Category Archives: Pros and Cons of Medicare for All

US Health-Care Prices Are Off the Charts, Pros and Cons of Public vs Private healthcare and possible Financing of Medicare for All

After listening to the debates and the House debating and finally voting to approve the Articles of Impeachment I can actually say that I am embarrassed for we Americas and our Country. We all look like such fools! I say this because I have read critically the transcripts of the phone call that President Trump made to the President of Ukraine, listened to the witnesses in the case and have found no credible data to support an Impeachment. But how can one argue with the Hate of the party that lost the 2016 election? But on to discuss additional information on healthcare.

Michael Rainey of the Fuscal Times reported that a CT scan of the abdomen typically costs more than $1,000 in the U.S., but the same procedure in the U.K. costs $470, while in the Netherlands it costs just $140. Those numbers come from a new report, released Tuesday by the Health Care Cost Institute and the International Federation of Health Plans, that compares private insurance health-care prices in the U.S. to those in a sample of other wealthy countries – and finds that the U.S. is just about always the most expensive.

“The median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the iFHP study,” the report says. “Figure 1 [below] shows the prices paid for medical services in each country as a percent of the US price.”

Note that U.S. prices are marked by the red dots. In almost every case, the prices in other countries are just a fraction of the U.S. price. (Avoid getting cataract surgery in New Zealand, apparently.) 

The report also looks at drug prices, and finds that with only one exception, prices in the U.S. are the highest in the group. Harvoni, used to treat hepatitis C, costs $4,840 in South Africa and $12,780 in the Netherlands, but it costs more than twice that ($31,620) in the U.S. Similarly, a Humira pen, used to treat arthritis, costs $860 in the U.K., but $4,480 in the U.S.

“Drug prices for most countries were less than half the US price for most of the administered and prescription drugs included in the study,” the report says.

Writing about the report Tuesday, Vox’s Dylan Scott said that high medical prices in the U.S. have many causes, but one in particular stands out: “The US is still the wealthiest country in the world. It’s home to the world’s leading biopharmaceutical industry. It tends to have the most cutting-edge treatments. All this contributes to higher prices here than elsewhere. But one big and unavoidable culprit is the lack of price regulation.”

American health care is a farce

Rick Newman reported that the cost of private health insurance is skyrocketing. Medicare will run short of money soon. About 28 million Americans still lack health insurance.

Are your elected officials on it? NOPE! Why should they be. They get generous coverage through a choice of plans and enjoy taxpayer subsidies covering most of the cost. So they’ve taken care of themselves, which is the only thing that matters in Washington.

Wait, that’s not quite correct. Republicans are also determined to keep hacking away at the Affordable Care Act, now in place for 9 years. A GOP lawsuit—backed by the Trump administration—claims the entire ACA is unconstitutional, because in 2017 Congress repealed the penalty for people who lack insurance. It’s a convoluted argument, yet an appeals court recently upheld part of the case and sent the rest back to a lower-court judge, to assess which other parts of the ACA to kill. The law isn’t dead yet, and it might ultimately survive, but it could take the Supreme Court to rescue the ACA from its third or fourth near-death experience.

So here’s the story: There’s a health care crisis in the United States, with millions of people lacking care and many millions more facing costs that are rising far faster than their incomes. Health care costs are devouring both the family and the federal budget. And many workers stay in jobs they’re not suited for simply for the health benefits. Yet Republicans are trying to take care away from about 18 million Americans, and repeal the ACA’s prohibition against denying coverage to people with preexisting coverage. Their answer to giant problems of access and affordability is to make coverage even harder to obtain and drive up costs even more.

The Democrats have answers! Presidential candidates Bernie Sanders and Elizabeth Warren want to annihilate the private insurance system and create a government program, Medicare for All, which would be 15 times larger than the ACA Republicans hate so much. Sure, that’ll work. In response to obstinate political opposition, peddle a fantasy plan that generates even more furious resistance. And tell voters you refuse to compromise because it’s more important to stand for the right thing than to actually accomplish something that could improve people’s lives.

There are better ideas out there. Democrats such as Joe Biden, Pete Buttigieg and Amy Klobuchar favor enhancements to the ACA and a new public option that would provide coverage to nearly all the uninsured while leaving private insurance in place, for those who want to stick with that. It will never get Republican support, since Republicans favor the law of the jungle over government aid. But a Bidenesque plan could happen in the unlikely event a few reddish states grow momentarily sensible and elect a few pragmatic Democrats, including a majority in both the House and Senate.

If that doesn’t happen, we can look forward to posturing on both sides that will fool some voters into thinking politicians care, without accomplishing anything likely to help. The Trump administration is pushing a new plan that would allow states to import prescription drugs from Canada, which enforces price controls that make drugs cheaper. Great idea, as long as Canada has no problem diverting drugs meant for Canadians back to America, where many of the drugs come from in the first place. Why doesn’t America just impose its own price controls? Because pharmaceutical companies own Senate Majority Leader Mitch McConnell and many other members of Congress, who won’t let it happen. So Trump is hoping more principled Canadian legislators will help Americans gets cheaper drugs made in America by American companies.

At least you’ll be free of all these worries once you turn 65, and Medicare kicks in. Except Medicare is going to run short of money starting in 2026, and will eventually be able to pay only about 77% of its obligations. So here’s the real health care plan: Don’t get sick until you turn 65, and then, get just 77% as sick as you would have otherwise. Or just move to Canada.

Pros and cons of private, public healthcare

A study by Flinders University found that the rising cost of private health cover and public hospital standards raise concerns among heart patients to obtain the best outcomes.

In one of the few direct comparisons, medical researchers in South Australia have analyzed data from pacemaker and defibrillator implant surgeries in all public and private hospitals in New South Wales and Queensland between 2010 and 2015 to make an assessment of medical safety outcomes, including infection levels and mortality.

Overall the outcomes were quite similar, says lead researcher Flinders cardiologist and electrophysiologist Associate Professor Anand Ganesan, who joined other Flinders University and University of Adelaide researchers in a new article just published in the Royal Australasian College of Physicians Internal Medicine Journal.

“There is growing community interest in the value of private health insurance and, to date, there are few head-to-head studies of the outcomes of care in public and private hospitals to compare the same service with adjustments for differences in patient characteristics,” says Associate Professor Ganesan, a Matthew Flinders Research Fellow and National Heart Foundation Future Leader Fellow.

“We believe our results are of community interest for patients to assess the value and benefit of private health insurance, as well as for policymakers who decide on resource allocations between the public and private healthcare systems.”

He stressed that further “head-to-head” studies are needed across all major medical procedures to provide patients and clinicians in both the public and private system with the most up-to-date safety information.

The population level study of pacemaker complications found few key differences in overall major safety issues, although there were slightly higher infection rates in public hospitals but slightly lower acute mortality rates compared to the private hospital system.

This could be connected to the greater number of older, frail patients relying on private health cover—and greater number of people in the public system—although further studies were needed to explain these differences.

Associate Professor Ganesan says more regular comparative assessments of public versus private hospital care quality are very important, particularly for Australian health consumers.

Australia’s hospitals account for more than 40% of healthcare spending with a cumulative cost exceeding $60 billion per annum. Hospital care in Australia is delivered by a combination of 695 public (or 62,000 beds) and 630 private sector hospitals (33,100 beds).

The research paper, “Complications of cardiac implantable electronic device placement in public and private hospitals” has been published in the Internal Medicine Journal.

Budget watchdog group outlines ‘Medicare for All’ financing options

So, one of my oppositions to the program Medicare for All has been the question as to financing the program. The Committee for a Responsible Federal Budget (CRFB) on Monday released a paper providing its preliminary estimates for various ways to finance “Medicare for All,” as the issue of how to pay for such a health plan has taken center stage in the Democratic presidential primary.

“Policymakers have a number of options available to finance the $30 trillion cost of Medicare for All, but each option would come with its own set of trade-offs,” the budget watchdog group wrote. 

The issue of how to pay for Medicare for All — single-payer health care that eliminates premiums and deductibles — has become a key discussion topic in the Democratic presidential race.

Sen. Elizabeth Warren (D-Mass.), one of the top tier 2020 hopefuls, recently said that she would release a financing plan for her Medicare for All proposal after being criticized by some of her rivals in the primary race for refusing to give a direct answer about whether she’d raise taxes on the middle class to pay for the massive health care overhaul. 

CRFB said most estimates find that implementing Medicare for All would cost the federal government about $30 trillion over 10 years.

“How this cost is financed would have considerable distributional, economic, and policy implications,” the group wrote.

CRFB provided several options that each could raise the revenue needed to pay for Medicare for All. These included a 32 percent payroll tax, a 25 percent surtax on income above the standard-deduction amount, a 42 percent value-added tax, mandatory premiums averaging $7,500 per capita, and more than doubling all individual and corporate tax rates.

The group estimated that Medicare for All could not be fully financed just by raising taxes on the wealthy.

CRFB also estimated that cutting all nonhealth spending by 80 percent, or by more than doubling the national debt, so that it increased to 205 percent of gross domestic product, could finance Medicare for All.

The group said that the financing options it listed could be combined, or that policymakers could reduce the cost of Medicare for All by making it less generous.

“Adopting smaller versions of several policies may prove more viable than adopting any one policy in full,” CRFB wrote. 

CRFB said that most of the financing options it listed would on average be more progressive than current law, but most of the financing options would also shrink the economy.

Out-of-pocket costs for Medicare recipients will rise in the New Year

Dennis Thompson reviewed the future costs of Medicare since the Democratic primary discussion seems to point to Medicare or All. He noted that the standard monthly premium for Medicare Part B would rise $9.10, to $144 a month, the U.S. Centers for Medicare and Medicaid Services (CMS) announced.

The annual deductible for Part B also will increase $13 to $198 per year, CMS said.

Both increases are relatively large compared to 2019, when the Part B premium rose $1.50 a month and the deductible $2 for the year.

“This year there’s an unusual tick up in the Part B premium that could be a real concern for people living on a fixed income,” said Tricia Neuman, director of the Henry J. Kaiser Family Foundation’s Program on Medicare Policy.

The Part B premium increase will affect people enrolled in original Medicare as well as those who are covered under Medicare Advantage, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“One thing I definitely wanted to make clear is that the increase in the Part B premium itself also applies to everyone on Medicare Advantage,” he said. “People on Medicare Advantage have to continue to pay the part B premium.”

Some, but not all, Medicare Advantage plans cover the Part B premium as part of their package, Lipschutz added.

The annual inpatient hospital deductible for Medicare Part A is also increasing to $1,408 a year, up $44. In 2019, the increase was $24.

These cost increases will wipe out much of the 1.6% cost-of-living (COLA) increase for Social Security benefits in 2020, CBS News reported. The COLA amounts to about $24 extra a month for the average retiree.

Medicare Part A covers inpatient hospital stays, nursing facility care and some home health care services. Part B covers doctor visits, outpatient hospital treatment, durable medical equipment, and certain home health care and medical services not covered by Part A.

Unless Congress acts, the prescription benefit in Medicare Part D also will start drawing a lot more money out of the pockets of seniors taking pricey drugs, the experts added.

The Affordable Care Act (ACA) included a provision that limited how much a senior with Part D would pay out-of-pocket after reaching a “catastrophic coverage” threshold, Neuman and Lipschutz said.

Once they reach that threshold, seniors pay 5% of their prescription costs. Until then, they pay 25% of the costs for brand-name drugs and 37% of generic drug costs.

But that ACA provision expires this year. When that happens, the catastrophic coverage threshold will jump $1,250, the Kaiser Family Foundation estimates. People will have to pay $6,350 out-of-pocket before reaching the threshold.

“There will be a jump up in the threshold, which means that people with high drug spending will have to pay more before they can get this extra help,” Neuman said.

Both the Senate and the House of Representatives have bills in the works that could address this Part D increase, but it’s hard to predict whether Congress will be able to cooperate on a solution, Neuman and Lipschutz said.

“No matter what your allegiances are, everyone agrees something should be done about the high cost of prescription drugs,” Lipschutz said.

It’s not all bad news, however.

Folks with Medicare Advantage are expected to pay lower premiums, even with the increase in Part B, according to the CMS.

On average, Medicare Advantage premiums are expected be at their lowest in the past 13 years, and 23% lower than in 2018, the CMS said.

Medicare Advantage enrollees also will have more plans to choose from. The Kaiser Family Foundation estimates that the average beneficiary will have access to 28 plans, compared with a low of 18 in 2014.

Original Medicare is the traditional fee-for-service program offered by the federal government, while Medicare Advantage plans are an alternative provided through private insurance companies.

Medicare beneficiaries spent an estimated $5,460 out-of-pocket for health care in 2016, according to the Kaiser Family Foundation. About 58% went to medical and long-term care services, with the remainder spent on premiums for Medicare and supplemental insurance.

So, the ultimate question is :

Equal health care for all: A philosopher’s answer to a political question

The University of Pennsylvania staff asked the question-Should access to health care, especially in life-threatening situations, depend on whether you can afford it? Absolutely not, says Robert C. Hughes, Wharton professor of legal studies and business ethics, who compared health care systems in the U.K., Canada, and Australia. He writes about this question and other issues in a recent paper titled, “Egalitarian Provision of Necessary Medical Treatment.”

Hughes identifies two key features of an egalitarian health care system. First, he argues, it would protect people’s liberty to ensure that access to money does not decide if people get the health care they need. Second, it would promote stability and encourage people to be law abiding. “The central finding of [my research] is that it’s morally necessary to make sure that people’s finances don’t affect their ability to get truly medically necessary treatment,” he says.

Hughes favors universal health care coverage in the U.S. Further, in order to ensure that everybody has access to the medical care they need, he says one option is to eliminate private health insurance for coverage provided under “Medicare for All,” the solution that Democratic presidential candidates Elizabeth Warren and Bernie Sanders have proposed. Hughes explores what legislators, the pharmaceutical industry, and other health care providers could do to ensure a fair health care system where private parties don’t get to decide who is eligible for what treatments.

I mentioned my embarrassment and disappointment in our political system we all have to give thanks for all the good things in our lives. As Christmas approaches we all should reflect on the good in our lives and enjoy the Holiday including family and friends. Merry Christmas, Happy Hanukkah, and Happy Kwanzaa! And I hope Santa leaves coal in all the stockings of our politicians who can’t even do the job that we the voters asked them to do when we voted them in. Oh, how you are making a mockery of the system in the games that you all are playing!

I have been avoiding the discussion regarding single payer system, what it is, how it would work and what are the consequences, etc.? More to come! 

Again, Democrats Spar at Debate Over Health Care, How to Beat Trump and Could Medicare for All Really Go Horribly Wrong?

 

deal549[5953]Was there anything different about last week’s Democratic debate? Bill Barrow, Will Weissert and Jill Colvin reported that the Democratic presidential candidates clashed in a debate over the future of health care in America, racial inequality and their ability to build a winning coalition to take on President Donald Trump next year.
The Wednesday night faceoff came after hours of testimony in the impeachment inquiry of Trump and at a critical juncture in the Democratic race to run against him in 2020. With less than three months before the first voting contests, big questions hang over the front-runners, time is running out for lower tier candidates to make their move and new Democrats are launching improbable last-minute bids for the nomination.
But amid the turbulence, the White House hopefuls often found themselves fighting on well-trodden terrain, particularly over whether the party should embrace a sweeping “Medicare for All” program or make more modest changes to the current health care system.
Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, the field’s most progressive voices, staunchly defended Medicare for All, which would eliminate private insurance coverage in favor of a government-run system.
“The American people understand that the current health care system is not only cruel — it is dysfunctional,” Sanders said.
Former Vice President Joe Biden countered that many people are happy with private insurance through their jobs, while Mayor Pete Buttigieg of South Bend, Indiana, complained about other candidates seeking to take “the divisive step” of ordering people onto universal health care, “whether they like it or not.”
Democrats successfully campaigned on health care last year, winning control of the House on a message that Republicans were slashing existing benefits. But moderates worry that Medicare for All is more complicated and may not pay the same political dividend. That’s especially true after Democrats won elections earlier this month in Kentucky and Virginia without embracing the program.
“We must get our fired-up Democratic base with us,” said Sen. Amy Klobuchar of Minnesota. “But let’s also get those independents and moderate Republicans who cannot stomach (Trump) anymore.”
The fifth Democratic debate unfolded in Atlanta, a city that played a central role in the civil rights movement, and the party’s diversity, including two African American candidates, was on display. But there was disagreement on how best to appeal to minority voters, who are vital to winning the Democratic nomination and will be crucial in the general election.
Sens. Kamala Harris of California and Cory Booker of New Jersey said the party has sometimes come up short in its outreach to black Americans.
“For too long, I think, candidates have taken for granted constituencies that have been a backbone of the Democratic Party,” Harris said. “You show up in a black church and want to get the vote but just haven’t been there before.”
Booker declared, “Black voters are pissed off, and they’re worried.”
In the moderators’ chairs were four women, including Rachel Maddow, MSNBC’s liberal darling, and Ashley Parker, a White House reporter for The Washington Post. It was only the third time a primary debate has been hosted by an all-female panel.
Buttigieg — who was a natural target given his recent rise in the polls to join Biden, Warren and Sanders among the crowded field’s front-runners — was asked early about how being mayor of a city of 100,000 residents qualified him for the White House.
“I know that from the perspective of Washington, what goes on in my city might look small,” Buttigieg said. “But frankly, where we live, the infighting on Capitol Hill is what looks small.”
Klobuchar argued that she has more experience enacting legislation and suggested that women in politics are held to a higher standard.
“Otherwise we could play a game called ‘Name your favorite woman president,’ which we can’t do because it has all been men,” she said.
Another memorable exchange occurred when Biden — who didn’t face any real attacks from his rivals — was asked about curbing violence against women and responded awkwardly.
“We have to just change the culture,” he said. “And keep punching at it. And punching at it. And punching at it.”
Harris scrapped with another low polling candidate: Hawaii Rep. Tulsi Gabbard, who has criticized prominent Democrats, including 2016 nominee Hillary Clinton.
“I think that it’s unfortunate that we have someone on the stage who is attempting to be the Democratic nominee for the president of the United States who during the Obama administration spent four years full time on Fox News criticizing President Obama,” Harris said.
“I’m not going to put party interests first,” Gabbard responded.
But the discussion kept finding its way back to Medicare for All, which has dominated the primary — especially for Warren. She released plans to raise $20-plus trillion in new government revenue for universal health care. But she also said implementation of the program may take three years — drawing criticism both from moderates like Biden and Buttigieg, who think she’s trying to distance herself from an unpopular idea, and Sanders supporters, who see the Massachusetts senator’s commitment to Medicare for All wavering.
Sanders made a point of saying Wednesday that he’d send Medicare for All legislation to Congress during the first week of his administration.
Booker faced especially intense pressure Wednesday since he’s yet to meet the Democratic National Committee’s polling requirements for the December debate in California. He spent several minutes arguing with Warren about the need to more appropriately tax the wealthy, but also called for “building wealth” among people of color and other marginalized communities.
“We’ve got to start empowering people,” Booker said.
Businessman Andrew Yang was asked what he would say to Russian President Vladimir Putin if he got the chance — and joked about that leader’s cordial relationship with Trump.
“First of all, I’d say I’m sorry I beat your guy,” Yang said with a grin, drawing howls of laughter from the audience.
Is Warren retreating on Medicare-for-all?
Almost one week before the fifth Democratic presidential debate, Elizabeth Warren released the latest plan in her slew of policy proposals: An outline detailing how, if elected, she would gradually shift the U.S. toward a single-payer health care system.
“I have put out a plan to fully finance Medicare for All when it’s up and running without raising taxes on the middle class by one penny,” the Massachusetts senator wrote in a post introducing the plan. “But how do we get there? Every serious proposal for Medicare for All contemplates a significant transition period.”
It was a marked shift from her previous calls to quickly bring the country toward Medicare-for-all and, notably, included similar tenets laid out in the health care proposals of more moderate candidates, like former Vice President Joe Biden and South Bend, Indiana Mayor Pete Buttigieg.
In the transition plan, Warren said she would take several steps in her first 100 days in office to expand insurance coverage, like pushing to pass a bill that would allow all Americans to either buy into a government-run program if they wanted, or keep their private insurance. It would extend free coverage to about half of the country, including children and poor families. She would also lower the eligibility age for Medicare to 50 and let young people buy into a “true Medicare-for-all” option.
“Combining the parts into a whole reveals a bit of a mess,” wrote David Dayen of The American Prospect, a progressive magazine. “After putting forward a comprehensive cost control and financing bill, Warren split that apart and asked people to accept two bruising fights to get to her purported end goal. It’s reasonable for people to see that as a bait and switch.”
Rivals portrayed the move as a retreat from one of her most high-profile positions on an issue that voters repeatedly rank as one of the most important. A campaign spokesperson for Biden called the senator’s health stance “problematic,” while Buttigieg’s spokeswoman Lis Smith criticized the latest measure as a “transparently political attempt to paper over a very serious policy problem.”
Vermont Sen. Bernie Sanders, who has wholeheartedly pledged to fight for a single-payer health system, took a swipe at Warren when accepting an endorsement on Friday from the largest nurses’ union in the country.
“Some people say we should delay that fight for a few more years — I don’t think so,” he said, according to The Washington Post. “We are ready to take them on right now, and we’re going to take them on Day One.”
The similarities come as Warren, who experienced a somewhat momentous surge in the polls, has begun to falter. In early October, her national polling climbed to 28 percent, according to a Fox News poll, but since then, her numbers have steadily declined. In the latest Iowa poll, Buttigieg pulled ahead of Warren by a staggering nine percentage points, indicating the 37-year-old could be a serious contender.
The timing of the seeming loss of campaign momentum appears to be tied to the release of her sweeping Medicare-for-all proposal at the beginning of November. Warren said it could be paid for with a series of taxes, largely via new levies on Wall Street and the ultra-wealthy (and, she’s repeatedly stressed, none on the middle class).
According to a recent poll conducted by the Kaiser Family Foundation and Cook Political Report, while universal coverage is popular with a majority of Democratic voters, almost two-thirds of voters in key swing states said a national health plan in which all Americans receive their health coverage through a single-payer system was not a good idea.
It also precludes the start of the next debate in Georgia, during which Warren will very likely face fierce criticism and scrutiny over her $20 trillion Medicare-for-all plan and remember the cost is really closer to$52-$72 trillion>
Still, Warren told reporters over the weekend that “my commitment to Medicare for All is all the way,” according to The Associated Press.
And Rep. Pramila Jayapal, the Washington Democrat who introduced the House version of the Medicare-for-all bill, called the plan a “smart approach to take on Big Pharma & private-for-profit insurance companies.”
Medicare for All’s thorniest issue is how much to pay doctors and hospitals. Any new system could become a convoluted mess if it goes wrong.
Earlier this month, Sen. Elizabeth Warren unveiled her $20.5 trillion package to finance Medicare for All, a system that would provide comprehensive health insurance to every American and virtually erase private insurance.
If its details are made reality, it would be nothing short of a sweeping transformation of the way Americans receive and pay for their medical care.
The proposal attempts to address one of the thorniest problems that any candidate pushing for a single-payer system in the US faces: how much to pay doctors and hospitals.
Dismantling the current payment structure and replacing it with another would likely require some tough trade-offs, experts say, creating winners and losers when the dust settles.
Sen. Elizabeth Warren recently unveiled details of her Medicare for All health plan, a system that would provide comprehensive health coverage to every American and virtually erase private insurance.
If its details are made reality, it would be a sweeping transformation in the way Americans get and pay for their medical care. Its the only financing model for universal coverage that a Democratic presidential candidate has rolled out in the primary so far.
It attempts to address one of the thorniest problems any candidate pushing for a single-payer system in the US faces: how much to pay the country’s doctors and hospitals. Pay them too little, and you risk wreaking havoc on their bottom line — and possibly forcing a wave of hospital closures as some critics have warned. Pay them too much, and it becomes much more expensive to finance care for everybody.
“The challenge is that when you expand Medicare to new populations, they’re going to use more healthcare,” Katherine Baicker, a health policy expert who serves as the dean of the University of Chicago Harris School of Public Policy, told Business Insider. “But that means there is going to be a substantial increase in demand for healthcare at the same time that you’re potentially cutting payments to providers.”
Warren has proposed big cuts in payments to many hospitals and doctors in her $20.5 trillion package to bring universal healthcare to the United States. Single-payer advocates argue that eliminating private insurance would lower administrative burdens on doctors and hospitals, freeing them up to treat more insured patients.
Several outside analyses of Medicare for All proposals suggest it can lead to considerable savings through negotiation of lower prices and reduced administrative spending.
The cuts in Warren’s plan are steep, because private insurers currently pay around twice as much as Medicare does for hospital care, according to research from the Center for American Progress, a liberal think tank. Warren’s reform blueprint sets them in line with the Medicare program. Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate.
‘A recipe for shortages’
As a result, those rates would lower doctor pay by around 6.5%, according to an estimate from economists who analyzed the Warren plan. For hospitals, who are used to bigger payments from private insurers, the payments under Warren’s plan would be roughly enough to cover the cost of care, the economists said.
Baicker says the healthcare system may not be prepared to meet the rapid rise in demand, especially if payments fall at the same time.
“You’re going to see people wanting more services at the same time you pay providers less, and that’s a recipe for shortages unless something else changes,” she said.
That echoes a report from the nonpartisan Congressional Budget Office released in May. It found that setting payments in line with Medicare would “substantially” lower the average amount of money providers currently receive. “Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care,” the CBO report said.
Business Insider reached out to the five largest hospital systems to ask the possible effects of lowering payment rates to Medicare levels and whether they would be prepared to weather the transition.
Only one responded: the 92-hospital Trinity Health System based in Michigan.
“Trinity Health supports policies that advance access to affordable health care coverage for all, payment models that improve health outcomes and accelerate transformation, and initiatives that enhance community health and well-being,” spokeswoman Eve Pidgeon told Business Insider.
Pidgeon said that Trinity Health welcomes the dialogue around “critical questions” of financing and access to coverage, and would “analyze Medicare for All proposals as more details emerge.”
The healthcare industry generally opposes Medicare for All
“Trinity Health has a rich tradition of honoring the voices of the communities we serve, and we will continue to dialogue around policy proposals designed to improve affordability, quality and access for all,” Pidgeon said.
The healthcare industry generally opposes Medicare for All, arguing that it would lead to hospital closures and hurt the overall quality of care for Americans.
The American Hospital Association is staunchly against it. In a statement to Business Insider, executive vice president Tom Nickels called it “a one-size -fits-all approach” that “could disrupt coverage for more than 180 million Americans who are already covered through employer plans.”
“The AHA believes there is a better alternative to help all Americans access health coverage – one built on improving our existing system rather than ripping it apart and starting from scratch,” Nickels said.
Meanwhile, the American Medical Association, the nation’s largest physician organization, came out against the single-payer system, though its membership nearly voted to overturn its opposition in June, Vox reported. The group since pulled out of an industry coalition fighting the proposal.
While many big hospitals could face payment cuts, others could benefit, particularly those that mainly serve people with low incomes or who don’t have insurance.
“If you’re a facility serving a lot of Medicaid and uninsured patients today, you might come out ahead here,” Matthew Fiedler, a health policy expert at the Brookings Institution, told Politico. “But the dominant hospitals in a lot of markets that are able to command extremely high private rates today will take a big hit. I don’t think we’d see hospitals closing, but the question is: What would they do to bring down spending?”
Chris Pope, a healthcare payment expert and senior fellow at the conservative Manhattan Institute, said fewer dollars would ultimately mean a cutback in services hospitals would be able to offer. “The less you pay, the less you’re going to get in return.”
“What would likely happen is if you give a fixed lump sum of money, they would start dialing back on access to care,” Pope told Business Insider. “You’re just not going to be able to have a scan done when you need one done.”
The impact on hospitals and doctors
I have pointed these next few points before but thought that it would be worth mentioning again. The surging cost of hospital bills has fanned consumer outrage in recent years as people struggle to afford needed care and helped elevate support for some type of government insurance plan, whether its the more incremental route allowing people to simply buy into a public insurance option or Medicare for All.
In a preview of battles to come, Congress has struggled to pass legislation addressing exorbitant and confusing hospital bills, an issue with widespread public support and bipartisan interest that the White House backed as well, the Washington Post reported in September. Its movement grinded to a halt amid an onslaught of outside spending from doctor and insurer groups.
Dr. Stephen Klasko, chief executive of the Jefferson Health hospital system in Pennsylvania, said the political debate has oversimplified the difficult decisions that would need to be taken in moving to Medicare for All.
“They haven’t been willing to talk about what you would really have to do to bring a dollar and a quarter down to a dollar,” Klasko said, referring to candidates like Warren and Sanders who back universal health coverage.
The hospital executive said that while the nation’s healthcare system is “inefficient” and “fragmented,” slashing overhead wouldn’t necessarily improve the quality of care.
“This myth that there’s these trillions of dollars of administrative costs that are out there in the ether, that’s not true. Every dollar you take away is somebody’s dollar,” Klasko said.
He added that pricing reform on the scale that Warren proposes “is doable,” though there’s likely a caveat.
“It will change how consumers interact with the healthcare system and they won’t get everything they want,” he said.
I’m not sure that Medicare for All will be the Democratic party’s continual push as the debates continue and they realize that moderation to develop a health care system will be the only way to challenge a run against President Trump. I wonder when the rest of the Democratic potential candidates realize that besides the gaffs that former Vice President Biden makes, that improving the Affordable Care Act is the only strategy that may work.
Now I want to wish all a Happy Thanksgiving and hope that we all will appreciate all that we all have and as Mister Rogers said we all need to be Kind, and be Kind and also be Kind. Enjoy you Turkey Day!

Elizabeth Warren’s Number-Crunchers Out of Sync With Her on Some Big Plans and Is Soaking Rich the Answer. And How Did It Work Out for the French?

73495095_2337220289740950_8378943902677204992_nAs a physician and an economist, I am amazed at the lack of knowledge of both medicine and finance by Ms. Warren and her Team as well as the rest of the Democrats running for President as they tout Medicare for All and give up on Affordable Health Care/ Obamacare. Sahil Kapur and Katia Dmitrieva pointed out that Elizabeth Warren is careful to cite economic experts to back up the costs of her multi-trillion-dollar policy plans. But even those experts disagree among themselves about how or whether those plans will work.

University of California Berkeley economists Emmanuel Saez and Gabriel Zucman advised Warren on her wealth tax and say she could raise $2.75 trillion over a decade by imposing a 2% tax on wealth worth $50 million or more, going up to 3% for a wealth of more than $1 billion.

But Mark Zandi, chief economist at Moody’s Analytics who Warren’s campaign asked to review her separate Medicare-for-All funding plan, which includes an additional 3% tax on wealth over $1 billion among other levies, is skeptical it would bring in that much money.

On health care, Zandi has projected that Warren could raise the $20.5 trillion she estimates it will cost to give everyone free health-care without any new middle-class taxes, even though he disagrees with her vision. Saez and Zucman support her policy in general but their funding approach does raise taxes on the middle class.

The disagreements among those who helped shape and gauge her policies highlight the challenges for Warren as she tries to convince voters that she can generate enough revenue to provide free health care, free public college, universal childcare, forgive a portion of student loans and mitigate climate change, among other ambitious policies.

Saez said in an email that Warren’s health care numbers are “reasonable” — with a caveat.

“Scoring is not hard science, and much will depend on the quality of enforcement. Her numbers assume that enforcement will be excellent,” he said. “We believe this is possible but it will require a big and successful push (a big policy change in and by itself).”

Zandi said the Warren wealth tax will be difficult to enforce, with billionaires likely to use multiple loopholes to avoid it. Several European countries experienced this issue when implementing their own tax programs. Warren has said she would empower the Internal Revenue Service to enforce collection, a promise made by many presidential candidates over the years.

“When considering all of Warren’s policy proposals, which includes a number of different tax increases on the wealthy, tax avoidance may be higher than she is assuming. But this doesn’t mean Medicare-for-All or any of other plans won’t be paid for,” Zandi said in an email.

Warren’s plan to pay for her Medicare-for-All proposal, which she released this month under pressure from rivals, increases her wealth tax and is predicated on avoiding any tax increases on the middle class in the hope of avoiding the political blowback such a move would likely bring.

Under Medicare for All, 98% of the money companies now pay for employees’ health care would be shifted to the government instead.

But Saez and Zucman, who priced out Warren’s tax plan, have floated a different way to pay for Medicare-for-All — a progressive tax that may hit some in the middle class, but would compensate by requiring companies to put the money they would have provided to their employees’ health care into higher paychecks.

Saez said Warren’s employer tax “is a tax on the middle class as economists pretty much all believe that such taxes are effectively borne by workers.” But he said workers are already bearing that cost. “Hence, if you count existing premiums as a pre-existing tax, the Warren plan effectively does not ‘increase’ taxes on the middle class.”

A campaign aide said that Zandi was only scoring her health care plan, while Saez and Zucman were advising her on the wealth tax. Warren tweeted Wednesday, “I knew Mark Zandi was skeptical, so I had him check the numbers on my plan to pay for #MedicareForAll. He confirmed they add up.”

Senator Bernie Sanders, who wrote the Medicare-for-All bill that Warren campaigns on, has released his own suggestions for how to fund it. His ideas include a more aggressive wealth tax than Warren’s and a 4% payroll tax which would hit many Americans though overall they would pay lower costs because of health care savings. He has acknowledged the middle-class would pay more in taxes.

Overall, Zandi backs up Warren’s health care math. He said in the email that Warren can finance her plan without raising taxes on the middle class, even though he doesn’t agree with the policy. And even if the rich don’t pay their fair share, she could find those funds elsewhere.

“Warren’s Medicare for All plan isn’t the only way to provide health insurance to all Americans, rein in growing health care costs and improve health care outcomes,” Zandi wrote in a CNN op-ed that was published on Wednesday. “A more tractable approach in my view is to allow those who like their private health insurance to keep it and to build on Obamacare by giving everyone else an option to get Medicare.”

Mark Cuban: Elizabeth Warren’s Medicare-for-all will take years to achieve

Frank Connor pointed out that Elizabeth Warren unveiled a massive overhaul of the U.S. health care system in her single-payer Medicare-for-all plan. However, Dallas Mavericks owner Mark Cuban believes the proposal will take years to accomplish.

“Getting from where we are, to getting there is not something you can accomplish in 4, 8, 12, or even 20 years,” Cuban told FOX Business’, Maria Bartiromo.

Cuban does, however, believe that health care is a right for everyone and that there is a need for people with lower incomes to have access to healthcare. This, he suggested, may indicate an opportunity for a “hybrid plan.”

“Maybe we can expand Medicaid and Medicare and still have a good capitalist system for health care in the middle,” Cuban said.

Business, he argued, cannot operate when there are communities where there is “disruption and social unrest” and so these areas need a basis of health care.

One of the problems with the health care industry, according to Cuban, is a misalignment of incentives between payers and providers.

“The goal of, hopefully, a health care system is to make people healthy,” he said. “And so you don’t get that, you know, when payers, the insurance companies, and the providers work together.”

Cuban described this as a “malicious circle,” suggesting that the parties involved charge each other more in order to make more money.

“None of their metrics have to do with making people healthier,” he said.

The billionaire businessman does not believe the rise of high deductible insurance programs will lead to the growth of a consumer market in health care or lead to customers shopping for health care pricing. He argued high deductible programs are problematic because they make up such a high percentage of their actual income making it more difficult for them to get care.

Additionally, he noted that people don’t shop for care, they make these decisions based on who they trust.

He also believes that artificial intelligence will help the industry.

“As you get more into artificial intelligence and be able to use data more smartly, then you’re going to see a lot of benefits, particularly in radiology,” he said.

France Tried Soaking the Rich. It Didn’t Go Well.

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What about the idea that Elizabeth Warren pushes that the rich should be taxed to the fullest? Noah Smith noted that in recent years, several prominent economists have brought attention to the problem of growing inequality. These scholars include Thomas Piketty, author of the best-selling book “Capital in the Twenty-First Century,” and Emmanuel Saez and Gabriel Zucman, who in a new book chronicle the rise in American wealth inequality. All three embrace the same solution:  much higher taxes. Piketty has declared that billionaires should be taxed out of existence, and he called for a global wealth tax, while Saez and Zucman helped Democratic presidential candidate Elizabeth Warren design her proposal for a U.S. wealth tax. Piketty and Saez have also suggested taxing top incomes at a rate of more than 80%.

Other economists have struggled to evaluate dramatic proposals like this. Studies on the effects of taxation when rates are moderate might not be a good guide to what happens when rates are very high. Economic theories tend to make a host of simplifying assumptions that might break down under a very high-tax regime. Historical experience is of some help because the U.S. had very high top income taxes in the 1950s, but economic conditions could be very different now.

One way to predict the possible effects of the taxes is to look at a country that tried something similar: France, where Piketty, Saez, and Zucman all hail from.

During the past few decades, as income inequality rose in most rich countries, it stayed relatively constant in France. The biggest reason is government redistribution in the form of taxes and social-welfare spending. France leads its rich-country peers, including the legendarily egalitarian Scandinavian countries, on both measures:

France, therefore, shows that inequality, at least to some degree, is a choice. Taxes and spending really can make a big difference.

But there’s probably a limit to how much even France can do in this regard. The country has experimented with both wealth taxes and very high top income taxes, with disappointing results.

France had a wealth tax from 1982 to 1986 and again from 1988 to 2017. The top rate was between 1.5% and 1.8%, with the total tax rate on fortunes larger than 13 million euros ($14.3 million) hovering at about 1.4%. This is much less than the 6% top rate proposed by Warren (not to mention the 8% proposed by her fellow candidate, Senator Bernie Sanders), but it’s close to the 2% rate Warren would impose on fortunes larger than $50 million.

The wealth tax might have generated social solidarity, but as a practical matter, it was a disappointment. The revenue it raised was rather paltry; only a few billion euros at its peak, or about 1% of France’s total revenue from all taxes. At least 10,000 wealthy people left the country to avoid paying the tax; most moved to neighbor Belgium, which has a large French-speaking population. When these individuals left, France lost not only their wealth tax revenue but their income taxes and other taxes as well. French economist Eric Pichet estimates that this ended up costing the French government almost twice as much revenue as the total yielded by the wealth tax. When President Emmanuel Macron ended the wealth tax in 2017, it was viewed mostly as a symbolic move.

Another French experiment was the so-called supertax, a 75% levy on incomes of more than 1 million euros. Introduced by socialist President François Hollande in 2012, the supertax added to the exodus of wealthy individuals, most notably actor Gerard Depardieu and Bernard Arnault, chairman of LVMH Moet Hennessy Louis Vuitton. Star soccer players threatened to go on strike, and there was fear that France would become a wasteland for entrepreneurs. Meanwhile, the supertax raised much less money than even the wealth tax had — only 160 million euros in 2014. The unpopular tax was repealed two years after its adoption.

France’s experiments with taxing the wealthy at very high rates didn’t raise much money and didn’t prove politically sustainable. The flight of wealthy individuals from the country probably helped reduce inequality on paper, but it’s not clear that their departure left France better off.

It’s possible that similar tax experiments in the U.S. might be more successful than in France. The U.S. economy is much larger than France’s; although a French business owner who moves to Belgium can still do business and move about freely within the European Union, an American mogul who moves to Canada might find access to one of the world’s largest markets restricted. That might allow the U.S. to raise more money from high taxes than France ever could.

But it’s also worth noting that France’s wealth tax and supertax ultimately weren’t that important. Despite repealing the supertax, France managed to increase government revenue and to reduce inequality. The end of the wealth tax will probably be a similar story. France simply didn’t need these flamboyant taxes on the rich to have very high levels of taxation and social spending. That means the U.S. probably doesn’t need them either. Tax increases across the board — on top incomes, capital gains, estates, pass-through businesses, corporations, and so on — might not excite populist firebrands, but they’re probably a more effective strategy for fighting inequality.

‘Save public hospitals’, French health workers urge Macron

Gabriel Bourovitch, Clare Byrne and Aurelle Carabiin looked at the French healthcare system and noted that thousands of French hospital workers demonstrated Thursday over years of cutbacks they say have harmed care in a country with a health system once the envy of the world. Also, remember what I pointed out as Medicare for All pays all doctors and hospital Medicare rates- about 50-60 cents on the dollar. You think when Medicare for All reimburses physicians and hospitals that doctors can pay their staff, their medical education bills, malpractice bills as well as run the hospitals? I think not!

Public hospitals in France have been forced to cut 9.0 billion euros ($9.9 billion) off their debts since 2005, leading to the scrapping of hundreds of beds and dozens of operating theatres while stagnant salaries have fuelled a flight to the private sector.

Calling on President Emmanuel Macron to “save public hospitals”, thousands of hospital doctors, nurses, students, and administrative staff held protests in Paris and a dozen other cities on Thursday.

The protests began in March when emergency room staff, who complain of elderly patients being left for hours on trolleys in corridors while waiting for a bed, began strike action.

Over 260 emergency rooms nationwide are still affected by work stoppages.

On Thursday, staff from other hospital departments joined in the protests.

In Paris, organizers said that some 10,000 demonstrators marched through the city waving placards with a message such as: “Exhausted caregivers = endangered patients”, “Public hospitals in a life-threatening emergency” and “The hospital is suffocating, let’s save it.”

In the southwestern city of Toulouse, 3,000 staff took to the streets, around 400 in Brest and Quimper in the northwest, and a few hundred each in other cities such as Nantes, Lyon, Bordeaux, Lille, and Marseille.

Jean-Michel Carayol, a hospital technician who demonstrated in the Mediterranean port city of Marseille, said the staff were “at the end of their tether and exhausted”.

Monique Aubin, a 61-year-old nurse who also joined the protest, complained of a “lack of materials, even medication” and of being swamped in paperwork which left her little time for patients.

In 2000, the World Health Organization ranked France’s health system the best of 191 countries.

But a study by the Institute for Health Metrics and Evaluation published in The Lancet medical journal in 2017 placed it in 15th place for quality of care.

The country is still one of Europe’s biggest spenders when it comes to healthcare.

In 2016, France spent 12 percent of its GDP on health, well above the western European average of 10 percent, and was also the country where the patient’s share of the health bill was the lowest.

– New winter of discontent? –

The protests have created jitters in the government, which fears that hospital staff could band together with other disgruntled groups such as transport workers who are planning mass strike action in December over pension reforms.

Three health plans in the past two years have failed to appease the anger of beleaguered hospital staff.

In an attempt to head off another winter of discontent, a year after the start of the “yellow vest” revolt, Macron said Thursday the government would unveil plans next week for “substantial” hospital investments.

While arguing that his centrist government had inherited an ailing hospital system, he said he had “heard the anger and the indignation over working conditions” in hospitals.

The protesters are demanding 3.8 billion euros in emergency investment in public hospitals — twice the amount set aside in the draft 2020 budget currently before parliament.

On Thursday, the upper house of the parliament, the right-wing dominated Senate, threw out the draft social security bill at its first reading in protest over what some senators described as Macron’s “disdain” for the workers in the sector.

Economy Minister Bruno Le Maire has warned that hiking health spending will mean having to make cuts elsewhere.

France’s budget deficit is expected to breach an EU limit of 3.0 percent of GDP this year, reaching 3.1 percent.

I am amazed at how easy the voters can be swayed and convinced that everything will be free if “you vote for me!” I say be very wary of what you all wish for because you and the rest of may have to live with the results, as we are all sold a bill of false goods. Be very careful voters!!

 

Warren’s Health Care Plan Will Cost More Than She Says; Hillary’s take on the matters and what does Medicare cover and the VA “new” system!

veteran529Tyler Cowen reported that Elizabeth Warren claims she can pay for her 10-year, $52 trillion health care plan without increasing taxes on the middle class. But both she and her critics are approaching the question wrong. What really matters is the opportunity cost of policy choices, in terms of foregone goods and services — not whether the money can be raised to pay for a chosen policy.

Consider this point in the context of Warren’s plan, which includes a complex series of health-care savings and higher taxes on the wealthy.

NOAH SMITH: Warren Tries to Make Medicare for All as Painless as Possible

One way of financing the plan is to pay doctors in hospitals lower fees (part of “saving” $2.3 trillion). There will then be fewer profitable hospitals, and fewer doctors working fewer hours because some of them might retire earlier than they otherwise would. Fewer hospitals mean they will likely increase their monopolistic tendencies, to the detriment of patients. A related plan to pay hospitals less is supposed to save another $600 billion.

The practical impact of these changes will be to deprive health-care consumers, including middle-class consumers, of goods and services. The larger point is that the real cost of any economic arrangement is not its nominal sticker price, but rather the consequences of who ends up not getting what.

Another part of the plan is to pay lower prices — 70% lower — for branded prescription drugs. That is supposed to save about $1.7 trillion, but again focus on which opportunities are lost. Lower drug prices will mean fewer new drugs are developed. There is good evidence that pharmaceuticals are among the most cost-effective ways of saving human lives, so the resulting higher mortality and illness might be especially severe.

Of course, many critics of the pharmaceutical industry downplay its role in the drug-discovery process. Regardless of the merits of those arguments, they do not show that a 70% cut in prices will leave supplies, or research and development, unchanged.

Another unstated cost of the Warren plan concerns current health-insurance customers: Many of them prefer their current private coverage to Medicare for All. Switching them into Medicare for All is an opportunity cost not covered by Warren’s $52 trillion estimates. Even if you believe that Medicare for All will be cheaper in monetary terms, tens of millions of Americans seem to prefer their current arrangements.

Warren also proposes higher taxes on corporations, capital gains, stock trades and the wealthy, as well as stronger tax enforcement — all of which is supposed to raise more than $10 trillion. Again, regardless of your position on those policies, they will diminish investment and (to some extent) consumption among the wealthy. You might not worry much about the consumption of the wealthy. But the decline in investment will lead to lower wages, less job creation, and fewer goods and services. These are all opportunity costs, for both the middle class and just about everyone else.

Supposedly $400 billion will be picked up from taxes on new immigrants, following the passage of a law legalizing millions now in the country illegally. I favor such legislation. Still, I don’t necessarily see this as a windfall. Yes, more immigrant labor will produce more goods and services. Tax revenue from this new productivity could be used in any number of ways, with universal health-care coverage just one option of many.

You might think that universal health insurance coverage is clearly the highest priority, but is it? America’s health-care sector is relatively costly and inefficient, and even major health-care legislation does not much improve health outcomes. What about investing in green energy or climate change alleviation? Private-sector job creation? Public health measures outside of the health-insurance system, such as fighting air pollution or lead? Checking California forest fires?

Even if you think health care is a human right, there are alternative policies that will benefit human health. They cannot all be carried out, at least not very well.

I don’t mean to pick on Warren. Virtually all politicians, of both parties, fall prey to similar fallacies when presenting the costs of their policies. Warren’s proposals, when all is said and done, are best viewed not as a way of paying for her program but as a series of admissions about just how expensive it would be. Whether or not you call those taxes, they are very real burdens — and many of them will end up falling on the middle class.

How Sen. Warren’s health care plan could impact 401(k)s

Senator Elizabeth Warren’s “Medicare for All” plan may impact your future nest egg. Some critics of the proposal note the presidential hopeful could potentially tax investors, which would make it more difficult to save for retirement. Edelman Financial Engines Founder Ric Edelman discusses with Yahoo Finance’s Zack Guzman, Sibile Marcellus, and ‘The Morning Brew’ Business Editor and Podcast Host, Kinsey Grant.

Hillary Clinton: Warren’s Medicare for All Plan Won’t Ever Get Enacted

Yuval Rosenberg noted that Hillary Clinton said Wednesday that she doesn’t believe Elizabeth Warren’s Medicare-for-All plan would ever become law and that there are better ways to raise revenues than Warren’s proposed wealth tax.

Asked at a New York Times conference whether she thinks the health-care plan released by Warren would ever get enacted, the 2016 Democratic presidential nominee said: “No, I don’t. I don’t but the goal is the right goal.”

In her 2016 campaign, Clinton supported a public health insurance option and rejected calls from Bernie Sanders, her rival for the Democratic nomination, for a single-payer system. On Wednesday, Clinton said she still favors a public option to build on the Affordable Care Act, which lifted insurance coverage rates to 90%. “I believe the smarter approach is to build on what we have. A public option is something I’ve been in favor of for a very long time,” she said. “I don’t believe we should be in the midst of a big disruption while we are trying to get to 100 percent coverage and deal with costs and face some tough issues about competitiveness and other kinds of innovation in health care.”

Clinton also said she supports the health care debate Democrats are having and tried to contrast that with the Republican efforts to repeal the Affordable Care Act. “Yeah, we’re having a debate on our side of the political ledger, but it’s a debate about the right issue, how do we get to health care coverage for everybody that we can afford?” Clinton said.

Warren responded on Thursday. “I’m saying, you don’t get what you don’t fight for,” she said, according to The Times. “You know, you’ve got to be willing to get out there and fight.”

On the issue of a wealth tax, another central element of Warren’s campaign, Clinton said she doesn’t understand how the proposal could work, suggesting it would be too disruptive. Clinton added that there are better ways to raise revenues, get the rich to pay more and combat inequality. “I just think there are better ways of doing it,” she said, adding that she would be in favor of raising the estate tax.

Also, Hillary Clinton called the wealth taxes proposed by Sens. Bernie Sanders and Elizabeth Warren “unworkable” and said they would be “incredibly disruptive” if enforced.

Warren health plan departs from US ‘social insurance’ idea

Ricardo Alonso-Zaldivar reported that Sen. Elizabeth Warren’s plan to pay for “Medicare for All” without raising taxes on the middle class departs from how the U.S. has traditionally financed bedrock social insurance programs. That might impact its political viability now and in the future.

While echoing her party’s longstanding call for universal health care, the Massachusetts Democrat is proposing to raise most of the additional $20.5 trillion her campaign believes would be needed from taxes on businesses, wealthy people and investors.

That’s different from the “social insurance” — or shared responsibility — the approach taken by Democratic presidents like Franklin D. Roosevelt, Harry Truman, and Lyndon Baines Johnson.

Broad financing through payroll taxes collected from workers and their employers has fostered a sense of ownership of Social Security and Medicare among ordinary Americans. That helped derail several Republican-led privatization efforts. And signs declaring “Keep Government Out Of My Medicare” proliferated during protests against President Barack Obama’s health care legislation, which scaled back Medicare payments to hospitals.

The Warren campaign says the reason programs like Social Security and Medicare are popular is that benefits are broadly shared. A campaign statement said her plan would put money now spent on medical costs back in the pockets of middle-class families “substantially larger than the largest tax cut in American history.”

But Roosevelt was once famously quoted explaining that he settled on a payroll tax for Social Security to give Americans the feeling they had a “legal, moral and political right” to benefits, thereby guaranteeing “no damn politician” could take it down.

Medicare passed under Johnson, is paid for with a payroll tax for hospital services and a combination of seniors’ premiums and general tax revenues for outpatient care and prescriptions. Truman’s plan for universal health insurance did not pass, but it would have been supported by payroll taxes.

“If you look at the two core social insurance programs in the United States, they have always been financed as a partnership,” said William Arnone, CEO of the National Academy of Social Insurance, a nonpartisan organization that educates on how social insurance builds economic security.

On Warren’s plan, “the question is, will people still look at it as an earned right, or will they say that their health care is coming out of the generosity of the wealthy?” Arnone added. His group takes no position on Medicare for All.

“It’s not an accident that Social Security is on the chopping block a lot less frequently than so-called welfare programs,” said retirement expert Charles Blahous, a political conservative and a former public trustee overseeing Social Security and Medicare finances.

With Warren’s approach, “you are going to have this clash of interests between the people paying the bills and the beneficiaries,” Blahous added. His own estimates indicate Medicare for All would cost the government about $12 trillion more over 10 years than Warren projects.

The Warren campaign downplays the role of shared responsibility and instead points to promised benefits under Medicare for All.

“Every person in America will have full health coverage, get the doctors and the treatments they need, and no more going broke over medical bills,” the campaign said in a statement. “Backed up by leading experts, Elizabeth has shown how her plan will do this by having the richest 1% and giant corporations pay a little bit more and without raising taxes on the middle class by one penny.”

Under Warren’s plan, nearly $9 trillion would come from businesses, in lieu of what they’re already paying for employees’ health care. About $7 trillion would come from increased taxes on investors, wealthy people, and large corporations. An IRS crackdown on tax evasion would net about $2 trillion. The remainder would come from various sources, including dividends of a projected immigration overhaul and eliminating a Pentagon contingency fund used for anti-terrorism operations.

Sen. Bernie Sanders’ list of options to pay for Medicare for All includes a 4% income-based premium collected from most households.

John Rother, CEO of the National Coalition on Health Care umbrella group, said he can follow Warren’s argument about making the wealthy pay, but it still looks like a hard sell.

“What is different today is the tremendous gap between the well-off and middle-class people,” he said. “In a way, it makes sense as a step toward greater equality, but it is still a little tricky politically because you don’t have that same sense that ‘this is mine, I paid into it, and therefore no one is going to take it away.'” His group has taken no position on Medicare for All.

History records that various payment options were offered for Social Security in the 1930s and FDR favored a broad payroll tax. One competing idea involved a national sales tax.

An adviser’s memo in the Social Security archives distills Roosevelt’s thinking.

“We put those payroll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions and their unemployment benefits,” Roosevelt was quoted as saying.

“With those taxes in there, no damn politician can ever scrap my social security program,” he added. “Those taxes aren’t a matter of economics, they’re straight politics.”

Medicare-for-all could cause ‘enormous’ doctor shortage

Julia Limitone pointed out something I mentioned that I am concerned about in the Medicare for All plan outlined by Sen. Warren. Sen. Elizabeth Warren’s Medicare-for-all plan is a disaster and would lead to an “enormous” doctor shortage, according to FOX News medical correspondent Dr. Marc Siegel.

If Warren’s plan came to pass, doctors would be working for the government, which in turn would decide their pay, Dr. Siegel told FOX Business’ Stuart Varney.

“The government doctors will be paid up to 40 percent less,” he said on Thursday. “Many will leave the profession,”

In countries with socialized medicine doctors earn about half of what primary care doctors make in America, he said.

“I’ve interviewed an Australian physician who’s from Canada, and she’s making about 30 to 40 dollars for a visit at the most,” he said.

But even more than that, a patient wouldn’t necessarily be able to get the care they need, Siegel said.

“I have to wait a month to figure out if someone has a problem up here,” he said.

What’s more, he said, it would hit hospitals hard. Hospitals rely on private insurance to pay for research, medical students and quality care, Dr. Siegel said. Under the plan, they’d get a flat fee from the government, and would not be able to differentiate between medical centers and great care and something that’s of lower quality, he explained.

“Hospitals are going to go belly up,” he warned.

Warren’s campaign said the single-payer plan would cost the country “just under” $52 trillion.

VA launches new health care options under MISSION Act

Because we are celebrating Veterans Day I thought that I would review some of the changes in the VA healthcare system. The VA system represents a health care system that is run by the government and look where that is going…….back to the private health care system. The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.

The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.

“The changes not only improve our ability to provide the health care Veterans need but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”

Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:

  1. A Veteran needs a service not available at any VA medical facility.
  2. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
  3. A Veteran qualifies under the “grandfather” provisions related to distance eligibility under the Veterans Choice Program.
  4. VA cannot furnish care within certain designated access standards. The specific access standards are described below:
  • Drive time to a specific VA medical facility
  • Thirty-minute average drive time for primary care, mental health, and noninstitutional extended care services.
  • Sixty-minute average drive time for specialty care.

Note: Drive times are calculated using geomapping software.

  • Appointment wait time at a specific VA medical facility
  • Twenty days from the date of the request for primary care, mental health care, and noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  • Twenty-eight days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  1. The Veteran and the referring clinician agree it is in the best medical interest of the Veteran to receive community care based on defined factors.
  2. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.

In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in-person support for the rollout.

The VA MISSION Act:

  • Strengthens VA’s ability to recruit and retain clinicians.
  • Authorizes “Anywhere to Anywhere” telehealth across state lines.
  • Empowers Veterans with increased access to community care.
  • Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.

VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year. We send our military representatives-soldiers, sailors and airmen and women to fight for us and now we are arguing about how to care for them when they are injured, whether physically or mentally. Imagine if we adopt another government-run health care system??

Thank you, all you Vets for all you have done for us to keep us and our beloved country free!

 

Death toll from vaping-linked illness now at 19 in the ​US. Trump’s answer for Medicare and Bernie’s health issue!

bernie465Why aren’t more people interested in the severity of the vaping complications in our youth? We are now up to 19 deaths, and this is just the reported deaths. We haven’t figured the long-term severity of chronic vaping inhalation, a form of COPD-chronic obstructive pulmonary disease!

The death toll in the United States from illnesses linked to e-cigarette use has risen to at least 19, health authorities say, as more than 1,000 others have suffered lung injuries probably linked to vaping.

Officials have yet to identify the cause for the outbreak, which dates back to March and is pursuing multiple lines of investigation.

A report by clinicians in North Carolina last month pointed to the inhalation of fatty substances from aerosolized oils, but a new study by the Mayo Clinic published this week found patients’ lungs had been exposed to noxious fumes.

The Centers for Disease Control and Prevention said Thursday that 18 deaths in 15 states had now been positively linked to vaping, from a total of 1,080 cases of people sickened —a jump of 275 since last week.

Connecticut officials also announced the first death in the state, bringing the total to at least 19.

The CDC attributed the sharp increase to a combination of new patients becoming ill in the past two weeks and recent reporting of previously identified patients.

“I think we really have the feeling right now that there may be a lot of different nasty things in e-cigarette or vaping products, and they may cause different harms in the lung,” Anne Schuchat, a senior official with the Centers for Disease Control and Prevention (CDC), said in a call with reporters.

Among a group of 578 patients interviewed on substances they had used, 78 percent reported using tetrahydrocannabinol (THC), the primary psychoactive substance of marijuana, with or without nicotine products.

Another 37 percent reported exclusive use of THC products, and 17 percent said they had only used nicotine-containing products.

About 70 percent of patients are male, and 80 percent are under 35 years old.

Skyrocketing use

E-cigarettes have been available in the US since 2006.

It is not clear whether the outbreak is only happening now—or if there were cases earlier that were wrongly diagnosed.

Initially conceived as a smoking cessation device, e-cigarette use has skyrocketed among teens, with preliminary official data for 2019 showing more than a quarter of high school students using e-cigarettes in the past 30 days.

They were until recently perceived as a less harmful alternative to smoking because they do not contain the 7,000 chemicals in cigarettes, dozens of which are known to cause cancer.

Only one case of lung injury has been reported abroad, making the outbreak more mysterious still.

Canadian authorities said in September a youth had been hospitalized, but so far no other countries have reported anything similar.

Public and political opinion appears to be hardening, however, with the administration of US President Donald Trump announcing in September that it would ban in the coming month’s flavored e-cigarette products, which are particularly attractive to young people.

India has issued an outright ban on all e-cigarette products, as has the US state of Massachusetts.

E-cigarettes: five things to know about vaping linked deaths and illnesses in the U.S.

E-cigarettes have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about a product, already banned in some places.

Here are five things to know about electronic cigarettes.

Around for two decades

Early designs for an electronic cigarette were drawn up in the United States in the 1960s but Chinese pharmacist Hon Lik is acknowledged as the inventor of a viable commercial version in the early 2000s.

Hon, who was trying to quit his own pack-a-day habit, took out patents between 2003 and 2005. But his devices would soon be overtaken as the international market exploded.

How do they work?

A battery powers a coil that heats a liquid containing various amounts of nicotine as well as propylene glycol and vegetable glycerin, which mimic tobacco smoke when heated.

This “e-juice” can also contain flavorings and other substances, such as THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana.

E-cigarettes are mostly draw-activated, with the puffing releasing vapor.

They do not produce tar or carbon monoxide—two of tobacco’s most noxious elements and associated with cancer and cardiovascular disease.

Harmful to health?

E-cigarettes were initially touted as less damaging than tobacco, which causes around eight million deaths a year.

In 2015 public health authorities in England said best estimates showed they were 95 percent less harmful than tobacco.

“Even if it is difficult to quantify precisely the long-term toxicity of electronic cigarettes, there is evidence that it is significantly lower than traditional cigarettes,” the French Academy of Medicine said the same year.

However, concern has been growing.

On October 3, 2019, US health authorities reported 18 vaping-related deaths and more than 1,000 cases of damage since March, the cause of which had not been identified.

The US Centers for Disease Control and Prevention said on September 2019 that many of the cases involved the use of black-market marijuana products.

In July 2019 the World Health Organization (WHO) warned that electronic smoking devices were “undoubtedly harmful and should, therefore, be subject to regulation”.

Another worry is that the vaping flavors are particularly attractive to teenagers and an enticement to pick up the habit.

Exponential growth

The number of vapers worldwide has leaped from seven million in 2011 to 41 million in 2018, according to leading market researcher Euromonitor International.

By comparison, there were 1.1 billion tobacco smokers on the planet in 2016, according to the latest WHO figures on its website.

The largest markets for e-cigarettes are the United States followed by Britain, France, Germany, and China.

The increase in vaping has been particularly dramatic among teenagers.

Moving towards regulation

In September 2019 India became the latest country to ban the import, sale, production, and advertising of e-cigarettes, citing in particular concerns about its youth.

The devices are already banned in several places, such as Brazil, Singapore, Thailand and the US state of Massachusetts, but elsewhere legislations are inconsistent.

In June 2019 San Francisco became the first major US city to effectively ban the sale and manufacture of electronic cigarettes.

In September New York followed Michigan in banning flavored e-cigarettes.

Trump woos seniors with an order to boost Medicare health program

Reporter Jeff Mason pointed out that U.S. President Donald Trump sought to woo seniors on Thursday with an executive order aimed at strengthening the Medicare health program by reducing regulations, curbing fraud, and providing faster access to new medical devices and therapies.

The order, which Trump discussed during a visit to a retirement community in Florida known as The Villages, is the Republican president’s answer to some Democrats who are pushing for a broad and expensive expansion of Medicare to cover all Americans.

Trump referred to such proposals as socialist and pledged to prevent them from coming to fruition, a political promise with an eye toward his 2020 re-election campaign in which healthcare is likely to be a major issue.

“They want to raid Medicare to fund a thing called socialism,” Trump told an enthusiastic crowd in Florida, a political swing state that is critical to his goal of keeping the White House.

The executive order follows measures his administration rolled out in recent months designed to curtail drug prices and correct other perceived problems with the U.S. healthcare system. Policy experts say the efforts are unlikely to slow the tide of rising drug prices in a meaningful way.

Trump suggested that drug companies were backing impeachment efforts in Washington, which he considers a “hoax,” as a way to sabotage his efforts to make prescriptions affordable.

“We’re lowering the cost of prescription drugs, taking on the pharmaceutical companies. And you think that’s easy? It’s not easy… I wouldn’t be surprised if the hoax didn’t come from some of the people that we’re taking on,” he said.

Medicare covers Americans who are 65 and older and includes traditional fee-for-service coverage in which the government pays healthcare providers directly and Medicare Advantage plans, in which private insurers manage patient benefits on its behalf.

Seniors are a key political constituency in America because of a high percentage of the vote.

The order pushes for Medicare to use more medical telehealth services, which is care delivered by phone or digital means, leading to cost reductions by reducing expensive emergency room visits, an administration official told Reuters ahead of the announcement.

The order directs the government to work to allow private insurers that operate Medicare Advantage plans to use new plan pricing methods, such as allowing beneficiaries to share in the savings when they choose lower-cost health services.

It also aims to bring payments for the traditional Medicare fee-for-service program in line with payments for Medicare Advantage.

Trump’s plans contrast with the Medicare for All program promoted by Bernie Sanders, a Democratic socialist who is running to become the Democratic Party’s nominee against Trump in the 2020 presidential election.

Sanders’ proposal, backed by left-leaning Democrats but opposed by moderates such as former Vice President Joe Biden, would create a single-payer system, effectively eliminating private insurance by providing government coverage to everyone, using the Medicare model.

“Medicare for All is Medicare for none,” said Seema Verma, the administrator of the U.S. Centers for Medicare and Medicaid Services, on a conference call with reporters, calling the proposal a “pipe dream” that would lead to higher taxes.

Sanders has argued that Americans would pay less for healthcare under his plan.

The White House is eager to show Trump making progress on healthcare, an issue Democrats successfully used to garner support and take control of the House of Representatives in the 2018 midterm elections. Trump campaigned in 2016 on a promise to repeal and replace the Affordable Care Act, his predecessor President Barack Obama’s signature healthcare law also known as “Obamacare.” So far he has not repealed or replaced it.

In July, the U.S. Department of Health and Human Services (HHS) said it would propose a rule for imports of cheaper drugs from Canada into the United States. A formal rule has not yet been unveiled.

The administration also issued an executive order in June demanding hospitals and insurers make prices they charge patients more transparent. Another in July encouraged novel treatments for kidney disease.

Trump considered other proposals that did not reach fruition.

A federal judge in July shot down an executive order that would have forced drugmakers to display list prices in advertisements, and Trump scrapped another planned order that would have banned some rebate payments drugmakers make to payers.

The administration is mulling a plan to tie some Medicare reimbursement rates for drugs to the price paid for those drugs by foreign governments, Reuters reported.

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

Faced with the pressure from the Democrats and their proposal for health care, Medicare for All 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. The major divide is between a Medicare for All system — supported by only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — 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.”

Sanders presidential campaign pivots health scare to Medicare for All message

And now Bernie Sander’s health becomes an issue! Simon Lewis reported that Bernie Sanders’ 2020 presidential election campaign on Wednesday sought to use news the candidate had a heart procedure to highlight the benefits of his trademark Medicare for All healthcare plan.

Sanders’ campaign canceled campaign events and pulled TV ads after the 78-year-old U.S. senator had two stents inserted into an artery after he experienced discomfort during a campaign visit to Nevada on Tuesday.

The candidate would rest for a few days after the relatively common procedure, his campaign for the November 2020 presidential election said.

Sanders’ speechwriter, David Sirota, said in a daily newsletter that the unexpected medical procedure was “a perfect example of why the United States needs to join the rest of the world and pass Bernie’s Medicare for All legislation.”

Sirota cited a 2018 paper by researchers at the London School of Economics that found cardiac implant devices cost up to six times more in the United States than in some European countries with government-run healthcare systems.

Sanders advocates an approach that would extend the existing Medicare program for Americans aged over 65 to all Americans and largely eliminate the private insurance industry.

Sirota argued the gulf in price was in part due to the U.S. healthcare system’s “complex web of payers – rather than a single-payer Medicare for All system that can negotiate better prices.”

As many as 1 million Americans a year get stents, a procedure that involves inserting a balloon-tipped catheter to open the blockage and deploy tiny wire-mesh tubes to prop open the artery.

“I’m feeling good. I’m fortunate to have good health care and great doctors and nurses helping me to recover,” Sanders tweeted on Wednesday afternoon, his first public statement since the procedure.

“None of us know when a medical emergency might affect us. And no one should fear going bankrupt if it occurs. Medicare for All!”

News of Sanders’ health scare sparked mean-spirited jokes pointing out the U.S. senator was treated by the healthcare system he wants to overhaul.

“Any bets on whether he’ll be going to Cuba for their great communist medical care? Get well soon Bern. #SocialismSucks!” tweeted Ben Bergquam, a right-wing California radio host.

Sanders’ supporters also took to social media to post #GetWellBernie messages.

The senator from Vermont’s campaign manager, Faiz Shakir, retweeted one message from a supporter that read, “take my heart, Bernie!!”

Another issue, which his campaign manager refuses to point out is did Bernie used his Medicare insurance to cover his diagnostic studies, his stenting procedure or his post-op care? As they are touting Medicare for All after Bernie had a quick diagnosis and stenting of his coronary artery disease we should all remember that Bernie, as well as all of the candidates for the presidency, don’t have Medicare for their health care insurance. No, they all have Congressional Blue Cross and Blue Care. So, don’t fall for their politicization of healthcare. Again, I point out, how can you promote Medicare for all when you all have no idea of the impact on patients of being insured under Medicare and the multiple restrictions and the true expense of Medicare insurance!

The 3 Reasons the U.S. Health-Care System Is the Worst, the AMA and more on Medicare for All and an angry teenager scolding the United Nations!

healthcare158[788]The head of the Commonwealth Fund, which compares the health systems of developed nations, pinpoints why America’s is so expensive and inefficient.

Olga Khazan reviewed the three reasons that the U.S. Health Care system is the worst. A woman has her blood pressure taken at the Care Harbor four-day free clinic, which offers free medical, dental, and vision care to around 4,000 uninsured people in Los Angeles.

According to the Commonwealth Fund, which regularly ranks the health systems of a handful of developed countries, the best countries for health care are the United Kingdom, the Netherlands, and Australia.

The lowest performer? The United States, even though it spends the most. “And this is consistent across 20 years,” said the Commonwealth Fund’s president, David Blumenthal, on Friday at the Spotlight Health Festival, which is co-hosted by the Aspen Institute and The Atlantic.

Blumenthal laid out three reasons why the United States lags behind its peers so consistently. It all comes down to:

  1. A lack of insurance coverage. A common talking point on the right is that health care and health insurance are not equivalent—that getting more people insured will not necessarily improve health outcomes. But according to Blumenthal: “The literature on insurance demonstrates that having insurance lowers mortality. It is equivalent to a public-health intervention.” More than 27 million people in the United States were uninsured in 2016—nearly a tenth of the population—often because they can’t afford coverage, live in a state that didn’t expand Medicaid or are undocumented. Those aren’t problems that people in places like the United Kingdom have to worry about.
  2. Administrative inefficiency.“We waste a lot of money on administration,” Blumenthal said. According to the Commonwealth Fund’s most recent report, in the United States, “doctors and patients [report] wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce the administrative burden for providers and ensure that patients face predictable copayments.” In other words, while insurance coverage, in general, is great, it’s not ideal that different insurance plans cover different treatments and procedures, forcing doctors to spend precious hours coordinating with insurance companies to provide care.
  3. Underperforming primary care.“We have a very disorganized, fragmented, inefficient and under-resourced primary care system,” Blumenthal added. As I wrote at the time, in 2014 the Commonwealth Fund found that “many primary-care physicians struggle to receive relevant clinical information from specialists and hospitals, complicating efforts to provide seamless, coordinated care.” On top of a lack of investment in primary care, “we don’t invest in social services, which are important determinants of health” Blumenthal said. Things like home visiting, better housing, and subsidized healthy food could extend the work of doctors and do a lot to improve chronic disease outcomes.

Together, these reasons help explain why U.S. life expectancy has, for the first time since the 1960s, recently gone down for two years in a row.

Two Experts Debunk Four Big Health Care Fallacies

Yuval Rosenbery of The Fiscal Times reported that in a The New York Times op-ed, Ezekiel Emanuel, a health policy expert, and a former adviser in the Obama administration, and Victor Fuchs, a Stanford health economist, look to clarify what they call “four fundamental health care fallacies”:

  1. Employers pay for workers’ health insurance.“Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent,” they write. “But at that time, average wages have hardly moved, increasing just 7 percent. Clearly, workers’ wages, not corporate profits, have been paying for higher health insurance premiums.”
  2. Medicare for All is unaffordable. As I have mentioned in previous posts Medicare for All is too expensive. “True, Medicare for All would increase federal health care spending. But that is not the same as increasing total health care spending, which was over $3.5 trillion last year,” Emanuel and Fuchs said. “We have our doubts about Medicare for All. But unaffordability is nota reason to oppose it. … When you hear a health care price tag in the trillions, know that the existing system has already brought us there.”
  3. 3. Insurance company profits drive health care costs.“The fact is, we could eliminate those profits and it would hardly matter to the cost of health care. You would not notice it in your premiums. … True, $22.1 billion is a lot of money — but it is 0.6 percent of health spending. And last year alone health care costs increased over $130 billion — six times insurance company profits. Health care spending would not be significantly cheaper if all insurance companies’ profits were zero.”

4. Price transparency can bring down health care costs.“Over 80 percent of the cost of medical care is paid by private and public insurance. Patients have little incentive to seek out the cheapest provider. When pricing websites exist, few patients use them. … Furthermore, price considerations are useful for choosing only about 40 percent of procedures — routine services like colonoscopies, M.R.I. scans and laboratory tests. Most of the expensive services — think heart catheterizations, cancer chemotherapy, and organ transplants — are not the kind of thing you decide based on price.”

AMA President: It’s Still ‘No’ to Single Payer

Shannon Firth, Washington correspondent of the MedPage, noted that Dr. Barbara McAneny still doesn’t believe in the Single Payer system for health care but she and the AMA applauds a ban on pharmacy gag clause and APMs.A single-payer healthcare system in the U.S. would break her practice, said the president of the American Medical Association (AMA), who argued that Medicare and other government programs as currently structured simply don’t pay enough.

“We need a payment system that the country can afford,” said Barbara McAneny, MD, AMA president, and a practicing oncologist/hematologist in New Mexico.

McAneny pointed out that in the portion of her practice that serves the Navajo Nation, 70% of payments are from governmental payers, and “I have struggled for the last 10 years to keep that practice breaking even.”

Medicare payments are designed to cover about 80% of the cost of doing business, McAneny said. If all her commercial patients were to pay Medicare rates, there would be no other place from which to shift costs, she explained. “My doors would be closed. I would no longer be able to make payroll.”

Moving to a single-payer healthcare system won’t fix what’s broken, she said during a meeting with reporters Tuesday to discuss a variety of issues, including drug pricing, value-based payments, and turf battles.

While she said she strongly supported Medicaid expansion in New Mexico, McAneny expressed skepticism about the possibility of a Medicaid “buy-in,” which would allow people to purchase Medicaid-based public insurance plans.

She pointed out that only about a quarter of the population in New Mexico has commercial insurance, and “Medicaid and Medicare do not cover the expenses of providing care.” With fewer patients to cost-shift from, independent practices and small rural practices “would not be able to keep the lights on.”

AMA policy supports patients buying “individually selected health insurance,” subsidized with advanced or refundable tax credits that correspond inversely to income, McAneny said.

McAneny also discussed the Trump administration’s recent efforts to curb drug prices and the challenge of transitioning from fee-for-service to value-based care.

She called the latest bill banning pharmacy gag clauses”really important. When patients discover that they can pay less than the co-pay to buy the drug, they need to know that because patients are going broke out there, trying to buy their drugs.”

Gag clauses prevent pharmacists from telling customers whether paying for their prescription might be cheaper if they paid the cash price instead of using their insurance.

Earlier this week, the Department of Health and Human Services (HHS) announced that drug makers would need to include the list price of any drug paid for by Medicare or Medicaid in their TV advertisements. In an AMA press release, McAneny stated that the HHS move seemed like “a step in the right direction,” although the AMA is opposed to direct-to-consumer advertising in general.

McAneny said greater transparency was a “first step” toward addressing such high drug costs.

“There’s so much the public doesn’t understand about the market, including the true costs of research and development and the role of middlemen, like pharmacy benefit managers and insurance mark-ups, she said.

“Before we suggest any sort of treatment, we think it’ s a good idea to make the diagnosis, and that means really understanding that entire process, which means they’re going to have to pull back the curtain and let us, the healthcare community, really take a look at that and figure out what adds value and what doesn’t,” she said.

McAneny was less supportive of changing the way Part B drugs are bought and paid for. In May, HHS Secretary Alex Azar suggested moving some Part B drugs administered in a physician’s office into the Part D program, in an attempt to negotiate more competitive prices.

“People cannot afford a 20% co-insurance on a drug that costs $5,000 a month,” she said.

In terms of value-based payment, McAneny said she’s excited about the work the physician-focused Payment Model Technical Advisory Committee (PTAC) is doing. Doctors are well-positioned to help design alternative payment models, she noted.

“We see all the time places where healthcare dollars get wasted, and patients don’t get what they want,” she said, so allowing doctors to come up with new methods of care delivery, which incorporate things they’ve always wanted to do for their patients, has “tremendous potential.”

McAneny said she hopes Azar will test as many pilots projects as possible, and see what works, but not penalize groups who fail. “If you’re trying something innovative … sometimes you’re going to be wrong, and those people shouldn’t have to lose their practices… they should be allowed to fail quickly, and move on to something else,” she stated.

McAneny said she will present an alternative model to the PTAC in December.

Her proposed model integrates clinical data from a group of oncology practices with claims data “to set accurate and realistic targets that reflect what oncologists can actually control, rather than the total cost of care,” McAneny told MedPage Today in an email.

“We will measure quality by compliance with physician derived pathways that reflect the best care in the medical literature… [and] improve patient satisfaction by getting patients the care they need, when they need it, at a practice site that knows them and understands what they are going through.”

The model saves money by reducing hospitalizations and “aggressively managing or preventing” adverse effects.

Another challenge in healthcare is the scope of practice, with some physicians expressing concern that nurse practitioners and physicians assistants (PAs) are encroaching on their territory.

McAneny acknowledged that concern, noting that primary care physicians must be “incredible diagnosticians,” she said. “They need to know when a sore throat is a sore throat and when it’s really cancer.”

“In my own practice, where we have everyone working to the top of their license, I value my nurse practitioners and I value my PAs immensely, but I don’t expect them to be oncologists, and I don’t really expect them to be primary care doctors,” she added.

“Everybody has a place in healthcare,” McAneny stressed, “but I do not feel that a nurse practitioner who has gone to nursing school and done one extra year… and has not practiced in that post-doc process, has the same level of expertise to be that diagnostician.”

A new report from the AMA’s Council on Medical Service, “Covering the Uninsured Under the AMA Proposal for Reform,” also reaffirms that stance, calling for improvements in the Affordable Care Act — increasing subsidies, and expanding eligibility and the size of cost-sharing reductions — rather than “threatening the stability of coverage for those individuals who are generally satisfied with their coverage.”

There will be resolutions calling on the AMA to support federal laws that would not eliminate the private health insurance market and to collect data comparing Medicare reimbursement to the cost of delivering services.

ACTION ALERT: The A.M.A. must support Medicare for All!

But we find out that the President of the AMA may not reflect the total view of the national organization of physicians. On June 8, 2019, at 1:30 PM CST, students, physicians, nurses, allied health care workers, and activists from around the country will unite in Chicago to protest the annual meeting of the American Medical Association (A.M.A.).

Representatives of a rapidly growing coalition of Medicare for All supporters, including National Nurses United, Students for a National Health Program, Physicians for a National Health Program, People’s Action, Public Citizen, The Center for Popular Democracy, The Jane Addams Senior Caucus, various labor unions, teachers, activists, and more, will be taking a stand AGAINST corporate greed, misleading advertising, and the profit motive in health care.

And for a system that guarantees quality health care and choice of provider for all Americans, regardless of income.

The action recalls similar campaigns waged throughout the 1960s in which members of the African-American-led National Medical Association, the Medical Committee for Human Rights and the Poor People’s Campaign picketed the A.M.A.’s annual meetings because of its refusal to take a stand against segregated medical services and for allowing local medical societies to discriminate against physicians and patients of color.

When we join together, we can send a powerful message to the A.M.A. and corporate medicine that we won’t stop until every American is guaranteed quality medical care without going into debt or bankruptcy.

Everybody in, nobody out!

Also, I need to comment on that sixteen-year-old who was invited to a United Nation session where she berated the countries all about not taking up the environmental banner and cleaning up the world. She is a spoiled “child” who knows nothing about economics as well as politics and what it would take to move ahead with cleaning up the environment. Where are all the countries to get the trillions of dollars or Euros, etc. to make the changes that she demands?

Greta Thunberg excoriated world leaders for their “betrayal” of young people through their inertia over the climate crisis at a United Nations summit that failed to deliver ambitious new commitments to address dangerous global heating.

If world leaders choose to fail us, my generation will never forgive them

In a stinging speech on Monday, the teenage Swedish climate activist told governments that “you are still not mature enough to tell it like it is. You are failing us. But the young people are starting to understand your betrayal.”

But Thunberg predicted the summit would not deliver any new plans in line with the radical cuts in greenhouse gas emissions that scientists say are needed to avoid catastrophic climate breakdown.

“You have stolen my dreams and my childhood with your empty words,” a visibly emotional Thunberg said.

“The eyes of all future generations are upon you. And if you choose to fail us I say we will never forgive you. We will not let you get away with this. Right here, right now is where we draw the line.”

Suggestion for Miss Thunberg, get an education! Go to the university and get the real facts. Get an education so you can understand the system and the only ways that we can truly deal with our environmental issues! Instead, you sail around the world! Must be nice instead of working or going to school!

And back to health care next week.

What Single Payer Healthcare Would Do For American Families; and Do We Need Medicare for All?

medicare360Lizzy Francis of Fatherly noted that Every Democratic frontrunner in the 2020 election has some sort of universal health care plan akin to Medicare for All. While all of their plans “possibly” answer a real question — how to fix a health insurance system that is expensive, confusing, and mired in bureaucracy — they differ in many ways. Meanwhile, pundits and moderate politicians have called single-payer unrealistic and expensive, while arguing that many people really like their private insurance and don’t want to be kicked off of it. Others worry about what it would do to the private health care system, which would be gutted. But the costs of considering single-payer are too big to ignore including the cost of establishing and running a system such as what the Democrats advertise as their solutions.

Today, individually insured middle class families spend about 15.5 percent of their income on health care — not counting what their employees cover in premiums before their pay even hits their paycheck. Meanwhile, the wealthiest Americans actually receive such great tax exemptions for their health care spending that they receive a surplus of .1 percent to .9 percent on top of their income.

“Overall health expenditures throughout the whole economy will go down, due to the efficiencies of a single-payer system,” says Matt Bruenig, lawyer, policy analyst, and founder of the People’s Policy Project, a think tank that studies single-payer healthcare. “And the distribution of those expenditures and who pays for those expenditures will be shifted up the income ladder. Middle class families can expect at least thousands of dollars of savings a year from not having to pay premiums or co-pays,” he says.

Today, families that make about $60,000 a year spend about $10,000 of their pay on health care. Under universal health care, they would pay less than $1,000 in taxes (really??) and no longer have to pay deductibles, deal with surprise billing, or contend with the fact that a major medical event could bankrupt them.

Aside from costs, there are more reasons our current healthcare system is failing families. For example, even someone on employer-sponsored health insurance who might like their health insurance has a one in four chance of getting kicked off of it over the course of any given year. And given that today the average worker has about 11 jobs from age 18 to 50, per Bruenig, health insurance turnover is all but inevitable for the modern worker.

The numbers on insurance turnover are alarming, starting with the fact that about 28 million Americans have no insurance at all. All of these people likely got kicked off of their insurance: the 3.7 million people who turned 65 in 2017, the 22 million people who were fired in 2018, the 40.1 million people who quit their jobs in 2018, and the employees who work at 15 percent of companies with employer-sponsored health insurance that switched carriers, the latter of which changes the providers that employees can see and causes a lot of paperwork. Then one must consider the 1.5 million people who got divorced in 2015 and 7.4 million people who moved states and the 35 percent of people on Medicaid had their income increase to the point where they were too well off for Medicaid but not well off enough to afford other insurance plans.

Beyond that, insurers are constantly changing what providers they work with, which means the doctor that someone sees in April might not be on their plan three months later. Employees and families often feel stuck to their jobs that may have a bad work-life balance, pay poorly, or otherwise not be a good fit because the costs of trying to get on another health care plan or the risks of leaving a job due to the health care plan it offers are far too high when kids are in the mix.

“Having consistency is key, even for people who have jobs,” says Bruenig. “That job will only last so long before they’re off to another one. They could get fired, the company could close down. Being in the labor force and having the security that [your insurance will] follow you no matter which job you go to is useful,” says Bruenig.

It’s especially useful for parents, who have more than their own health to worry about. And even people who have health insurance through their private plan or employer go bankrupt with alarming frequency. Out of pocket spending for people with employer-provided health insurance has increased by more than 50 percent in the last 10 years; half of all insurance policyholders have a deductible of at least $1,000; and most deductibles for families near $3,000. When more than 40 percent of Americans say they cannot afford an emergency expense of $400 or more, it’s a wonder to think how they could ever meet that deductible before their health insurance coverage kicks in. About one in four Americans in a 2015 poll said they could not afford medical bills, and another poll showed that half of those polled had received a medical bill that they could not afford to pay. Medical debt affects 79 million Americans or about half of working-age people.

Two thirds of people who file for bankruptcy say that their inability to pay their medical bills is why they are doing so. These are often people who are insured. These are people who should be protected. They pay into an insurance program — sometimes 20 percent of their income — in order to protect them and their families from this, but insurance companies do not protect them.

One reason is that in medical emergencies, ambulances often take people to the nearest possible hospital. That hospital might not be in their network. Or it might be, but the attending doctor might not be in their network. When the bill comes due, Americans are gutted. That would never happen under a single-payer system.

The average American middle class family spends about 15-20 percent of their income on health care each year. That would shrink to just around 5 percent under many versions of the payment plan, with out-of-pocket costs completely eliminated from the equation and no deductible to discourage families from getting the medical help they need. They could continue to see the providers they like without worrying that their provider will stop working with their insurer. People don’t like to wade through the bureaucracy of their employer sponsored or private insurance plans: they like their doctors. They like having relationships with them. They like to be able to see them without being surprise billed or being told their insurance only covers half of their visits.

But what about business? What single-payer would do to the overall economy is hard to say. Retirement portfolios would surely be affected by the change. The stock market would be affected. People in the health insurance industry could lose their jobs. But many of the companies, which still sell medications and medical tech, would survive, even if the scope of their business would radically change. And for businesses that spend money to insure their employees, there would either be a slight reduction in the cost of business or very little change in cost at all, says Bruenig.

Today, businesses, which help insure 155 million Americans, spend about $1 trillion in premiums to the private health insurance industry. That actually probably wouldn’t change under a single-payer system, per Bruenig.

“The question of the bottom line for businesses, money-wise, is a little bit uncertain. But the idea is not to necessarily save them money — it’s more of a question of flexibility. The objective savings that employers would realize in terms of not having to hire staff to talk to insurers and enroll people in insurance go down a lot. But in general, we want to keep them [paying into the system] instead of trying to shift them off to some other person.”

That’s how employer-sponsored insurance basically works today. What many people don’t realize is that part of the premiums that employers pay for their employees is set aside as part of their salary when they are hired. So, per Bruenig, if someone makes $50,000 a year, that means that about $15,000 on average is set aside from the employer perspective (that employees don’t know about) to pay into the health insurance system while employees cover about 30 percent of that premium cost through their paycheck, not including deductibles and out-of-pocket costs.

While that wouldn’t change under Medicare for All, instead of paying premiums to private insurers, employers would pay those premiums to the government. In the meantime, their costs associated with HR, payroll, and the time spent poring over health care plans would be eliminated.

There are a few ways this can be handled: one is called a ‘maintenance of effort approach,’ which is where employers pay what they were paying under private insurance to the government every year, accounting for inflation.

Another oft-cited method of payment is through an increase in the payroll tax — a tax employers already pay — to the government to help fund government-sponsored health care. Other plans include making the federal income tax more progressive and raising the marginal tax rate to 70 percent to those who make more than $10 million a year and establishing an extreme wealth tax like that proposed by Elizabeth Warren.

Estimates show that Bernie Sanders’ Medicare For All plan would save $5.1 trillion of taxpayer and business money over a decade while cutting out-of-pocket spending on health care. While total health care spending will indeed need to increase as more people will be covered by health care, the overall savings in expenses would bring that cost back down so much that the government only needs to raise about 1 trillion dollars to fund Medicare for All when met with taxpayer money and private business investment. This number has been proven incorrect. The cost is about $40 trillion over 10 years.

But the reasons that it would help employers often go beyond the strictly financial, much how the reasons for universal health care being so great for families to go beyond the financial benefits as well.

“In the current system, mandates trigger based on if someone is a full-time employee. To the extent that that goes away, you would expect that you won’t have a big employer making sure people only work 29 hours so that [they don’t get benefits.],” argues Bruenig. “Essentially, those “cliffs,” where if you take one extra step, and work 30 hours [instead of 29], the cost goes way up at the margin. Those would get eliminated, and would give businesses more flexibility, and would seemingly help workers at the same time who might want more hours.”

Families could switch jobs without worrying about what they would do during a probationary period at their new job before their health benefits kick in, and people with chronic medical conditions wouldn’t have to spend hours a day on the phone haggling with their health insurance providers to get essential services covered by them. From a cost perspective, yes, a single-payer system is cheaper than what we operate today. But from a time-saved perspective, from worrying-about-money-perspective, and from a can-I-take-my-kid-to-the-pediatrician? perspective, this works better. The time spent poring over confusing health care documents? Gone. Deductibles? Gone. What’s simpler is simpler — and for businesses and families, a seamless single-payer-system would lessen a lot of headaches and prevent a lot of pain.

Majority of U.S. doctors believe ACA has improved access to care

Sixty percent of U.S. physicians believe that the Affordable Care Act (ACA) has improved access to care and insurance after five years of implementation, according to a report published in the September issue of Health Affairs.

Lindsay Riordan, from the Mayo Clinic Alix School of Medicine in Rochester, Minnesota, and colleagues readministered elements of a previous survey to U.S. physicians to examine how their opinions of the ACA may have changed during the five-year implementation period (2012 to 2017). Responses were compared across surveys. A total of 489 physicians responded to the 2017 survey.

The researchers found that 60 percent of respondents believed that the ACA had improved access to care and insurance, but 43 percent felt that it had reduced coverage affordability. Despite reporting perceived worsening in several practice conditions, in 2017, more physicians agreed that the ACA “would turn the United States health care in the right direction” compared with 2012 (53 versus 42 percent). In the 2017 results, only political party affiliation was a significant predictor of support for the ACA after adjustment for potential confounding variables.

“A slight majority of U.S. physicians, after experiencing the ACA’s implementation, believed that it is a net positive for U.S. health care,” the authors write. “Their favorable impressions increased, despite their reports of declining affordability of insurance, increased administrative burdens, and other challenges they and their patients faced.”

And remember my suggestion was to improve the failures in the Affordable Care Act/Obamacare instead of this Medicare for All solution which is so short-sighted if anybody out there is on Medicare realizes….and it is not FREE!!

Walmart, CVS, Walgreen health clinics can fill a need, but there’s a hitch: Dr. Marc Siegel

Matthew Wisner reported that Walmart is opening its first health clinic in Georgia with plans to offer everything from shots to X-rays, dental and even eye care.

“You go to Walmart and you’re going to be able to get psychotherapy now. Labs, X-rays as you mentioned, immunizations, medications, there are nurses there, doctors there. They’re opening up in Texas, Georgia, and South Carolina,” Fox News medical correspondent Dr. Marc Siegel told the FOX Business Network’s “Varney & Co.”

According to Siegel, Walmart is trying to compete against the big pharmacy chains heading in the same direction.

“It’s also to compete with CVS/Aetna right, who is going to be opening 1,500 of these locations around the country. And, Walgreens as well, with Humana and United Healthcare. So all of these big pharmacy chains are getting into the stand-alone health-care model,” Siegel said.

Siegel says these types of clinics will offer access to health care that some consumers may not have, but he said there is a downside.

“But what happens to the results? Where is the follow-up? I don’t really want a Walmart doing all of the, or CVS, or Walgreens doing all of the follow-ups. I’m worried about someone coming in for one-stop shopping and not having follow up,” explained Siegel.

Lindsay Riordan, from the Mayo Clinic Alix School of Medicine in Rochester, Minnesota, and colleagues readministered elements of a previous survey to U.S. physicians to examine how their opinions of the ACA may have changed during the five-year implementation period (2012 to 2017). Responses were compared across surveys. A total of 489 physicians responded to the 2017 survey.

The researchers found that 60 percent of respondents believed that the ACA had improved access to care and insurance, but 43 percent felt that it had reduced coverage affordability. Despite reporting perceived worsening in several practice conditions, in 2017, more physicians agreed that the ACA “would turn the United States health care in the right direction” compared with 2012 (53 versus 42 percent). In the 2017 results, only political party affiliation was a significant predictor of support for the ACA after adjustment for potential confounding variables.

“A slight majority of U.S. physicians, after experiencing the ACA’s implementation, believed that it is a net positive for U.S. health care,” the authors write. “Their favorable impressions increased, despite their reports of declining affordability of insurance, increased administrative burdens, and other challenges they and their patients faced.”

Opinion: The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’. Dr. Ben Carson suggested using HSA’s to solve the health care problem and this article looks at funding the HSA deductible, as Indiana and Whole Foods do, and put real prices on everything

Sean Masaki Flynn noted that as the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

By contrast, there is intense competition among the providers of medical services like LASIK eye surgery that aren’t covered by health insurance. For those procedures, providers must compete for market share and profits by figuring out ways to improve efficiency and lower prices. They must also advertise to get customers in the door and must ensure high quality to generate customer loyalty and benefit from word of mouth.

That’s why the price of LASIK eye surgery, as just one example, has fallen so dramatically even as quality has soared. Adjusted for inflation, LASIK cost nearly $4,000 per eye when it made its debut in the 1990s. These days, the average price is around $2,000 per eye and you can get it done for as little as $1,000 on sale.

By contrast, ask yourself what a colonoscopy or knee replacement will cost you. There’s no way to tell.

Price tags also insure that everybody pays the same amount. We currently have a health-care system in which providers charge patients wildly different prices depending on their insurance. That injustice will end if we insist on legally mandated price tags and require that every patient be charged at the same price.

As a side benefit, we will also see massively lower administrative costs. They are currently extremely high because once a doctor submits a bill to an insurance company, the insurance company works hard to deny or discount the claim. Thus begins a hideously costly and drawn-out negotiation that eventually yields the dollar amount that the doctor will get reimbursed. If you have price tags for every procedure and require that every patient be charged the same price, all of that bickering and chicanery goes away. As does the need for gargantuan bureaucracies to process claims.

What happened in Indiana?

The second policy—deductible security—pairs an insurance policy that has an annual deductible with a health savings account (HSA) that the policy’s sponsor funds each year with an amount equal to the annual deductible.

The policy’s sponsor can be either a private employer like Whole Foods (now part of Amazon.AMZN, -0.39%), which has been doing this since 2002 or a government entity like the state of Indiana, which has been offering deductible security to its employees since 2007.

While Indiana offers its workers a variety of health-care plans, the vast majority opt for the deductible security plan, under which the state covers the premium and then gifts $2,850 into each employee’s HSA every year.

Since that amount is equal to the annual deductible, participants have money to pay for out-of-pocket expenses. But the annual gifts do more than ensure that participants are financially secure; they give people skin in the game. Participants spend prudently because they know that any unspent HSA balances are theirs to keep. The result? Massively lower health-care spending without any decrement to health outcomes.

We know this because Indiana Gov. Mitch Daniels ordered a study that tracked health-care spending and outcomes for state employees during the 2007-to-2009 period when deductible security was first offered. Employees choosing this plan were, for example, 67% less likely to go to high-cost emergency rooms (rather than low-cost urgent care centers.) They also spent $18 less per prescription because they were vastly more likely to opt for generic equivalents rather than brand-name medicines.

Those behavioral changes resulted in 35% lower health-care spending than when the same employees were enrolled in traditional health insurance. Even better, the study found that employees enrolled in the deductible security plan were going in for mammograms, annual check-ups, and other forms of preventive medicine at the same rate as when they were enrolled in traditional insurance. Thus, these cost savings are real and not due to people delaying necessary care in order to hoard their HSA balances.

By contrast, the single-payer “Medicare for All” proposal that is being pushed by Bernie Sanders and Kamala Harris would create a health-care system in which consumers never have skin in the game and in which prices are hidden for every procedure.

That lack of skin in the game will generate an expenditure explosion. We know this because when Oregon randomized 10,000 previously uninsured people into single-payer health insurance starting in 2008, the recipients’ annual health-care spending jumped 36% without any statistically significant improvements in health outcomes.

Look at Singapore

By contrast, if we were to require price tags in addition to deductible security, the combined savings would amount to about 75% of what we are paying now for health care.

We know this to be true because while price tags and deductible security were invented in the United States, only one country has had the good sense to roll them out nationwide. By doing so, Singapore is able to deliver universal coverage and the best health outcomes in the world while spending 77% less per capita than the United States and about 60% less per capita than the United Kingdom, Canada, Japan, and other advanced industrial economies.

Providers post prices in Singapore, and people have plenty of money in their HSA balances to cover out-of-pocket expenses. As in the United States, regulators set coverage standards for private insurance companies, which then accept premiums and pay for costs in excess of the annual deductible. The government also directly pays for health care for the indigent.

The result is a system in which government spending constitutes about half of all health-care spending, as is the case in the United States. But because prices are so much lower, the Singapore government spends only about 2.4% of GDP on health care. By contrast, government health-care spending in the United States runs at 8% of GDP.

With Singapore’s citizenry empowered by deductible security and price tags, competition has worked its magic, forcing providers to constantly figure out ways to lower costs and improve quality. The result is not only 77% less spending than the United States but also, as Bloomberg Businessweek reports, one of the healthiest populations in the world.

If we are going to be serious about squashing health-care costs and improving the quality of care, we need to foster intense competition among health-care providers to win business from consumers who are informed, empowered and protected from financial surprises. Price tags and deductible security are the only policies that accomplish all of these goals.

I hope that politicians on both sides of the aisle will get behind these proven solutions. But realize that all these programs are missing a number of important parts of the equation to make the programs work: tort reform, the cost of medical education and the cost of drugs. These issues need to be included in the final solution and the eventual program. Washington should not be a place where good ideas go to die.