By Adam Gaffney
The Guardian (2/25/18)
On Thursday, the Center for American Progress (CAP), a Democratic party-affiliated think tank, launched a proposal confusingly called “Medicare Extra for All”. For proponents of a Bernie Sanders-style single-payer “Medicare for All”, this might seem like a positive development. Well, yes and no.
On the one hand, “Medicare Extra” is a step to the left for CAP, suggesting that the Democratic establishment is following the lead of its galvanized base. On the other hand, this new proposal would exact sacrifices from patients to placate the insurance industry, and could serve to divert the single-payer movement, which has been rapidly gaining steam.
Medicare Extra offers an inferior policy option, when a better one is on the table. Improved “Medicare for all” can affordably provide healthcare to everyone.
A debate over the next step on health reform has roiled the Democratic party. Some, like Hillary Clinton, have advocated incremental changes to Obamacare, such as a “public option”. Others, led by Bernie Sanders, seek to replace the hodge-podge of private and public health plans with “Medicare for All” – a single-payer program covering everyone without copays or deductibles.
Though Trump’s victory might have dampened support for the more radical road, it did just the opposite. The president swore to repeal the Affordable Care Act, and try he did – but apart from felling the individual mandate, the effort flopped in Congress. He did, however, rouse millions of Americans behind the cause of healthcare justice. Single-payer bills in both houses of Congress accrued record support in 2017, including a majority of House Democrats and more than a third of Democratic senators.
The political winds had shifted: progressives were out of power, but they were coalescing around a post-Trump plan – improved “Medicare for All”–overwhelmingly popular with the party’s base: about 69% of Democratssupported it, according to a September survey.
Voodoo healthcare
Enter Medicare Extra. CAP’s proposal is a response to these shifting winds. The new Medicare Extra program would automatically enroll anyone without other insurance. Premiums and out-of-pocket payments (eg copays and deductibles) would continue, with limits based on income.
Employers could choose to offer private coverage, or switch their employees into Medicare Extra. Notably, private insurers would get a big slice of the Medicare Extra market, enrolling millions in “Medicare Choice” coverage modeled on today’s wasteful, privatized Medicare Advantage plans, which in effect cost taxpayers “104% of per capita traditional Medicare spending” per enrollee, as noted in the Journal of the American Medical Association.
What’s not to like?
First, there’s the proposal’s voodoo economics. The US healthcare system hemorrhages cash through useless billing and bureaucracy, the inevitable consequence of battles between our jumble of profit-seeking insurers and the country’s providers. Transitioning to single-payer could end this waste, saving about $500bn annually; multi-payer systems such as Medicare Extra that add yet another plan to the existing slew of private insurers cannot. And without these efficiencies, expanding to fully universal coverage could prove unaffordable.
Second, because the economics don’t work, the coverage is insufficient. Although Medicare Extra would be more generous than most Obamacare plans, it would still leave millions encumbered with copayments and deductibles, which force people to choose between healthcare and other necessities. Keep in mind that one survey found that almost half of Americans couldn’t afford an unanticipated $400 expense, per the Washington Post.
Indeed, under the CAP program, some might see their coverage worsen if their employer elected to transition them to Medicare Extra. …
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Most Americans Want Universal Healthcare. What Are We Waiting For?
By Bernie Sanders
The Guardian (8/14/17)
As Americans, we need to answer some fundamental questions regarding the future of our healthcare system.
First, do we consider healthcare to be a right of all people, or a commodity made available based on income and wealth? Today, people in the highest-income counties in America live, on average, 20 years longer than people residing in the poorest counties. There are a number of reasons for that disgraceful reality, but one of them has to do with grossly unequal access to quality healthcare.
If you are upper-income and have good insurance, you go to the doctor on a regular basis, and life-threatening illnesses can be detected at an early stage when they can be effectively treated. If you are a working-class person without health insurance, or with high deductibles that keep you out of a doctor’s office when you’re sick, your chances of survival from a serious illness are significantly reduced.
The time is long overdue for a major overhaul of our health care system, one which creates universal, high quality and cost-effective healthcare for all.
In the wealthiest nation in the history of the world, should lower-income and working-class people have shorter and less healthy lives because they cannot afford the healthcare and medicine they need?
In my view, the moral answer is an emphatic No!
Second, why is our current healthcare system so enormously expensive? Today, despite having 28 million uninsured and even more under-insured, we are spending far, far more per capita than any other industrialized country – all of which guarantee healthcare to all of their people.
How does it happen that we spend almost $10,000 per capita each year on health care, while the Canadians spend $4,533, the Germans $5,353, the French $4,530, and the British $4,125?
Why, with that massive level of spending, is our life expectancy lower than most other industrialized countries, while our infant mortality rates are higher? Why do we pay, by far, the highest prices in the world for prescription drugs when nearly one out of five adult Americans cannot even afford the medicine their doctors prescribe?
What American helathcare is really about?
Here is the simple truth: the function of our current healthcare system is not to provide quality, cost-effective care for all. Rather, it is to create a complicated, wasteful and bureaucratic system designed to make many hundreds of billions a year in profits for insurance companies, drug companies and medical equipment suppliers.
It is a system which makes CEOs and stockholders in the healthcare industry incredibly rich, while tens of millions of Americans suffer because they are unable to get the healthcare they need.
What can we do to better serve the American people? …