Status Updates From Medicare for All: A Citizen...

“Improving competition from generic drugs by cracking down on abuses of the patent system is a good idea that would lower prices for some medications, and these reforms should be pursued whether under M4A or under our current system.”

“Finally, a system that builds on the ACA alone is likely to remain inequitable. The ACA marketplaces separate insurance plans into four “metal levels”: platinum, gold, silver, and bronze. People who can afford platinum plans enjoy comprehensive health coverage, while people with bronze plans are saddled with deductibles so high they might not be able to afford care altogether.”

“a reform plan that only builds on the ACA lacks nearly all the active ingredients of Medicare for All: although we could approach universal coverage, coverage would not become more comprehensive, the public would not gain negotiating leverage against the healthcare industry to rein in prices, administrative efficiency would not be improved, financing would remain regressive... ”

“the failure of the Clinton reform in the 1990s led many strategists to treat incremental reform as politically necessary, as well as to favor plans that are acceptable to the healthcare industry in order to allay the all-out attacks that spoiled reform for much of the twentieth century. The Affordable Care Act is often viewed as a vindication of this political strategy... ”

“Six key elements of M4A: 1. Universal coverage. M4A guarantees health coverage to every American. 2. Comprehensive coverage. 3. Pricing power. M4A can wield its considerable negotiating leverage to rein in the cost of drugs, hospital stays, and physician services. 4. Administrative efficiency. M4A eliminates the high overhead costs of private insurance companies 5. Progressive financing. 6. Public accountability. ”

“In addition to lack of insurance... we outlined a fuller set of major problems that Americans face in our current system: our healthcare is too expensive, too many Americans can’t access the care they need, we’re sicker than we should be, and the experience of giving and receiving care is eroding.”

“Healthcare consumes nearly a fifth of the American economy. The highly technical debate about how to pay for M4A masks a fundamental truth: behind the number crunching, Medicare for All expresses a new vision for economic justice.”

“M4A would also have a tremendous impact on where our healthcare dollars are spent and how those costs are shared across the population. Our current system funnels a sizable portion of healthcare dollars to pay the overhead costs of insurance companies and providers, and it places an outsized burden on Americans with lower incomes and greater medical need.”

“The Sanders approach to financing M4A bears many similarities in terms of the kitchen table budget. Families would save on insurance premiums and out-of-pocket costs; in exchange, they would pay a 4% income-based premium for M4A. Because private insurance is financed regressively, this change is likely to produce savings for middle-class and low-income families, while high-income families would likely pay more... ”

“For most Americans, what really matters is the “kitchen table” budget: how much does your family spend on healthcare each month, and how much is left over for other priorities? A focus on the kitchen table budget—rather than the government budget or overall national health spending—highlights how M4A would impact the finances of individuals and families.”

“In essence, employers would spend about the same under the Warren Medicare for All plan as they would spend in the status quo, and federal and state governments would shift their current healthcare spending into M4A. But nearly $11 trillion in healthcare costs would be shifted from American families onto large corporations and the wealthy.”

“M4A could also be financed through new progressive taxes that are not meant to replace existing healthcare spending but are designed to bring in money from new sources... a wealth tax on the richest Americans, raising the marginal income tax rate on the highest earners, reforming the corporate tax code, a financial transactions tax, taxing income from investments at the same rate as income from work... ”

“A reasonable policy goal would be to have any new taxes on middle-class or low-income families be lower than what these families currently pay for healthcare.”

“Family spending on premiums and out-of-pocket costs could be replaced by an income tax, a payroll tax, a Medicare for All premium (standardized or income-based to make it progressive)... options could be designed to be progressive, thereby saving money for the middle class and the poor.”

“Today, employers might send a portion of payroll each month to Aetna or Blue Cross to fund insurance premiums for workers. Under a Medicare for All payroll tax, employers would continue to send a portion of payroll each month to fund insurance for workers—but the check would be sent to Medicare.”

“But there are two basic elements likely to serve as the foundation to any M4A financing plan: repurposing existing public funds, and replacing private healthcare spending with progressive taxes. The primary way to pay for M4A is to use money the government is already spending on healthcare. The federal government already finances almost half the nation’s healthcare spending.”

“the federal government also spends a considerable sum of money subsidizing private health insurance, including subsidies on the ACA marketplace and the tax break for employer-based insurance. Indeed, in 2017 the federal government spent nearly $280 billion subsidizing employer insurance—the largest expenditure in the entire tax code, worth about $1,800 for each person with job-based coverage.”

“If national health spending stays about the same under M4A but we spend trillions less on administration, that means more total dollars will be spent on medical services: hospital care, physician services, nursing facilities, home healthcare, prescription drugs, and more. M4A does not starve the healthcare system of funds; instead, it redirects more of what we’re spending already into actual care.”

“This shift toward patient care is reflected in the ledger of the costs and savings under Medicare for All. One of the largest sources of savings under M4A is administrative efficiency: streamlining insurance overhead, and also reducing the administrative costs of providers. In contrast, virtually all the new costs under M4A represent new spending on clinical care... ”

“evidence [cuts] through the partisan rhetoric on single-payer healthcare. On one side, critics sometimes speak as if M4A would launch our spending into the stratosphere. On the other side, supporters sometimes hope that because single-payer systems in other countries are half as expensive as our current system, Medicare for All would swiftly cut our health spending in half. Neither of these scenarios is likely.”

“the broad consensus that American health policy should provide strong protections for people with preexisting conditions. One of these protections is that insurance companies shouldn’t be able to charge higher premiums to a person who has a preexisting condition. But high deductibles serve nearly the same role: people with preexisting conditions are likely to pay thousands of dollars [to reach their] deductible.”

“Private healthcare spending is regressive because insurance premiums and out-of-pocket costs are regressive: a $20,000 insurance premium and a $5,000 deductible aren’t much of a burden for a millionaire executive but might be a huge drag on the finances of a teacher or a nurse.”

“employer-paid premiums function like a hidden tax, taking more and more money out of American paychecks every year. As a result, the hidden costs of healthcare are particularly stark for Americans with insurance through their jobs”

”Employees technically have a large chunk of their premiums covered by employers, but at the end of the day those premium payments come out of money set aside for employee remuneration. For instance, if your work is worth $75,000 a year to your employer, who has to chip in $15,000 for your insurance premium, your salary will only be $60,000.”

“Under the current system, Americans are projected to share a $52 trillion healthcare bill during the 2020s, with annual expenditures above $4 trillion at the start of the decade and over $6 trillion by its close. We each contribute to that bill in three main ways: taxes, insurance premiums, and out-of-pocket costs.”

“Every dollar spent on medical care is a dollar that comes out of someone’s income, taken from a worker or a business owner or a shareholder or a family. … We pay the premiums or the taxes—and usually both. Insurance companies and the government are the intermediaries that collect the money and send it where it needs to go. But the money comes from us, no matter the healthcare system.”

“Another transitional approach is to phase in Medicare for All by age—for instance, make all children and those over fifty-five eligible in the first year, and then expand coverage by ten-year age increments every year.”

“What needs to happen during the transition? Most obviously, people need to transition onto M4A coverage. One approach is to create a Medicare for All option that anyone can opt into during the transition period. The transition could also adopt principles of triage to provide assistance quickly to the uninsured.”

“Though M4A will almost certainly mean more clinical jobs, it will also likely mean far fewer administrative jobs. Indeed, most private insurers will downsize or close, leaving many people without job prospects in the industry; this will similarly affect the armies of billers and coders in hospital and physician back offices…A critical piece of the transition must include assistance for these workers”