The State of Health Care Today
The cost and quality of the U.S. healthcare system is one of the most prominent issues facing everyday Americans. It is a top policy concern for voters, a key indicator of economic efficiency, and a significant driver of the national debt.
Americans will spend $52 trillion over the next decade on health care,
The Affordable Care Act offered subsidies for individuals and families to buy private plans through a government exchange. Unfortunately the ACA’s exchanges have struggled to attract insurance companies, leaving many areas with few choices of plans. Customers who make too much money to qualify for subsidies have sometimes found the plans unaffordable, while others have complained that deductibles, while capped under the law, are still too high. While it reduced the share of uninsured, 27 million Americans still don’t have insurance.
The ACA also expanded and extended Medicaid eligibility to uninsured adults and children whose incomes are at or below 138% of the federal poverty level (family of 4 can make up to $34,638). As of July 2019, however, only 36 states and the District of Columbia have chosen to adopt the adult expansion.
For those who do have insurance through their job or through an individual plan, deductibles are rising faster than wages and customers can face surprise hospital bills from out-of-network doctors and specialists. The US health care system now costs nearly double what other high-income countries pay, per capita. The industry is crippled by an expensive, nontransparent and discriminatory pricing system. A complex system of profit-driven corporations, from manufactures to insurance companies, add cost at every juncture. Americans spent $3.56 trillion on health care in 2018 with 59% going to hospitals, doctors, and clinical services. Prescription drug spending was up 3.5% due to higher prices. Medical debt and/or bankruptcy has severe consequences for the 80 million struggling with medical bills. It is a problem that cuts across age groups and educational levels. It is time for health care reform in America.
Right now, multiple groups pay for healthcare. That includes private health insurance companies, employers, and the government, through programs like Medicare and Medicaid. There are a number of proposals out there that would expand the role of public programs in healthcare.
UPDATED MARCH 11:
The Sanders “Medicare For All” Plan
Medicare for All is a single-payer, government-run health care program in which all Americans are covered. Most people tend to think of the most far-reaching “Medicare for All” proposals outlined in bills sponsored by Presidential Candidate Senator Bernie Sanders and Rep. Pramila Jayapal, These two bills share many similarities. Presidential Candidate Senator Elizabeth Warren signed onto Mr. Sanders’s single-payer legislation.
The Nuts and Bolts
This single payer national health insurance plan is tax financed and includes comprehensive benefits. It is a replacement for all private health insurance, as well as the current Medicare program. The plan includes lifetime enrollment and no premiums. There will be no out-of-pocket costs for healthcare-related expenses. Deductibles, coinsurance, and co-pays would be prohibited. Pre-existing conditions will be covered. The plan includes inpatient and outpatient hospital care, emergency services, preventative services, most prescription drugs, as well as dental and vision coverage. The Sanders and Warren websites provide more detail.
What will the Sanders “Medicare For All” plan cost?
A report released by the Urban Institute found that his single-payer approach would cost $34 trillion over 10 years.
How will Sanders “Medicare For All” plan be paid for?
Sanders proposes paying for his version of Medicare For All with a payroll tax on employers, income based household premiums, taxes on the wealthy, and taxes on corporations. He would also make the federal income and estate tax more progressive, impose a large fee on large financial institutions and close the Gingrich-Edwards Loophole. The loophole allows self-employed people who set up so-called S corporations to avoid paying taxes into Social Security and Medicare.
Critics & Supporters of Sanders’ “Medicare For All”
Critics say the cost of “Medicare For All” will be astronomical, worry how it will be paid for and question whether the government can effectively manage such a massive undertaking. They also believe the plans require Congress to pass far-reaching legislation, an enormous political challenge and a virtual impossibility unless Democrats win control of the Senate. Other say that people who get employer insurance report being satisfied with their plans, and could be upset if they’re required to join a new government program instead.
Supporters of a single-payer plan argue it could hold down costs by negotiating or requiring lower payments to doctors, hospitals and drug companies, while eliminating overhead associated with private insurance.They argue that money currently going to premiums would help offset the new taxes on individuals and families.
Single Payer “Public Option” Health Care Plans
UPDATED BIDEN PLAN (MARCH 11):
Many people believe that Biden’s plan is much more ambitious than Obamacare – and despite its incremental label, would make some very controversial changes. “No matter how much Biden wants to draw distinctions between his proposals and single-payer, his plan looks suspiciously like “SandersCare Lite,” writes former congressional aide and conservative commentator Chris Jacobs in a column for The Federalist.
The centerpiece of the Biden plan is a Medicare-like public option for people seeking individual coverage on the ACA exchanges. It would be offered as an alternative to private insurance, not as a replacement.
His plan would would enhance premium subsidies for the insurance purchased on ACA exchanges . They would be scaled so that premiums would consume no more than 8.5 percent of family income. It would allow employees, presently in an employer sponsored plan, become eligible for subsidies if they switch to plans offered on the ACA exchanges.
The Biden plan retains Medicaid as the primary vehicle for delivering health care to people with low incomes. States presently in the expanded Medicaid can switch to the public option provided they continued to pay their current share of the costs. In the 14 states that have not offered expanded coverage, low-income residents would be eligible for zero-premium coverage under the new public option.
UPDATED MARCH 11: POLICIES OF PAST CANDIDATES
What will the Warren’s “Medicare For All” plan cost?
Warren’s campaign said her single-payer health plan would cost $20.5 trillion over ten years. She recently modified her plan to start with a public option and transition into Medicare For All. She has yet posted a new projection of cost.
How will Warren’s “Medicare For All” plan be paid for?
Warren pledged not to raise middle class taxes, but instead to tax financial firms, large corporations, top 1% and other sources. In addition she will shift the burden of most health-care costs from consumers, in the form of spending such as premiums, deductibles and copays, to federal, state and local governments and employers. Her tax on employers is meant to replace the amount that companies now pay directly to health insurers.
Elizabeth Warren just recently modified her Medicare For All plan by starting out with a public option . Only later, in her third year in the White House, does Warren say she would pursue Medicare-for-all legislation. The remaining Democratic candidates back more modest proposals that would expand access to Medicare and Medicaid without ending the private insurance system. Most of these alternatives involve allowing individuals or employers to purchase a Medicare-like “public option,” a government insurance plan that would compete with private plans rather than replace them.
Pete Buttigieg’s ( Medicare For All Who Want It plan would cost $1.5 trillion over ten years. It would offer public health insurance to those who want it , while also keeping private health care plans available. Affordable insurance will be offered to the currently uninsured. It would end surprise billing, make the marketplace coverage more affordable, limit cost of out of network care and offer mental health parity. In addition, it would tackle high administrative costs, and monitor health care mergers. Critics of the plan believe it won’t guarantee universal coverage, props up the existing health care industry, and only offers to finance the plan by tightening corporate taxes.
Amy Klobucher prefers offering a Medicaid-type plan, embracing a bill to create a Medicaid-based public health-care option on state insurance marketplaces. She also signed onto a bill to lower the Medicare eligibility age to 50. She has specific plans for health care (public option), prescription drug, addiction, mental health and more.
Michael Bloomberg unveiled a health plan that would create a government-run health insurance public option plan but not provide universal guaranteed coverage. He believes smaller changes can make medical care more affordable while preserving the private insurance more than 150 million Americans receive through their employers. His plan focuses focuses on building on the policies in the Affordable Care Act
Tom Steyer supports a universal health care system, including a strong public option that aggressively competes with the private insurance marketplace, drives down costs, and expands coverage.” His Affordable Health Care For All includes enacting antitrust regulations for the health care industry and limiting prescription pricing.
Tulis Gabbard co-sponsed the Medicare for All Act. “I support a single-payer system that will allow individuals to access private insurance if they choose,” A single-payer system like Medicare-for-all would effectively eliminate private insurance. Her Health Care For All plan guarantees every American will get the health care they need.
These candidates have dropped out:
Andrew Yang’s plan to work with Congress to create a Medicare For All system including holistic healthcare.
Cory Booker’s fight for Medicare For All, lowering prescription prices, combating opiod addiction and more.
Kamala Harris’ Medicare For All plan (public option) and fair prescription drug prices
How do Americans Feel About Health Care Reform?
Six in ten Americans believe that it is the federal government’s responsibility to make sure all Americans have health care coverage. American opinions about a single payer government run health care program have evolved over time. At the beginning of 2019 only one in 10 registered voters wanted the equivalent of Medicare For All if it meant abolishing private health insurance plans.
As time went on support grew for a Medicare For All plan if preferred providers stayed in the program. Recent polls are showing up to 70% supporting the Medicare for All proposal. There’s a sea change in the way doctors, themselves, are talking about health care reform. From 2008 to 2017, the share of physicians who favor single-payer health care increased from 42% to 56%.
But which version of Medicare For All? At this point public opinion seems to be split between expansive changes, like Sanders and Warren proposals, or a less sweeping overhaul that would simply move the country closer to universal coverage, such as those from Joe Biden and Pete Buttigieg. A final third support Republican plan which would reduce federal involvement in the health system and give more money and autonomy to states.
In a survey released on Oct 19, the Kaiser Family foundation found that “more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on the Affordable Care Act (Obamacare) in order to expand coverage and reduce costs…..In addition they found broad support for proposals that expand the role of public programs like Medicare and Medicaid as well as a government-administered public option.”
- Watch tomorrow’s debate in Georgia, Wednesday Nov 20
- Link to the presidential candidate sites above and learn more about those you are leaning toward.
- Attend Presidential candidates and your own Congressional member rallies and public events. Each presidential candidate will list activities and dates under the “Events” link. Your Congressional member will post town hall meetings and fundraising events. Ask questions.
- Volunteer and Donate to Presidential primary and Congressional candidates. Your Democratic House Representatives are already beginning their campaigns for re-election in 2020, along with 12 Democratic Senators.
- Follow the candidate(s) on Facebook, Instagram and Twitter
- Research the remaining 9 candidates who are still running, (as of Nov 18), and have their own policy proposals out there. Just recently, former Massachusetts Governor and Bain Capital partner Deval Patrick has announced his candidacy. In addition, billionaire former mayor Michael Bloomberg is close to announcing his decision to run. The remaining 7 Democratic candidates include Julian Castro, Steve Bullock, Michael Bennet, Marianne Williamson, John Delaney, Joe Sestak, and Wayne Messam
- Volunteer to Get Out The Vote for 2020 with organizations such as