February 6, 2019

Medicare-for-All

As the 2020 primary heats up, the two sides are debating the merits of ‘Medicare-for-All.’ AP News

According to a recent Kaiser Family Foundation Poll, 71 percent support a plan that would “guarantee health insurance as a right for all Americans,” but that number drops to 37 percent if it would “eliminate private insurance companies” or “require most Americans to pay more in taxes.” Kaiser Family Foundation

A separate poll, conducted in December 2018, showed that 46 percent of adults ‘have not heard anything’ about ‘Medicare-for-All’ health policy proposals. Forbes

See past issues

From the Left

The left argues that the current healthcare system needs to be overhauled, but is divided on the merits and political feasibility of Medicare-for-All.

Yale professor Jacob Hacker states, “We have a system that is truly distinctive in advanced democracies and distinctively poorly performing. We spend more than other countries. We don’t do a lot better or sometimes we do worse on health outcomes and we don’t cover everyone even after the Affordable Care Act… Even 15 years ago, there were a lot of people saying we have the best health care in the world and you didn’t want to screw that up by getting government too involved… But it’s almost impossible to sustain that argument today.”
Vox

Many note that “there are a slew of bills, introduced or suggested by other members of Congress and influential think tanks like the Center for American Progress, which use the language of Medicare for All but advocate for wildly different policies. They include three separate Medicare buy-in bills, a Medicaid buy-in bill, and CAP’s ‘Medicare for All’ bill, among others. The diversity of approacheshas created ambiguity that politicians don’t seem particularly eager to clear up — ‘Medicare for All’ is a galvanizing rallying cry.”
New York Magazine

“The thing Americans want most, if you look at the polling, is not single-payer per se. They want universal, affordable coverage that doesn’t leave them begging on GoFundMe for their kids’ insulin… And purity tests aside, there are many ways to achieve that outcome… These include allowing non-elderly adults to buy into Medicare… allowing employers to purchase Medicare for workers; a Medicaid buy-in program; and enrolling all newborns in a government health plan.”
Washington Post

Those in favor of universal healthcare posit that “you have to compare what a universal system would cost to what we’re paying now

“Last year we [collectively] spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade… you can criticize any particular universal plan on any number of grounds. But if it costs less than $50 trillion over 10 years — which every universal plan does — you can’t say it’s ‘unaffordable’ or it would ‘bankrupt’ us, because the truth is just the opposite.”
Washington Post

Those in favor of incremental reforms note that “during the ACA debate, Republicans failed to recognize the degree to which their traditional priority of minimizing government involvement in health care could threaten the financial security of the older and working-class whites now central to their electoral fortunes. Similarly, Democrats may be underestimating how much of their new coalition—which increasingly relies on well-educated whites in major metropolitan areas—may resist entrusting the health-care system entirely to government control.”
The Atlantic

Finally, “process matters… Absent a plan to get rid of the filibuster, or absent a bill that can fit entirely inside the budget reconciliation process, all of this is moot. In that world, [Ohio Sen. Sherrod] Brown’s plan to open Medicare to [the] 55-to-64 set is probably the best you can do…

“The history of health care reform is mostly a history of failure and backlash. That’s because America’s political institutions make big bills hard to pass, because moneyed interests fight like hell against its passage, and because people don’t trust the government to mess with their health care. How the various Democrats running for president propose to navigate or defuse those threats should be integral to this debate.”
Vox

“For Warren or anyone else to prevent the uniquely depressing experience of a Biden ‘national unity’ campaign, specifically targeted at a tiny cadre of wobbly Trump voters and Jeff Flake-style dissident Republicans, something has to change before next winter. Democratic voters and the media and basically everyone else must get over their skittish, fearful response to the Trump presidency, and their based-on-nothing certainty that nominating a progressive or a woman or a socialist or anybody who isn’t an avuncular white man with a vaguely reassuring demeanor and no discernible ideology will once again lead to disaster.”
Andrew O’Hehir, Salon

From the Right

The right opposes Medicare-for-All, arguing that it would reduce overall quality and be unaffordable.

From the Right

The right opposes Medicare-for-All, arguing that it would reduce overall quality and be unaffordable.

“The most comprehensive cost analysis of the Medicare for All bill estimated that the legislation would cost $32.6 trillion over its first decade. This estimate… assumes that physicians and hospitals would take home a reimbursement rate 40 percent lower than private insurance… One of two things would happen as a result. Physicians could play hardball with the government and demand more pay, thus blowing out that $32.6 trillion figure. Or, more realistically, there would be a mass exodus of providers from the market…

“[Moreover] we're the single most charitable nation in the world, with $33 billion going to health organizations and $22 billion going to international affairs. If you think that would continue with a socialized system — our boots-on-the-ground medical initiatives in the developing world and life-saving treatments distributed globally — do I have a bridge to sell you.”
Washington Examiner

“While the left often [criticizes] the disconnect between the United States and other industrialized nations in providing health care, those champions of medical equity nearly never mention the taxes necessary for getting there. American politicians have not suggested revising our tax structure to mirror any in Europe. Instead, they wave off the costs as something ‘the rich’ will pay for, which is mathematically impossible.”
The Federalist

“Currently, the quality of care received in the United States is limited only by your wallet. While this may seem unfair to some, your choice remains free from government interference… With the government controlling access to healthcare, they would also control the distribution of healthcare. In socialized healthcare systems, with supposedly universal access, it is not uncommon for patients to wait months (if not years) for treatment… patients even die on these waiting lists.”
Daily Wire

In Canada, “the median wait for treatment from a specialist following referral by a general practitioner is 19.8 weeks… In 1993 [before the current system was implemented], the median wait was less than half as much – 9.3 weeks. Waits are far longer for some specialties. For orthopedic surgery, the median wait for specialist treatment is 39 weeks.”
Fox News

In the US, primary care physicians already spend “up to twice as much time on their computers as they [do] with their patients, and a majority of physicians feel they are working at or beyond their capacity… there’s little to suggest that increasing government involvement would streamline health care delivery… outdated documentation requirements in the form of the evaluation and management codes—a major factor in an administrative burden that has been in place since 1995—are a requirement set by the Centers for Medicare and Medicaid Services.”
Daily Signal

Many also note that “[Medicare for all] would reduce access to needed, cutting-edge drugs… in the United Kingdom, Japan, and Greece, only 74 percent, 49 percent, and 8 percent, respectively, of cancer drugs launched between 2011 and 2018 are available. In contrast, 95 percent of these drugs are available today in the U.S… For patients, this choice matters. It’s why the United States has the highest five-year survival rate for cancers in the world.”
IJR

“Talk about ditching private health insurance may be the kind of thing that does well in super-liberal circles, and being super liberal may seem to be the kind of thing that gets you a decent cult following and a lot of media coverage… but the truth is, for a lot of Americans, the thought of making our system into a socialized one is still scary.”
National Review

“Medicare-for-all is obviously catnip to the progressive base, and just as obviously deadly nightshade to the suburbanites whom Trump has driven out of the Republican Party. You know, the ones who propelled Democrats to control of the House by such handsome margins in November… If you force suburbanites to choose between having a lewd race-baiter in the White House and sacrificing their health-insurance coverage… or paying higher taxes… or many of the other disruptive things progressives want to do… well, maybe they decide the troglodyte is the lesser of two evils.”
Washington Post

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