July 18, 2019

All Things Healthcare

“House Democrats and Republicans joined in a rare show of unity Wednesday, voting overwhelmingly to repeal an unpopular tax on generous health insurance… The so-called ‘Cadillac tax’ never went into effect, since lawmakers kept delaying it. Wednesday’s 419-6 vote increases chances that the Senate will follow the House, going for full repeal.” AP News

Also on Wednesday, “Bernie Sanders vigorously defended his signature ‘Medicare for All’ proposal… after criticism from his 2020 rival Joe Biden.”AP News

On Monday, Joe Biden “unveiled a health plan that’s intended to preserve the most popular parts of Obamacare — from Medicaid expansion to protections for patients with preexisting conditions — and build on them with a new government-run public insurance option.” Politico

“Among the five top-polling candidates nationally, Biden is one of two, along with South Bend, Indiana, Mayor Pete Buttigieg, running on a plan to build incrementally off the ACA. Three others (Sanders, Sen. Elizabeth Warren, D-Mass., and Sen. Kamala Harris, D-Calif.) are backing the same single-payer Medicare for All bill.” NBC News

See past issues

From the Left

The left views both Biden’s and Sanders’s plans favorably, and opposes repealing the Cadillac tax.

“Both Biden and his more progressive rivals are somewhat downplaying exactly how much more left wing than the ACA [his] idea is… The main difference between Biden’s plan and Medicare-for-all is a BidenCare transition that would be more gradual and much less costly in terms of explicit tax increases… make no mistake, if it were somehow to happen, it would be a really big deal.”
Matthew Yglesias, Vox

At the same time, many argue that “this is one issue where Obama nostalgia may fall short with the voters Biden needs to reach. For many Democrats, ObamaCare was a good first step, establishing the idea that the federal government has an important role to play in ensuring Americans have access to adequate insurance and care. But they also considered the law flawed — too reliant on profit-seeking private insurance companies, too derivative of Republican approaches to the issue, too much the result of the political compromises it took to get passed. For such activists, ObamaCare is the clunker they drive to work; Medicare-for-all — or something like it — is the shiny, sleek sports car they want to own someday.”
Joel Mathis, The Week

“Rep. John Delaney (D-Md.) said, let’s ‘keep what’s working’ in our current system. What does that mean? Today, millions of Americans remain uninsured or underinsured — with exorbitant deductibles and out-of-pocket costs on top of their ever-rising insurance premiums. Medical bankruptcy is common, even among the insured… And people with employer-sponsored private insurance? They lack health-care security. If they lose their job, they lose their insurance. If ‘working’ means decent and reliable coverage, private health insurance is definitely not cutting it

“Beto O’Rourke said ‘Choice is fundamental’ as an argument to retain commercial insurance. Yet it is our choice of doctor (not insurance company) that is fundamental to our care and that’s exactly the freedom that commercial insurance denies us — for profit.”
Dr. James G. Kahn and Elliot Marseille, The Hill

While “[public] support drops dramatically… once you explain that [Medicare for All] would force them to swap their current insurance for a public plan… It is not entirely clear why this is the case, since few people really seem to be in love with their insurance company. Some surveys have found that enthusiasm for Medicare for All bounces back up if pollsters explain that, while private carriers would disappear, people would still be able to keep their doctors. That suggests some Americans are actually worried about losing their favorite physician, not their Cigna card.”
Jordan Weissman, Slate

“More than 100 rural hospitals across the nation have closed in recent years, leaving many poor communities bereft of access to even basic health-care services. From 2004 to 2014, some 650,000 women of childbearing age in rural counties lost all access to obstetric services… Meanwhile, even as some hospitals close, others are seeing rising profits, or embarking on aggressive capital expansions and acquisitions, propelled by fierce competition. Fancy new towers rise as rural hospitals fall, yet both have a common cause. The poverty of some of our hospitals and the rich fortunes of others are but two manifestations of a single pathology: a dysfunctional, profit-oriented system of hospital payment…

“How would things be different with Medicare for All? Well… there [would be] no hospital profits, and so profitability ceases to be the criterion that dictates which hospitals open or close, and which expand and beautify. It would remove the incentive for hospitals to chase lucrative service lines, like spinal surgery, at the expense of unprofitable ones, like mental health. And it would ensure that we have hospitals, obstetric units, and mental health wards in the communities that need them—not just where firms think that they will be profitable.”
Adam Gaffney, The Nation

Regarding the Cadillac tax, “high-premium employer-based plans raise the cost of health care for everyone by encouraging the overconsumption of expensive services. This means that even Medicare and Medicaid face higher prices. Quite aside from its benefits for the health-care market, the Cadillac tax would also have the effect of expanding the tax base and making the tax code more efficient. It would raise revenues by about $15 billion a year… Rather than killing or delaying the Cadillac tax, Democrats should be trying to make it operational. The tax would raise revenue, lower costs, increase the efficiency of the tax code and give the Obamacare individual market its best chance at success.”
Karl W. Smith, Bloomberg

From the Right

The right is critical of all the Democrats’ healthcare plans, and generally in favor of repealing the Cadillac tax.

The right is critical of all the Democrats’ healthcare plans, and generally in favor of repealing the Cadillac tax.

“Cut through the spin, and the only debate Democrats are having is whether to eliminate private health insurance in one blow or on the installment plan… Mr. Biden supports a new government insurance plan that would ‘compete’ with private insurance. We use quotation marks since a government insurer with zero cost of capital and political backing starts with an unbeatable advantage. The public option would undercut competitors on price, stiff providers with low reimbursement rates, and crowd out private insurance over time…

“South Bend Mayor Pete Buttigieg has called a public option a ‘glide path toward Medicare for All.’ Senator Kirsten Gillibrand said at a town hall this year that with a public option ‘over a couple years you’re gonna transition into single payer.’ Remember this as Mr. Biden says—and this may sound familiar—that if you like your health insurance, you can keep it.”
Editorial Board, Wall Street Journal

Many are critical of Harris’s pledge not to increase middle class taxes. “Let's do some math. The liberal Urban Institute found that the 2016 campaign version of the Sanders plan would have cost $32 trillion over 10 years… Over the next decade, the federal government is expected to collect $23.34 trillion in individual income taxes and $3.76 trillion in corporate income taxes, according to Congressional Budget Office projections. If both individual income and corporate taxes were doubled, Harris would still need to come up with an additional $5 trillion…

Taking middle-class tax cuts off of the table would make it impossible to finance what Harris is proposing: Putting 330 million people onto a single government plan that offers extensive medical, dental, vision, prescription drug, and long-term care coverage without premiums, co-pays, or deductibles.”
Philip Klein, Washington Examiner

“There are few obvious overlaps between Harris and Trump politically but a major one is that neither sweats the details of policy. They both seem to understand that voters think big-picture: Details will change once Congress gets involved anyway, so focus on setting a broad policy vision instead. Trump’s going to build the wall, Harris is going to enact Medicare for All without any middle-class taxes. We’ll worry about the minutiae later.”
Allahpundit, Hot Air

Others criticize the cost of Sanders’s plan. “Forty trillion over ten years is an average of four trillion per year. Does anyone recall what the entire budget of the United States federal government was for 2018? It was 4.094 trillion dollars. So Sanders is casually talking about expending the equivalent of our entire budget on his health care plan… But don’t worry. President Sanders will make sure that there’s enough money for it by raising everyone’s taxes, including the middle class. And those taxes are going to have to go up a lot to cover this kind of a bill. Oh, and you won’t have an option of keeping your plan through your employer.”
Jazz Shaw, Hot Air

Regarding the Cadillac tax, “It’s encouraging that House Democrats have opted to repeal one of the biggest tax hikes of Obamacare. They are choosing to kill it without an offsetting tax increase — something Republicans have advocated for many years… There are three widely bipartisan Obamacare taxes that could be added to Cadillac Plan tax repeal. They are an excise tax on medical devices like pacemakers and breast pumps, an excise tax on health insurance premiums, and a repeal of a ‘medicine cabinet tax’ on over-the-counter prescription medicines. These, too, should attract supermajorities in both chambers…

“[It’s worth noting that] the Cadillac Plan tax has never gone into effect, and was likely never going to go into effect. That should tell us something about the political feasibility of going after the employer-sponsored private sector health insurance benefit. If our ultimate goal is to make health insurance portable and flexible, we need to do it while accommodating the strong desire of most families to keep the insurance they like.”
Ryan Ellis, Washington Examiner

Dated But Relevant: Some argue that “the Cadillac tax helps correct a major flaw of the tax system: the unlimited tax break for employer-provided health insurance. Although workers pay both income and payroll taxes on their cash wages, they are not taxed on their health benefits. That tax disparity creates an incentive for more of workers’ pay to be provided through health insurance rather than cash wages… If lawmakers on both sides of the aisle are serious about controlling health care costs and curbing misdirected tax breaks, the Cadillac tax, or a better designed replacement, should take effect as soon as possible.”
Alan Viard, The Hill

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