid for by the federal government.

“Everybody who is running for president right now knows that families are getting crushed by the high cost of health care,” Warren told the crowd of nearly 500 people. “They also know that the cheapest possible way to make sure that everyone gets the health care that they need is Medicare for All.”

Warren’s statement came after her standard 40-minute stump speech and three questions from attendees, none of whom asked about Medicare for All. The addition appeared to be an attempt to short-circuit recent criticisms of her health care plan.

Warren has previously promised, most recently at the Oct. 15 debate, that no middle-class family would see an increase in overall health care costs. And her aides have said since at least September that she was evaluating ways to pay for Medicare for All. She does not plan to significantly alter the details of the legislation she’s co-sponsored with Sanders in the way Sen. Kamala Harris (D-Calif.) did with her own health care proposal over the summer. Warren said she had been working on the problem of how to pay for the legislation for “months and months.”

“It’s just a little more work until it’s finished,” she said.

For a campaign that has long prided itself on detailed policy proposals, releasing a plan to pay for Medicare for All — which is sure to generate intense scrutiny from the media and her rivals for the nomination — is a high-risk but likely necessary move. Whether or not a plan for Medicare for All would lower costs for the middle class would rely heavily on complicated details, including how progressive the tax system supporting the plan is and how aggressively the government is able to control the cost of health care.

Estimates of how much the plan would cost vary wildly, as do estimates of how much switching to a single-payer system would increase or decrease overall health care costs.

Buttigieg, in particular, has aggressively questioned how Warren would pay for the plan, and said she is being dishonest by not saying whether or not taxes would go up for middle-class families. Sanders has said taxes would likely go up, while overall costs would drop. But Warren has resisted the question, arguing that admitting taxes would rise is equal to accepting a dishonest Republican framing of the issue. Warren has also attacked Buttigieg’s plan for failing to cover every American, dubbing it “Medicare for all who can afford it.”

“Your signature, Senator, is to have a plan for everything. Except this,” Buttigieg said at the debate. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for All plan that Senator Warren is putting forward.”

Soon, Buttigieg will get his answer.

She ended your last weekend rally asking the “people” to give her a little more time and she will announce how she proposes to pay for it. More important, is her plan, probably an increase of taxes for all, including Middle Americans, to pay for it…. realistic???? Remember, nothing in any of the political “experts” proposals are ever free. Someone, you and I, have to pay for it in some way or another!!

Winners and losers in Medicare for All

There’s a very unpleasant collectivist feel to this. It’s all very well to say you can’t make an omelet without breaking some eggs … unless you’re the egg. About 56% of Americans — more than 180 million — have private health insurance through an employer. Medicare for All would sweep that all away, whether the people who have that insurance like it or not, in the name of the common good. Perhaps worse, as Warren knows perfectly well but steadfastly refuses to admit, there are going to be winners and losers. Costs might go down in the aggregate, but individuals and families aren’t aggregates.

Elizabeth Warren’s choice: ‘Medicare for All’ purity or a path to beating Trump?

For example, Warren keeps saying that the total you pay for health care would end up being less under Medicare for All because it will eliminate out-of-pocket costs like premiums and copays. That’s an oversimplification at best, especially since she hasn’t said how she would finance this enormously expensive project.

But it is a given that everyone will pay higher taxes, and it’s older people who spend more on premiums and out-of-pocket health care costs — a lot more. Consequently, older people will be far more likely to see these higher taxes offset by a decrease in the cost of their health care. By contrast, younger people and families at healthier stages of their lives would still be paying new taxes but will see fewer benefits.

 Your Two-Minute Summary of Tuesday’s Democratic Medicare-for-All Debate

Tuesday night’s Democratic presidential debate once again highlighted the candidate’s deep divides over Medicare for All. After opening questions related to the House impeachment inquiry into President Trump, the debate quickly turned to the health care reform plan backed by Senators Elizabeth Warren and Bernie Sanders.

Warren again tried to reframe the question of whether she would raise middle-class taxes to pay for the plan. “Costs will go up for the wealthy. They will go up for big corporations. And for middle-class families, they will go down,” she said. “I will not sign a bill into law that does not lower costs for middle-class families.”

Pete Buttigieg, who last month called Warren “extremely evasive” on the tax question, pounced. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for all plan that Senator Warren is putting forward is supposed to get filled in,” he said, touting his “Medicare for All Who Want It” proposal as a better alternative. “I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance in four short years,” he said to Warren. “Why unnecessarily divide this country over health care when there’s a better way to deliver coverage for all?”

Warren jabbed back at Buttigieg, saying his “Medicare for All Who Want It” plan is really “Medicare for All Who Can Afford It.”

Joe Biden and Amy Klobuchar, both of whom support building on the Affordable Care Act with a public option, also attacked Medicare for All as expensive and impractical. “The difference between a plan and a pipe dream is something that you can actually get done,” Klobuchar said. “And we can get this public option done.”

Sanders defended his plan — and opened the door for further attacks on Warren. “At the end of the day, the overwhelming majority of people will save money on their health care bills,” Sanders said. “But I do think it is appropriate to acknowledge that taxes will go up. They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less than what they were paying for premiums and out-of-pocket expenses.”

Klobuchar took the opportunity to criticize Warren again. “At least Bernie is being honest here, and saying how he’s going to pay for this and that taxes are going to go up,” she said. “And I’m sorry, Elizabeth, but you have not said that, and I think we owe the American people to tell them where we will send the invoice.”

A political strategy: The attacks on Warren are widely seen as a sign that she’s now the Democratic frontrunner — and they’re likely a sign that, as tiresome as the repeated tax question might get, Warren is going to keep getting asked it by the media, Democratic rivals, and Republicans. She’s pointedly not willing to answer directly (or take the bait) and say that she will raise taxes, even as she continues to argue that overall costs under Medicare for All will go down for the middle class. Her caginess on the question suggests she thinks that higher taxes on the middle class, or the very word “taxes,” might be toxic in an election campaign against Trump. But her dodging hasn’t hurt her so far.

What the polls say: The latest Kaiser Family Foundation tracking poll found that 51% of those surveyed favor Medicare for All, while 47% oppose it. A majority of Democrats and about half of independents support a national Medicare-for-all plan, while more than 70% of Republicans oppose the idea. Support for a public option is higher, at 73%. A CBS News poll released Tuesday found that 59% of voters believe that a government-run plan should “compete with private insurance” as under a public option, while 32% said they would want it to replace private insurance. But polls have also found that support for Medicare for All or other health plans can shift significantly depending on the arguments presented.

The bottom line: Larry Levitt of the Kaiser Family Foundation reminds us that there is no simple answer to the question of ultimate costs, and that a wide variety of outcomes are possible depending on how Medicare for All is implemented. “A Medicare for all plan could be designed so that many people, including those who are middle class, pay less in taxes than they are paying now in premiums, deductibles, and copays,” Levitt tweeted Tuesday. “It depends entirely on the details.”

J&J Pulls Baby Powder From Market

FDA testing reveals chrysotile fibers in one lot of embattled product of the J&J babypowder, which the courts are suggested cause ovarian cancer.

John Gever the managing editor of the MedPage reported that Johnson  & Johnson is recalling one lot of its famous baby powder because of possible asbestos contamination, the FDA announced Friday.

“FDA testing has found that a sample from one lot of the product contains chrysotile fibers, a type of asbestos,” the agency said in a press release. “Consumers who have Johnson’s Baby Powder lot #22318RB should stop using it immediately and contact Johnson & Johnson for a refund.”

Although Johnson & Johnson agreed to initiate the recall, it stopped short of admitting that the product really was contaminated. It questioned “the integrity of the tested sample and the validity of the test results,” suggesting that it might not even be a genuine Johnson & Johnson product.

The company has consistently denied that its baby powder — on the market for more than a century — has ever been contaminated with asbestos, but the company has faced numerous lawsuits from consumers alleging that they or loved ones developed cancer because of asbestos in talc components. The baby powder is popular not only for use on babies; many women have used it to reduce “feminine odors” as well.

The FDA said it has tested some 50 cosmetic products since 2018 for asbestos contamination, including two lots of Johnson’s Baby Powder. One was negative and the other was positive. This lot of baby powder is not the first to test positive and the FDA has previously issued alerts on others.

“The FDA expects to issue the full results from this survey, including all tested products having both positive and negative results, by the end of the year,” the agency said.

 

The Big Push for Medicare Advantage, Trump’s Counter Health Care Proposal and Dumb Bernie!

rights328Michael Rainey reported that Medicare is shaping up as one of the most important issues in the 2020 election, with several leading Democrats offering proposals that would significantly expand the program. President Trump jumped into the fray with an executive order last week that he claimed would protect and improve the Medicare system, in part by promoting broader use of private Medicare Advantage plans. Those plans are quite lucrative for the private insurers that sell them, Bloomberg’s John Tozzi said Wednesday, and they’ll be pushing hard to sell more of them when Medicare enrollment begins next week.

Enrollment in Medicare Advantage has more than tripled in the last 20 years, and now about a third of all Medicare beneficiaries get coverage through private plans. If current trends continue, more than half of all beneficiaries will be in Medicare Advantage by 2025, according to Tozzi.

How it works: Those who sign up for Medicare Advantage pay the same monthly premiums as regular plans but agree to certain limits imposed by the insurers, such as a restricted network of doctors, and also receive a wider range of benefits, which can include drugs plans and dental care. Insurers get a fee from the government for each person who signs up and is responsible for managing their plans to ensure a profit. In 2019, the average fee for each of the roughly 22 million participants was $11,545 – which comes to a total of about $254 billion.

Big numbers for insurers: Insurers see Medicare Advantage as “as a lucrative market they can’t afford to pass by,” Tozzi said, especially as sales of traditional, employer-based insurance plans slow. Medicare is now the biggest part of UnitedHealthcare’s business and the insurance giant is expanding to reach 90% coverage of the market next year. Other major players including Humana and Aetna are also expanding their coverage, and competition in the space is growing.

More generous benefits: Recent rule changes have allowed private insurers to offer new benefits within Medicare Advantage, such as meal delivery, air-conditioners, and in-home help. Regular fee-for-service Medicare doesn’t offer such options due to concerns about fraud.

A potential political battle ahead: Insurers increasingly rely on the revenues and profits from Medicare Advantage and can be expected to fight any effort to restrict – or, as some Democrats are calling for, eliminate – the existing private system. And as the plans become more generous – and, as critics have pointed out, more expensive for the government – seniors are likely to resist changes as well, complicating any Democratic effort to enact sweeping changes in the Medicare system.

Targeting ‘Medicare For All’ Proposals, Trump Lays Out His Vision For Medicare

Selena Simmons reported that President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.

His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.

His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.

Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.

The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly what — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”

The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.

The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.

The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud, and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.

The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.

“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”

Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first-hour hashing out and defending various health care proposals and visions. Only two candidates, Sen. Bernie Sanders, and Sen. Elizabeth Warren — between a Medicare for All system — support the major divide and a public option supported by the rest of the field.

Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”

Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”

Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.

Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.

Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.

On Thursday, administration officials emphasized a number of its recent health care policy moves.

“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.

The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”

He highlighted a range of actions that the administration has taken, from a push on price transparency in health care to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”

Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.

“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”

Trump’s New Order For Medicare Packs Potential Rise In Patients’ Costs

Julie Appleby reported that vowing to protect Medicare with “every ounce of strength,” President Donald Trump last week spoke to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt-out.

The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers.

“Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center,” said economist Stephen Zuckerman, vice president for health policy at the Urban Institute.

While the executive order spells out few details, it calls for the removal of “unnecessary barriers” to private contracting, which allows patients and doctors to negotiate their own deals outside of Medicare. It’s an approach long supported by some conservatives, but critics fear it would lead to higher costs for patients. The order also seeks to ease rules that affect beneficiaries who want to opt-out of the hospital portion of Medicare, known as Part A.

Both ideas have a long history, with proponents and opponents duking it out since at least 1997, even spawning a tongue-in-cheek legislative proposal that year titled, in part, the “Buck Naked Act.” More on that later.

“For a long time, people who don’t want or don’t like the idea of social insurance have been trying to find ways to opt-out of Medicare and doctors have been trying to find a way to opt-out of Medicare payment,” said Timothy Jost, emeritus professor at Washington and Lee University School of Law in Virginia.

The specifics will not emerge until the Department of Health and Human Services writes the rules to implement the executive order, which could take six months or longer. In the meantime, here are a few things you should know about the possible Medicare changes.

What are the current rules about what doctors can charge in Medicare?

Right now, the vast majority of physicians agree to accept what Medicare pays them and not charge patients for the rest of the bill, a practice known as balance billing. Physicians (and hospitals) have complained that Medicare doesn’t pay enough, but most participate anyway. Still, there is wiggle room.

Medicare limits balance billing. Physicians can charge patients the difference between their bill and what Medicare allows, but those charges are limited to 9.25% above Medicare’s regular rates. But partly because of the paperwork hassles for all involved, only a small percentage of doctors choose this option.

Alternatively, physicians can “opt-out” of Medicare and charge whatever they want. But they can’t change their mind and try to get Medicare payments again for at least two years. Fewer than 1%of the nation’s physicians have currently opted out.

What would the executive order change?

That’s hard to know.

“It could mean a lot of things,” said Joseph Antos at the American Enterprise Institute, including possibly letting seniors make a contract with an individual doctor or buy into something that isn’t traditional Medicare or the current private Medicare Advantage program. “Exactly what that looks like is not so obvious.”

Others said eventual rules might result in lifting the 9.25% cap on the amount doctors can balance-bill some patients. Or the rules around fully “opting out” of Medicare might ease so physicians would not have to divorce themselves from the program or could stay in for some patients, but not others. That could leave some patients liable for the entire bill, which might lead to confusion among Medicare beneficiaries, critics of such a plan suggest.

The result may be that “it opens the door to surprise medical billing if people sign a contract with a doctor without realizing what they’re doing,” said Jost.

Would patients get a bigger choice in physicians?

Proponents say allowing for more private contracts between patients and doctors would encourage doctors to accept more Medicare patients, partly because they could get higher payments. That was one argument made by supporters of several House and Senate bills in 2015 that included direct-contracting provisions. All failed, as did an earlier effort in the late 1990s backed by then-Sen. Jon Kyl (R-Ariz.), who argued such contracting would give seniors more freedom to select doctors.

Then-Rep. Pete Stark (D-Calif.) opposed such direct contracting, arguing that patients had less power in negotiations than doctors. To make that point, he introduced the “No Private Contracts To Be Negotiated When the Patient Is Buck Naked Act of 1997.”

The bill was designed to illustrate how uneven the playing field is by prohibiting the discussion of or signing of private contracts at any time when “the patient is buck naked and the doctor is fully clothed (and conversely, to protect the rights of doctors, when the patient is fully clothed and the doctor is naked).” It, too, failed to pass.

Still, the current executive order might help counter a trend that “more physicians today are not taking new Medicare patients,” said Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank based in Washington, D.C.

It also might encourage boutique practices that operate outside of Medicare and are accessible primarily to the wealthy, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“It is both a gift to the industry and to those beneficiaries who are well off,” he said. “It has questionable utility to the rest of us.”

Elizabeth Warren Has Many Plans, But on Health Care, She’s ‘With Bernie’

Sahil Kaput noted that Elizabeth Warren has a plan for everything — but on the crucial 2020 issue of health care, she’s borrowing from a rival and fellow progressive — Bernie Sanders.

The presidential candidate who made a mark with her signature “I have a plan for that!” is the only one of the five top-polling Democrats without a sweeping proposal of her own to remake the health care system. She has instead championed Sanders’ legislation to replace private insurance by putting every American in an expanded Medicare program.

“I’m with Bernie on Medicare for All,” Warren said recently in New Hampshire when asked if she’d devise a blueprint of her own. “Health care is a basic human right. We need to make sure that everybody is covered at the lowest possible cost, and draining money out for health insurance companies to make a lot of profits, by saying no.”

Warren’s deference to a rival is unusual for a candidate who has styled herself as the policy wonk with a program for everything from cradle to grave. It has allowed her to attract many liberal voters who supported Sanders in 2016, leading her to a dead heat with former vice president Joe Biden for the top spot in the Democratic field. And if Sanders were to eventually drop out of the race before Warren, her embrace of his most popular plan could keep his supporters in her camp.

Sean McElwee, a left-wing activist, and researcher with Data For Progress said that Warren cannot afford to go soft on Medicare for All.

“It’s the best option for the campaign to stay in alignment with Sanders on health care through the general election,” he said. “These Sanders voters have the highest risk of voting third party or staying home, and you have to keep them mobilized.”

Weeks before Warren, a Massachusetts senator, announced that she was exploring a presidential run last December, she sounded less wedded to the Sanders proposal, describing a three-step approach to health care.

“Our first job is to defend the Affordable Care Act. Our second is to improve it and make changes, for example to families’ vulnerability to the impact of high-priced drugs,” she told Bloomberg News. “And the third is to find a system of Medicare available to all that will increase the quality of care while it decreases the cost of all of us.”

As Warren was rising in the polls, her allies began to pick up signals that Sanders supporters were questioning her commitment to progressive ideas. Since June, Warren has given them little ammunition to claim she’s going soft on Medicare for All, a defining issue for many left-wing voters.

“The biggest concern Warren has from the left is this idea that, at the end of the day, Sanders is the one true progressive,” McElwee said. “If your main issue is Medicare for All, and that’s a central tenet of your politics, Warren probably can’t win you. But she doesn’t want you to hate her. She wants to be your fallback option.”

At the same time, Warren faces attacks from Biden for supporting a plan that would replace Obamacare, which Democrats bitterly fought for in 2009 and 2010. “The senator says she’s for Bernie. Well, I’m for Barack,” the former vice president said in the third Democratic debate in September. “I think Obamacare worked.”

Biden’s plan would build out Obamacare and have a public option for those who want it.

Health care consistently ranks as the top issue for Democratic voters. Government-run health care is popular among Democrats and Americans overall, but that support dips once voters are given the arguments against it, including that it would require higher middle-class taxes and abolish employer-sponsored coverage.

Medicare for All, which lay at the heart of Sanders’ stronger-than-expected 2016 campaign, has become a litmus test for some progressive activists and voters. To them, it indicates a candidate’s belief in universal health care and willingness to take on private insurers who they say are gouging consumers for profit.

In Los Angeles on Friday, Warren was asked if her health care vision would raise middle-class taxes. She evaded the question and said working families would see their overall medical costs reduced, referring to the end of premiums and out-of-pocket expenses. “The very wealthy and big corporations will see their costs go up, but middle-class families will see their costs go down,” she said.

Surveys show that Sanders voters clearly prefer Warren as their second choice. But it doesn’t cut both ways — Warren’s supporters are more split among Sanders, Biden and Kamala Harris as their second choice.

Mary Anne Marsh, a Democratic consultant based in Boston, said that if Warren believes Sanders has the best plan, she has to “be all in on it — and if she’s got elements of her own to put in it, she needs to do that.”

The Sanders health care plan tracks with the “big structural change” Warren has called for, a message that also appeals to mainstream Democrats who backed Hillary Clinton in 2016. Maintaining that cross-section of support is critical to Warren’s path to the nomination. Biden is dominating with moderate and conservative Democrats, some of whom worry that running on Medicare for All will cost Democrats the general election.

“By supporting Bernie Sanders’ health care plan, Elizabeth Warren improves the chances of Bernie Sanders voters supporting her if she’s the nominee, thereby avoiding some for the heartburn Bernie gave Clinton and her supporters all the way through Election Day,” Marsh said.

A voter at her event in Keene, New Hampshire, asked Warren how she would handle the transition from private insurance to a government-run system.

“What we’ve got on Medicare for All is a framework,” she said. “And it doesn’t have the details, and you’re right to be antsy.”

To contact the reporter on this story: Sahil Kapur in Washington at skapur39@bloomberg.net

To contact the editors responsible for this story: Wendy Benjaminson at wbenjaminson@bloomberg.net, John Harney

Pete Buttigieg explains why he’s against Medicare for All

As reported by Adriana Belmont, Mayor Pete Buttigieg stands apart from other Democratic presidential candidates when it comes to health care policy. Unlike frontrunners Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-Mass.), he does not support for Medicare for All, but rather an alternative.

“I am a candidate who believes Medicare for All is not as attractive as Medicare for All Who Want It,” Buttigieg said at The New Yorker Festival. “Because it gives people a choice.”

Through Buttigieg’s plan, everyone would automatically be involved in universal health care coverage for those who are eligible. It would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers charge for out-of-network care at double what Medicare pays for the same service. However, those who still want to stay on private insurance can do so.

When asked whether or not this is a matter of “having your cake and eating it too,” Buttigieg responded: “Why not?”

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.”

This differs from other candidates like Sanders and Warren, both vocal supporters of a single-payer health system. Sanders has even gone so far as to call for the elimination of private insurance companies. Buttigieg, however, sees his plan as an opportunity for private insurance companies to step up.

“The way I come at it is with a certain humility about what’s going to happen,” Buttigieg said. “Because one of two things will happen. Either, there’s really no private option that’s as good as the public one we’re going to create … which means pretty soon everyone migrates to it and pretty soon it’s Medicare for all.”

“Or, some private plans are still better, in which case we’re going to be really glad we didn’t command the American people to abandon them whether they want to or not,” Buttigieg said. “I’m neutral on which one of those outcomes happen.”

According to Politico, although there is no official cost for what Medicare for All Who Want It would cost, a campaign adviser said the federal spending would “be in the ballpark” of $790 billion.

“The core principle is not whether or not the government is your health insurance provider,” Buttigieg said. “The core principle for me is you get covered one way or the other. That’s what Medicare for All Who Want It entails.”

Bernie Sanders admits he was ‘dumb’ for ignoring symptoms ahead of heart attack

Sen. Bernie Sanders (I-Vt.) is turning his heart attack into a PSA.

The 2020 candidate was hospitalized last week with what his doctors later said was a heart attack, leading Sanders to suspend his campaign events and a forthcoming Iowa ad buy. Sanders hasn’t said if he’ll resume campaigning before the Oct. 15 primary debate, but he does have a universally agreeable message in the meantime.

Sanders gave a health update at his home on Tuesday, telling reporters he was on his way to meet with a new cardiologist. “I must confess, I was dumb,” he said. Despite being “born” with “a lot of energy” and usually handling multiple rallies a day without a problem, “in the last month or two,” Sanders said he’d been “more fatigued than I usually have been.” “I should’ve listened to those symptoms,” Sanders continued, and then advised listeners to do the same “when you’re hurting when you’re fatigued when you have pain in your chest.”

Bernie Sanders is meeting a cardiologist this morning. A new doctor he has not met with before. Before he left he told reporters that he was “dumb” and should’ve listened to the warning signs his body was sending him prior to his heart attack.

Sanders first tied his hospitalization to his campaign in a tweet last week expressing his thanks for “well wishes,” “great doctors,” and “good health care.” “No one should fear going bankrupt” if they experience a medical emergency, he continued, and added in a call for “Medicare for All!”

What a dumb comment but it seems to follow how dumb Bernie is to neglect his heart disease however, he is telling us all about health care. And remember that Bernie has Congressional Blue Cross Blue Shield health care insurance, the best in the world!

 

The Democrats’ Gamble on Health Care for the Undocumented; but What About Our Own Citizens and Medicare?

health298Several 2020 candidates are proffering moral and policy arguments for providing coverage, but the politics of the move are another matter. “We” are now worried more about the undocumented immigrants than our own citizens? This is really an indication as to the idiocy seeping into all aspects of our society, especially during this competitive race for the Presidency.

Ronald Brownstein reported that anxiety spiked among many centrist Democrats when all 10 presidential candidates at a recent debate raised their hand as if pledging allegiance, to declare they would support providing health care to undocumented immigrants. The image, which drew instant ridicule from President Donald Trump on Twitter, seemed to encapsulate the primary’s larger lurch to the left during the early stages of the 2020 race, which has unnerved many moderates.

But opinion among the candidates on this polarizing question is actually much more divided than that moment suggested. And that division underscores a larger point: While the most left-leaning positions in the Democratic field have attracted the most attention in the race so far, it’s far from certain the party will pick a nominee who embodies them.

Led by Senator Bernie Sanders, nearly a half-dozen 2020 Democrats have embraced a clear position of offering full access to health-care benefits. Others, including former Vice President Joe Biden, the nominal front-runner, oppose full benefits, although that wasn’t apparent at the debate. The latter group would allow undocumented immigrants to purchase coverage through the exchanges established by the Affordable Care Act, but only with their own money. That approach would cover far fewer people, but also potentially create much less exposure to Republican counterattacks.

“If we are saying that we can put them into the pools and they can buy on the exchange, I don’t think voters are going to flip out on that because there is no subsidy,” says Matt Bennett, the executive vice president for public affairs at Third Way, a leading organization of Democratic centrists. “But I think beyond that gets pretty dicey.”

This debate affects millions of people. The Kaiser Family Foundation, using census data, has estimated that 47 percent of the country’s roughly 11 million undocumented immigrants are uninsured, compared with one-fourth of legally present immigrants and about one-tenth of American citizens. Similarly, the Urban Institute places the number of uninsured undocumented immigrants at nearly 4.9 million, or about one-sixth of the total population of uninsured people in America.

The case for expanding their health-care access rests on financial, public health, and moral arguments. Supporters contend that it’s cheaper to provide access to medical care upfront, rather than deal with health crises in emergency rooms; that allowing the undocumented to go untreated increases health risks for legal residents who come in contact with them; and that it is unjust to let people face health threats without care, regardless of their status. As Biden put it in a recent interview with CNN, “How do you say, ‘You’re undocumented. I’m going to let you die, man’? What are you going to do?” The counterargument, meanwhile, is that it’s unfair to ask taxpayers to subsidize their care, and that covering the undocumented will act as a “magnet” to incentivize more immigration.

Emergency rooms must provide aid to all who need it. But polls have consistently found that most Americans resist offering public benefits to the undocumented beyond that. In a recent CNN survey, Americans by a solid 3–2 margin said that “health insurance provided by the government” should not be available to immigrants here illegally. The idea faced resistance across a wide array of constituencies, including several that Democrats rely on: Just over half of college-educated white voters, half of young adults ages 18 to 34, and more than two-fifths of nonwhites said they opposed providing coverage for the undocumented. At the same time, three-fifths of voters who identified as Democrats or lean Democratic said they support the idea.

This mixed result leaves the 2020 candidates balancing competing political and policy considerations as they confront the question. In the process, they have reopened a debate that extends back to the consideration of the ACA during former President Barack Obama’s first year in office.

The original version of the ACA, passed by the Democratic-controlled House in November 2009, allowed undocumented immigrants to purchase insurance on the law’s exchanges with their own money. But it denied them eligibility for the subsidies the law established to help the uninsured afford such coverage, and it maintained their exclusion from Medicaid, which the ACA expanded to cover more of the working poor.

The Democratic-controlled Senate—and the Obama White House—would not even go as far as to allow them to buy into the exchanges. Republicans and conservatives had seized on the charge that the ACA would provide the undocumented with benefits as one of their talking points against the proposed law; when Republican Representative Joe Wilson of South Carolina famously yelled “You lie” at Obama during his 2009 speech to Congress about his health-care proposal, it was in response to Obama’s insistence that the law would not cover those in the U.S. illegally.

To a degree that’s been largely forgotten today, passing the ACA was a herculean political challenge. Presidents Bill Clinton, Richard Nixon, and Harry Truman had all failed to pass universal-coverage bills; indeed, none of them had even advanced their proposal as far as a floor vote in either chamber. Within the Obama administration, resolving the issue of health coverage for the undocumented was widely viewed as one brick too many on the load.

Rahm Emanuel, who directed the legislative fight for the ACA as Obama’s chief of staff, recalled in an interview that pressure for covering the undocumented never developed “in any concerted way,” and that “no one seriously demanded it.” Neera Tanden, who served as a senior adviser to former Health and Human Services Secretary Kathleen Sebelius, remembered the debate inside the administration in similar terms. “I don’t remember considering this at all,” said Tanden, now the president of the Center for American Progress, a leading liberal think tank.  The “whole issue was a lot more toxic then.”

The final ACA bill that Obama signed into law, on March 2010, completely excluded undocumented immigrants from the system. Even when Obama later instituted the Deferred Action for Childhood Arrivals program to block the deportation of young people brought into the country illegally by their parents, the administration denied them access to benefits under the ACA, notes Eric Rodriguez, the vice president for policy and advocacy at UnidosUS, a leading Latino group.

Toward the end of 2016, the Obama administration had an opportunity to reconsider at least one aspect of that policy. California passed legislation allowing the undocumented to buy coverage on state-run exchanges with their own money (without any public subsidy) and requested a waiver from the federal government to implement the policy. Anthony Wright, the executive director of the advocacy group Health Access California, which helped pass the law, said the state argued that opening up the exchanges made sense because as many as 70 percent of undocumented Californians were in “blended” families that included American citizens. “The argument we made was … isn’t there a benefit to allowing the whole family to buy into coverage at the same time? Rather than to tell these families we can cover the kid and maybe the mother, but the father has to go to buy coverage from a broker independently?” Wright recalled in an interview.

The issue was never resolved. The state submitted its waiver request too late in 2016 for the Obama administration to rule before it left the office. Once Trump took control, California withdrew its request because he was virtually certain to reject it.

Hillary Clinton had moved the party’s position in a more inclusive direction during the 2016 campaign, although her policy didn’t attract nearly as much attention as the hand-raising moment at last week’s debate. Clinton ran, essentially, on House Democrats’ initial proposal in the early days of the ACA debate: that the undocumented should be allowed to buy coverage on the exchanges, though without any subsidies to help.

Three years later, the current slate of candidates seems to have significant differences in how they would treat the undocumented, even if, as a group, they have moved beyond the Obama administration’s more cautious position on the ACA. Biden and Senator Michael Bennet of Colorado, both of whom raised their hand at the debate last month, are taking a similar position to House Democrats’ in 2009 and Clinton’s in 2016: In addition to opening the ACA exchanges to the undocumented, they would also allow them to buy into the new public insurance option they would create through an expanded Medicare system. But they would still deny the undocumented any public assistance. Biden, in his CNN interview, put greater emphasis on expanding federally funded community-health clinics as a means of delivering more health care to undocumented immigrants than he has on offering them insurance.

At the other pole of the debate is Sanders’s Medicare for All proposal, which would entitle the undocumented to the same health-care services as anyone else in America. The actual language of the bill is less definitive: It says that while “every individual who is a resident of the United States is entitled to benefits for health care services under this Act,” the federal government will promulgate regulations for “determining residency for eligibility purposes.” But in response to a health-care questionnaire from The New York Times, Sanders unequivocally included the undocumented in his system: “Medicare for All means just that: all. Bernie’s plan would provide coverage to all U.S. residents, regardless of immigration status,” his campaign wrote.

In response to my questions, the campaigns of Senators Kamala Harris of California, Elizabeth Warren of Massachusetts, and Cory Booker of New Jersey said they would provide full benefits to the undocumented; so would former Housing and Urban Development Secretary Julián Castro.

South Bend, Indiana, Mayor Pete Buttigieg made a passionate case for covering the uninsured during last month’s debate, but his campaign would not specify his exact plan for doing so, particularly whether he would subsidize coverage with public dollars. Former Representative Beto O’Rourke of Texas likewise would not nail down his position on that point.

“This issue is one of many reasons Beto believes that comprehensive immigration reform must be a top priority,” Aleigha Cavalier, his national press secretary, said in a statement. “Because our laws rightly require hospitals to provide care to everyone, the cost of care for uninsured individuals is currently shifted onto other consumers. Therefore, it is in everyone’s interest to provide a pathway for obtaining insurance, whether through the ACA, a new universal healthcare program, or on the private market.”

The rub for both health-care and immigration advocacy groups seems to be the matter of public subsidies. What has become the more centrist position—of allowing undocumented people to purchase coverage on their own—generates mixed feelings: The advocates consider it a valuable gesture, but little more than that, because so few could afford health coverage without assistance.

Wright, for instance, says, “any step toward inclusion is a positive one.” But he notes that when California offered its coverage proposal to the Obama administration, his group estimated that probably fewer than 30,000 of the estimated 1.5 to 2 million uninsured undocumented immigrants in California could afford to buy coverage.

Rodriguez stressed the limited practical impact of the position Biden and Bennet are endorsing now. “If you don’t have subsidies, there is no affordability to get into the system,” he says. “Symbolism these days are still important. The fact that all the candidates raised their hands [to cover the undocumented], that’s not insignificant. But what would be meaningful is proposals that would enable families [to] afford coverage.”

California pushed the debate into another front this week. Governor Gavin Newsom signed a budget that makes California the first state to cover undocumented young adults ages 19 to 26 under its Medicaid program; the state had already extended eligibility to undocumented children under 18 and to pregnant women.

Wright noted that the expansion was, from a cost perspective, a relatively small component of a much larger package, one that focused on providing middle-class families more financial help to afford health care. That linkage, he argues, is the key to winning public acceptance for greater aid to the undocumented.

“There will always be a group of folks who are animated by the immigration issue and that just might be something they are opposed to, period,” he said, basing his analysis on focus groups and polls his group has conducted in California. “But if they see an effort to help people broadly, most people don’t begrudge others being helped as part of that process.”

With either modest steps—or big leaps—toward providing undocumented immigrants health coverage, that may be exactly the wager Democrats are placing in 2020.

The poll of The Day: Faith in Trump’s Phantom Health Care Plan

Yuval Rosenberg of the Fiscal Times noted that American voters aren’t quite sure what to make of the latest lawsuit seeking to strike down the Affordable Care Act.

While legal experts have largely dismissed the lawsuit, now before a federal appeals court, as meritless, a new Morning Consult survey of 1,988 registered voters finds a much more divided electorate.

Nearly half of voters, 44%, say the GOP-led lawsuit isn’t likely to bring down Obamacare, compared to 37% who say it might. Those views fall along predictably partisan lines:

Screen Shot 2019-07-14 at 9.50.04 PM.pngMore surprising is that voters who expect the ACA to be overturned express a fairly high level of confidence that President Trump has a plan to replace it. The GOP has thus far failed to come to a consensus about how to replace Obamacare, and Trump has yet to reveal a promised health care plan. Yet 60% of voters who think Obamacare may be struck down are confident the administration has a plan of its own, including 87% of Republicans.

Analysts and pundits have warned that, if the lawsuit were to succeed, it would be a disaster for Republicans — and GOP lawmakers have shown little desire to grapple with a health care overhaul again before the 2020 elections.

The Morning Consult poll also found that voters are increasingly placing responsibility for the state of the U.S. health care system on Trump — and half of the voters say the system has gotten worse over the past decade.Screen Shot 2019-07-14 at 9.46.48 PM

And now back to our discussion on the history of Medicare:

The benefits that the various states were required to provide recipients were:

  1. Inpatient hospital care (other than in an institution for tuberculosis or mental disease),
  2. Outpatient hospital services
  3. Laboratory and x-ray services
  4. Nursing facility services for those over the ages of twenty-one (and, after July 1, 1970, to home health services
  5. Physicians” services, regardless of the location of treatment.

Also, the states could underwrite many other services such as physical therapy, dental care, diagnostic, preventive, and rehabilitative services, and the cost of prescribed drugs, dentures, prosthetic devices, and eyeglasses. Those elderly that were insured by Medicare but were also eligible because of the incomes for Medicaid had their hospital deductibles and copayments paid by Medicaid.

The Johnson administration then went on in 1967 to propose amendments to the Social Security program that included extending Medicare benefits to the disabled who were otherwise eligible for cash payments. To pay for this extension, a higher earnings base on which Medicare taxes would be levied was recommended. So, from then on the current $6,600, the amount as to rise to $7,800 in 1968, to $9,00 in 1971, and in 1974 and thereafter would rise to $10,800.

However, despite the strong support from the Johnson administration, the House Ways and Means Committee voted to defer consideration of the extension in light of the substantial costs associated with the amendment. The administration tried to present the case that the medical costs for each disabled beneficiary would be about the same as those associated with Medicare recipients over the age of 65. But a study released while the bill was before the committee indicated that in fact, these costs would be about two and a half to three times as high.

And to no one’s surprise looking at healthcare today, following the first year of operation of the Hospital Insurance program that its costs significantly exceeded the estimates put forward by the program’s proponents. You have to remember that the main purpose of enacting a national health insurance bill had been, after all, to encourage greater use of health care facilities by the elderly. It was therefore not surprising that with the measure’s passage there should have been an increased demand for hospital and medical services. However, not only was there greater utilization of medical facilities on the part of those covered by the Medicare program, but there followed a far higher increase in the prices of covered services than had been expected. Congress reviewed the data and increased the contribution schedule along the lines suggested by the administration despite its not having incorporated the disabled among the program’s beneficiaries.

By 1972 the costs associated with Medicare had increased at such a rate that even the administration and Congress were expressing concern. What followed was a number of studies to examine the causes and I will discuss this more next week. So, imagine the passage of Medicare for All and the true costs!!

I have finally decided that our society is crazy and I probably have said this before. I was reading about Nike’s decision to not sell the sneakers with the Betsy Ross flag on the back of the shoe because Mr. Kaepernick decided that the flag was racist. Did the company realize that Betsy Ross was a Quaker and that Quakers were Abolitionists who helped ban slavery in England? Also, Quakers were vital to the American Underground Railroad to free slaves. Objecting to the Betsy Ross flag, because it represents slavery, shows complete and utter ignorance of history!!

More next week!