By Marianne Bitler, Hilary Hoynes, Diane Whitmore Schanzenbach
Milbank Quarterly, April 30, 2020

Over the past two months, the United States has seen a historic increase in unemployment. While some of these jobs quickly will be regained when the public health measures needed to manage the crisis can be relaxed, the unemployment rate will likely remain elevated for several years.

History teaches us that those with low levels of education and earnings, as well as disadvantaged ethnic and racial minorities, tend to suffer more during recessions. They experience larger increases in unemployment and regain jobs more slowly than more advantaged groups. For example, even ten years after the 2007-2008 Great Recession, those with less than a college degree had not recovered to their prerecession employment levels. Rates of poverty and food insecurity spiked and remained elevated for at least five years.

In addition to Medicare, Medicaid, and the other important safety net programs that provide health insurance and health care, the United States has a patchwork of programs designed to help families meet their basic needs. Over the past two decades, since President Clinton made good on his pledge to “end welfare as we know it,” our safety net for the nonelderly (and nondisabled) has shifted primarily to a work-based safety net. And this has implications for how the safety net responds to economic downturns like the one we now face.

A core component of the safety net is the Earned Income Tax Credit (EITC), which pays annual refundable tax credits to low-earning working families—but provides no benefit to those who are unemployed. Research has shown that the EITC draws workers into employment, boosting their incomes and lifting millions of people above the poverty line annually. Another core program—the Supplemental Nutrition Assistance Program (SNAP)—provides monthly vouchers to low-income families regardless of employment status that can be used to purchase food at grocery stores. Overall, more families who participate in safety net programs are also working. In fact, our research has found that all of the increase in overall safety net spending on families with children during the past 25 years has gone to working families.

A well-functioning safety net automatically and quickly responds to increased need, ramping up payments when families face income losses and, in turn, stimulating the economy. SNAP offers a good example: When a family suffers a drop in earnings—due to job loss or reduced hours—its SNAP benefits increase. If the family already is receiving SNAP benefits, its monthly benefit increases to help offset the income loss. Other families that become newly eligible for benefits can enroll and generally will receive initial payments within one month. Importantly, SNAP is an entitlement program and, as demand for the program increases, there are no funding limits due to block grants or other restrictions. Owing to these factors, aggregate SNAP spending expands and contracts with the unemployment rate, providing resources to needy families while also helping stabilize the economy.

One drawback is that relatively few safety net programs are designed like SNAP to increase automatically when unemployment increases, so that those with incomes (after taxes and transfers) near the poverty level are harmed more during recessions than those at higher income levels. Furthermore, with the transition to a work-based safety net, incomes among the most disadvantaged decrease more when unemployment increases, and deep poverty increases more during recessions.

What do we know about the stabilizing effects of other elements of the social safety net? Unemployment insurance (UI) payments have increased well beyond historic levels during the COVID-19 pandemic, but many low-income workers do not qualify for UI benefits because of insufficient work histories. The EITC—the cornerstone of the safety net during good economic times—is not very responsive to economic downturns. Among single-parent families, who form the majority of EITC recipients, a decline in work generally leads to a loss of EITC eligibility or a decline in EITC payments. Among married filers, there is a modest countercyclical response—that is, a decline in family earnings makes them EITC eligible. Prior to welfare reform, the poorest out-of-work families received cash benefits through the Aid to Families with Dependent Children (AFDC) program, which expanded in response to increased need like SNAP does today. AFDC was block-granted in the mid-1990s as part of federal welfare reform, with the result that cash welfare was completely unresponsive to need during the Great Recession. With the powerful exception of SNAP, many low-income families fall through holes in the safety net during recessions.

More recently, there has been growing interest in expanding work requirements in SNAP (and in introducing them in Medicaid). Adults ages 18 to 49 can only receive SNAP for three months unless they also are working at least 20 hours per week. Putting aside the question of whether this is sensible during good economic times, it is unconscionable to withhold basic food assistance (and health care) from the unemployed during a recession. Recognizing this, Congress has long established the ability for states to waive work requirements for SNAP when the unemployment rate is high or when insufficient jobs are available. Work requirements in SNAP were suspended during the Great Recession and SNAP benefits were quickly paid out to the unemployed. The Trump administration, however, has argued that the waivers to work requirements are too permissive and has proposed tightening them to such an extent that the economy would have to be substantially worse before work requirements could be waived. As we face the beginning of a new recession, the acute spike in need underscores the importance of having safety net programs that can provide assistance to the unemployed. Congress has suspended SNAP work requirements until the end of the national health emergency.

In addition to these known drawbacks of a work-based safety net during a recession, there are new factors during the COVID-19 era that raise additional concerns. The widespread school closures deprive approximately 25 million children of subsidized school breakfasts and lunch—programs that typically are the front line of defense against childhood hunger. Because subsidized school meals have higher income eligibility thresholds than SNAP, these programs reach families that are SNAP-ineligible. While many school districts have attempted heroically to feed students despite school closures, only a small number of meals are being distributed at school sites. This loss is undoubtedly putting additional strain on family resources on top of the normal stresses caused by recessions.

Congress wisely authorized a program to address this shortfall named “Pandemic-EBT,” which provides approximately $110 per month in grocery vouchers to families who would have received subsidized school meals if school were in session. States must apply and receive approval from the US Department of Agriculture to implement this important backstop program, which is modeled after a summer feeding program which has been shown to be effective via randomized controlled trials. To date, only a few states have implemented these payments, but the program should remain in place as long as social distancing recommendations are in effect—through summer, when food insecurity spikes as students lose access to school meals, to fall, or beyond.

Another challenge has been the tidal wave of job losses that have come all at once, with states struggling to process new applications for safety net programs. This has been compounded by the surge in demand coupled with states needing to protect the health of their social service workforce through social distancing practices and transitioning to telework. Congress has authorized some temporary measures that states can adopt to help streamline application processes. For example, states may automatically extend eligibility for those currently on SNAP who would have had to recertify during the pandemic, and states may temporarily award participants the maximum SNAP benefit, which reduces the need to collect detailed information about usual expenses that are normally factored into benefits calculations. Unfortunately, these smart policy responses have been authorized for only two to three months but need to be extended to allow states to catch up on their backlogs. This crisis also highlights challenges with having a lean public workforce to manage and determine eligibility for programs like SNAP in times of crisis when needs are greatest and state budgets are shrinking.

The current pandemic is exposing the inadequacy of our social safety net for the most disadvantaged Americans. A safety net built around employment provides incomplete insurance against labor market shocks. Stay-at-home orders, loss of work, and their implications for declines in income require responsive government action. It is urgently necessary to expand the available programs, perhaps increasing SNAP benefit levels as was done in the 2009 stimulus and eliminating all work requirements to meet this challenge.

https://www.milbank.org…

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Comment:

By Don McCanne, M.D.

The COVID-19 pandemic is bringing home the reality that it is imperative that our government always be at the ready to provide safety net functions in times of need, whether individual or societal.

This discussion reveals how ill-considered policies such as work requirements and block grants actually impair the safety net functions that our government should be providing. And it is not just the Republicans; a Democratic administration made good on the pledge to “end welfare as we know it” as a remedy to the fictional “welfare queen” popularized under a previous Republican administration. When the policies should be to ensure that people with needs can have them met, then why do we introduce policies that create large rents in the safety net?

In our arena of health care, even though welfare programs exist such as Medicaid, the safety net leaks worse than a sieve. With the current pandemic and the loss of employment and of employer-sponsored insurance that goes with it, the need for government sponsorship of comprehensive health care has greatly expanded, though the need was already there before the coronavirus was on the scene. Just think of how it would be if we had a universal single payer Medicare for All already in place permanently. There would be no need for a health care safety net because there would be no holes in the health care financing system.

Be careful when you vote. It can be a matter of life or death, though, unfortunately, that prized “choice” we value so much may not be on the ballot.

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Fordham University, April 29, 2020

Despite apparent gaps in the United States’ healthcare system during the coronavirus outbreak, Americans are generally satisfied with the healthcare system’s performance, according to a new poll from Fordham University. The crisis may, however, be driving more Americans to support a government-run healthcare system. At this point, Americans also express support for guaranteed quality healthcare for all Americans, those infected with the coronavirus, and other groups, regardless of party affiliation. Support for access to quality care regardless of citizenship status is also widespread.

The poll, conducted by NORC at the University of Chicago, took place from April 16 through 20, 2020, among 1,003 respondents nationwide. It has a margin of sampling error of 4.33 percentage points. The poll is a product of the Fordham Graduate School of Arts and Sciences’ Advanced Certificate in Public Opinion and Survey Research and its M.A. in Elections and Campaign Management.

Support for Single-Payer Healthcare during the Pandemic

The coronavirus pandemic may be influencing Americans’ support for a single-payer healthcare system. When asked to choose between a single-payer system and a system based mostly on private insurance, a slim 53% majority of Americans now choose a single-payer system with 44% preferring insurance-based. Five months ago, pre-coronavirus, when Gallup asked a similar question the numbers were the reverse – 42% and 54% respectively.

Not surprisingly there are large partisan differences on this issue. Majorities of Democrats (68%) and independents (57%) would prefer a single-payer system in the midst of the pandemic, but nearly three-quarters (72%) of Republicans would rather have a system based primarily on private insurance.

Q: If you had to choose which of the following two approaches for providing healthcare in the midst of the coronavirus pandemic in the United States would you prefer–a government-run healthcare system, or a system based mostly on private health insurance?

Government run system:

• 53% – Total
• 68% – Democrat
• 57% – Ind/Other
• 27% – Republican

System based on private insurance:

• 44% – Total
• 26% – Democrat
• 41% – Ind/Other
• 72% – Republican

Perceptions of Government’s Healthcare Responsibilities

We asked Americans about the federal government’s responsibility to provide quality healthcare to various groups of Americans: the poor, senior citizens, veterans, those infected with the coronavirus, and all Americans. Majorities of all partisan affiliations agreed it was the federal government’s responsibility to provide healthcare to each of the groups.

Those who agree it is the federal government’s responsibility to provide quality healthcare for all Americans:

• 87% – Democrat
• 80% – Independent/Other
• 59% – Republican

For most of the target groups, the majority support for guaranteed quality healthcare is sizable. Only for guaranteeing healthcare to all Americans does a deep partisan divide develop – a smaller majority of Republicans – 59% – support guaranteed quality care for all, compared to seven-in-ten or more of Republicans that support the same for each of the other target groups. (Full results at link below)

Healthcare Coverage for Non-Citizens

Americans are also supportive of providing healthcare to non-citizens when it comes to the coronavirus outbreak. Nearly eight-in-ten respondents believe people should have access to quality medical care regardless of citizenship status, with half of all Americans strongly believing so. Here again, majorities of all parties are supportive of such access.

https://www.globenewswire.com…

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Comment:

By Don McCanne, M.D.

So this is yet one more poll that shows that a majority of Americans would prefer a “government run system,” though the number is not quite as high as other polls since 72% of Republicans preferred the option of a “system based on private insurance.”

The more significant finding in this poll is that a strong majority, including 59% of Republicans, agree that “it is the federal government’s responsibility to provide quality healthcare for all Americans.” Also, almost all agree, including 66% of Republicans, that during the coronavirus attack “people should have access to quality medical care, regardless of citizenship status.”

It is reassuring to see that there is strong agreement that the government needs to be involved in providing health care for all. We just have to do a better job in explaining to Republicans why an improved version of Medicare would be better than relying on private insurers.

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By Susannah Luthi
POLITICO, April 28, 2020

Big businesses and powerful Democrats are aligning around a proposal to bail out employer health plans in the wake of staggering losses to the insurance industry, as some worry that a surge in uninsured Americans could give new life to a stalled push for “Medicare for All.”

The business and labor interests, who have strong economic motives to keep the current system of employer-based care, are rallying behind a Democratic effort to subsidize temporary extensions of newly unemployed Americans’ workplace health plans in Congress’ next coronavirus rescue package.

But to some progressives who cheered Bernie Sanders’ (I-Vt.) Medicare for All plan, the crisis has exposed what they see as the folly of tying employment to health coverage. Sanders, who’s advocating for an emergency version of his health plan during the pandemic, ripped the idea of propping up an expensive employer system in a POLITICO op-ed Tuesday.

“Not only would health insurance corporations make massive profits off the plan—profits that come at the cost of the American taxpayers—but it would still leave tens of millions uninsured or underinsured,” the former Democratic presidential candidate wrote. “And during this pandemic, a lack of insurance means more Covid-19 transmissions and more deaths.”

Employers, health care groups and unions badly want the employer system to emerge from the health crisis unscathed, believing it would ward off any new expansion of government health care. Joe Biden’s rise to becoming the presumptive Democratic nominee was a relief to the health care industry, which has spent the past two years attacking Medicare for All.

“This crisis will be over — not soon enough, but it will be over — and we need to fundamentally keep that highway back to jobs and job-provided health care open,” said Ilyse Schuman, senior vice president of health policy for the American Benefits Council, which represents major employers.

While the health industry and Democrats still want to bolster Obamacare, an unusual bloc is pressuring Congress to fully subsidize workplace premiums for the uninsured. Corporations would benefit because the employer-based system supplies a big tax break for benefits they can use as a recruiting tool. Unions would keep the generous coverage they have negotiated with corporations. And hospitals and doctors could maintain the big payouts from private insurance, which are far higher than the Medicare and Medicaid rates paid by government.

Unions, major insurers, hospitals and the consumer advocacy group Families USA have banded together through a group called the Alliance to Fight for Health Care, and are lobbying Congress to subsidize COBRA through the next stimulus package.

Supporters said COBRA aid would provide a backstop to hospitals and physicians, whose finances have been hurt by the cancellation of elective procedures during the crisis.

“Hospitals and providers are seeing tremendous expense and increase in uncompensated care and uninsured individuals coming in, while also seeing drops in elective procedures, so I think it’s money well spent in protecting employees in a time of crisis,” said Katie Mahoney, vice president of health policy for the U.S. Chamber of Commerce.

House Speaker Nancy Pelosi first pitched COBRA subsidies a month ago in a proposed alternative to the $2.2 trillion CARES Act that was ultimately approved by Congress.

Support from unions puts pressure on progressive Democrats, the driving force behind Medicare for All, to back the policy.

Unite Here, representing mostly service workers, said Congress must subsidize workplace plans. The union’s international president, D. Taylor, estimates 95 percent of its members are unemployed during the crisis.

Moreover, experts note, COBRA subsidies come with a huge price tag and ultimately help the middle- and higher-income people, rather than lower-income people more likely to work retail and service jobs affected by shutdowns.

“Almost no matter the employment outlook or time horizon, COBRA subsidies are unlikely to be the most cost-effective way of expanding coverage or relieving financial hardship,” said Matt Fiedler, former chief economist of the Council of Economic Advisers under the Obama administration. “They’re just not targeted on the right people.”

https://www.politico.com…

Alliance to Fight for Health Care: Supporting the employer-provided health care system
https://www.fightforhealthcare.com

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Here’s How to Cover Uninsured Americans During the Pandemic

By Sen. Bernie Sanders
POLITICO, April 28, 2020

As the coronavirus continues to spread, and the United States climbs closer to 1 million cases and nearly 60,000 deaths, we face an unprecedented economic and health care crisis that demands an unprecedented response. While we work toward an economic solution that keeps people on the payroll, Washington is also in the midst of a crucial argument over how to help cover the costs of testing, treatment and all other essential care for the millions of people who are now uninsured or soon will be as the country faces record levels of job loss.

Last week, the White House said it would give an unspecified amount of federal aid directly to hospitals to cover the costs of treating uninsured Covid-19 patients, but details have not been released, and the proposal leaves out all non-Covid-19—but still crucial—medical care. The week before, a handful of Democrats proposed spending hundreds of billions of dollars on expanding subsidies for COBRA—the program that allows those who have lost their jobs to continue, on a temporary basis, paying out-of-pocket for the health insurance coverage they received from their previous employer.

But there’s another, better way to guarantee that everyone in America gets all the health care they need, without cost, for the duration of the pandemic: Empower Medicare to pay all of the health care costs for the uninsured, as well as all out-of-pocket expenses for those with existing public or private insurance, for as long as this pandemic continues. Our Health Care Emergency Guarantee Act is more comprehensive than Trump’s vague proposal and less expensive than the Democrats’ COBRA expansion.

While almost all Democrats understand the severity of the crisis and the need to act, too many of them are proposing a totally inadequate response that would simply lock in place the dysfunction and waste of our current health care system.

Subsidizing COBRA, as they have suggested, would be both expensive and ineffective: Not only would health insurance corporations make massive profits off the plan—profits that come at the cost of the American taxpayer—but it would still leave tens of millions uninsured or underinsured. And during this pandemic, a lack of insurance means more Covid-19 transmissions and more deaths.

Expanding COBRA during the pandemic would do nothing to cover those who already lacked insurance. It also won’t help the many Americans who continue to receive employer-provided health care but are still prevented from going to the doctor by massive deductibles and co-pays. In fact, the average family with employer-provided insurance faces $4,700 in out-of-pocket costs every year. The deductible alone for the average low-income worker is $2,600 a year. Maintaining the status quo does nothing to address these extraordinary costs, made worse during the pandemic economy.

Further, COBRA subsidies will only cement the inequities of our current health insurance system. Right now, low-wage workers are, on average, enrolled in plans with low premiums but higher deductibles. On the other hand, higher-wage employees, often professionals, have platinum plans with much higher premiums and far superior coverage. Expanding COBRA, which subsidizes only premiums, would treat high-income workers who lose their jobs far better than low-wage workers who do, even though the latter have suffered the brunt of the economic damage wrought by the pandemic.

The Health Care Emergency Guarantee Act would treat all people equally. For the duration of this crisis, under the act, Medicare will cover all medically necessary health care, including prescription drugs, for the uninsured, whether those who have recently lost their jobs or those who have been long without insurance. It is simply irresponsible and dangerous to the public to allow millions of people in this country to go without health coverage as a pandemic rips through our communities.

The American people deserve a health care response to the pandemic that’s simple, easy to understand and doesn’t require them to fill out complicated forms or deal with an already stressed bureaucracy in order to receive care. Under this proposal, everyone in the United States, regardless of insurance coverage or immigration status, would be able to walk into a doctor’s office to receive the care they need without worrying about the cost.

https://www.politico.com…

Health Care Emergency Guarantee Act:
https://www.sanders.senate.gov…

Summary of Emergency Guarantee Act:
https://www.sanders.senate.gov…

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Comment:

By Don McCanne, M.D.

One of the painful lessons of the tragic Covid-19 pandemic is that we see how terrible the functioning of our health care financing system is, as if it weren’t already obvious before the pandemic arrived. We knew that the current system was overpriced and underperforming, resulting in unacceptable levels of financial hardship, physical suffering and even death, but the severity of the deficiencies have been compounded by the impact of the pandemic.

The Affordable Care Act was a misguided effort to reform the system since the deficiencies in the model were well recognized before it was enacted and implemented. Now the pandemic has brought these deficiencies into sharper focus as the hardship and suffering increase. A model that would have been less expensive and vastly more effective is the single payer model of Medicare for All. As far as financing the increased health care services required during this pandemic, Medicare for All would have been much more effective had it been in place. Medicare for All along with reinforcement of our public health services would have reduced the severity of the detrimental medical and economic impacts of Cobvid-19.

Now it is obvious that we should promptly move forward with Medicare for All, and it is also very obvious to the various vested interests that currently fare well under our fragmented, dysfunctional system. These opponents of Medicare for All have aligned themselves in yet another organization to fight Medicare for All: the Alliance to Fight for Health Care. They have decided to support a temporary expansion of COBRA to fill in some of the void caused by the pandemic, a logical choice for them since COBRA is already a temporary insurance program designed to provide coverage during intervals of unemployment. This would provide the least disruption to our current financing system, allowing them to eventually pick up where they were before the onset of the pandemic.

Bernie Sanders has a much better idea. He proposes filling in the void with Medicare. It would be much more effective and less expensive than the COBRA expansion. So as an urgent measure his Health Care Emergency Guarantee Act would be far better. Everyone would get the health care they need, and it would be affordable.

Better yet, when the public sees how effective Medicare can be, it doesn’t take much imagination to see substantial reinforcement of the support that the Medicare for All proposal already has. At the end of the pandemic, the public would be nearly unanimous in their support for Better Medicare for All. Yet some Congressional Democrats, unions such as UNITE, and Families USA are joining big business on the COBRA bandwagon. We are at risk of losing the battle if we don’t take greater measures to overcome our inertia. This is the opening we’ve been looking for, and we should take it.

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By Gabriela Schulte
The Hill, April 24, 2020

Q: Would you support or oppose providing Medicare to every American?

• 69% – Net support
• 37% – Strongly support
• 32% – Somewhat support
• 31% – Net oppose
• 18% – Strongly oppose
• 14% – Somewhat oppose

Support for Medicare for All has remained consistently strong over the past two years, according to a new Hill-HarrisX poll.

Sixty-nine percent of registered voters in the April 19-20 survey support providing Medicare to every American, just down 1 percentage point from an Oct. 19-20, 2018 poll, and within the poll’s margin of error.

Popularity for Medicare for All grew slightly among Democratic voters, with a 2 percentage point increase from 2018.

Support among independent voters was steady at 68 percent.

However, support among Republican voters declined 6 percentage points over the course of two years, from 52 percent support in 2018 to 46 percent in 2020.

Progressive lawmakers have been pointing to the coronavirus crisis to make a case for the need for Medicare for All as millions of Americans are kicked off their employee-based health insurance due to the economic fallout of the pandemic.

“Crises are moments of opportunity for policy change,” Robert Griffin, Research Director of the Democracy Fund Voter Study Group, told Hill.TV.

“But it’s not a sure thing, it’s not going to happen automatically. It does require leadership at the end of the day,” he added.

President and CEO of the Roosevelt Institute, Felicia Wong, believes support for Medicare for All will only grow amid the coronavirus crisis.

“These progressive policies have been popular for a long time. I think COVID-19 will make them more popular as it becomes clear just how fragile our American political economy really is,” Wong told Hill.TV.

https://thehill.com…

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Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

KFF, April 3, 2020

Historically, our polls have shown support for the federal government doing more to help provide health insurance for more Americans, though support among Republicans has decreased over time. But this never translated into majority support for a national health plan in which all Americans would get their insurance from a single government plan until 2016.

As Medicare-for-all becomes a staple in national conversations around health care and people become aware of the details of any plan or hear arguments on either side, it is unclear how attitudes towards such a proposal may shift. KFF polling finds public support for Medicare-for-all shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment. KFF polling found that when such a plan is described in terms of the trade-offs (higher taxes but lower out-of-pocket costs), the public is almost equally split in their support. KFF polling also shows many people falsely assume they would be able to keep their current health insurance under a single-payer plan, suggesting another potential area for decreased support especially since most supporters (67 percent) of such a proposal think they would be able to keep their current health insurance coverage.

KFF polling finds more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on the ACA in order to expand coverage and reduce costs rather than replace the ACA with a national Medicare-for-all plan. Additionally, KFF polling has found broader public support for more incremental changes to expand the public health insurance program in this country including proposals that expand the role of public programs like Medicare and Medicaid. And while partisans are divided on a Medicare-for-all national health plan, there is robust support among Democrats, and even support among over four in ten Republicans, for a government-run health plan, sometimes called a public option. Notably, the public does not perceive major differences in how a public option or a Medicare-for-all plan would impact taxes and personal health care costs. However, there are some differences in perceptions of how the proposals would impact those with private health insurance coverage. KFF polling in early April 2020 finds about half of Americans support both a Medicare-for-all plan and a public option. So while the general idea of a national health plan (whether accomplished through an expansion of Medicare or some other way) may enjoy fairly broad support in the abstract, it remains unclear how this issue will play out in the 2020 election and beyond.

https://www.kff.org…

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Comment:

By Don McCanne, M.D.

Two-thirds voter support of Medicare for All sounds quite good. Most politicians would consider two-thirds support to be a clear voter mandate. But Kaiser Foundation polling has found that when you qualify the question on Medicare for All, the support can shift depending on whether the qualification is perceived as favorable or unfavorable. Also, when single payer is presented as a ballot issue, simple rhetorical sound bites by opponents have been effective in defeating such proposals by wide margins.

It would be great if one of the pollsters finally asked a question that would better define the will of the nation:

Which would you prefer?

1. One single comprehensive health care program, that you would have for your entire life, that is guaranteed by our government, that covers all essential health care services, that would allow you to choose your physicians and other health care professionals and your hospitals and clinics, and that would always be affordable for you because it would be paid through taxes that are based on your ability to pay.

2. An unstable series of different forms of health care coverage throughout your life dependent on your employment (with ever-changing private plans, if coverage is even provided), poverty status (Medicaid, if qualified), age (Medicare for seniors), chronic disability or chronic renal disease (Medicare), ACA exchange plans (may qualify for government subsidies based on income), available health plans in the individual market (if premiums and cost sharing are affordable), military status (Military Health System), veteran status (VA Health Care, if qualified), Native American status (Indian Health Service, if qualified), incarceration (prison health care), child (CHIP or Medicaid, depending on family income), temporary coverage between jobs (COBRA, if premiums are affordable), health savings account (if funded), retiree health plan (if provided in whole or in part by a prior employer), uninsured (full personal risk-bearing), charity (perhaps nominal fees in a community health center), or self funded (if adequate personal wealth); with coverage that is highly variable dependent on the program in which you may be enrolled, in which your choice of physicians and hospitals is limited by provider networks selected by the insurers, or providers employed by various private or government programs (such as those listed), and affordability would be dependent on premiums, deductibles, copayments, coinsurance, concierge fees, and income levels that establish eligibility for various programs; with no assurance that any particular program will be there for you when you need it.

3. “Healthcare Reform to Make America Great Again.” Proposed reforms include repealing the Affordable Care Act, allowing individuals to deduct the full amount of premiums for individual health plans from their federal tax returns, providing block grants to finance state Medicaid programs, and allowing insurers to sell insurance across state lines.

https://www.commonwealthfund.org…

4. Leave the system as it is (select #2).

It is difficult for individuals to grasp: 1) the simplicity, effectiveness, efficiency, ethics and affordability of the single payer model of Medicare for All, 2) the complexity and injustices of the system that we have, and 3) the gross inadequacies of the Republican rhetorical proposal. It is sad that when the dialogue on reform is reduced to buzzwords, the nation tends to line up on the political polarization scale, perpetuating inertia, and then we all suffer, except the wealthy.

Can’t we just take #1, and go with it?

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