By Adam Cancryn
POLITICO, December 10, 2018

The united front that helped Democrats save Obamacare just a year ago is falling apart over single-payer health care.

Deep-pocketed hospital, insurance and other lobbies are plotting to crush progressives’ hopes of expanding the government’s role in health care once they take control of the House. The private-sector interests, backed in some cases by key Obama administration and Hillary Clinton campaign alumni, are now focused on beating back another prospective health care overhaul, including plans that would allow people under 65 to buy into Medicare.

This sets up a potentially brutal battle between establishment Democrats who want to preserve Obamacare and a new wave of progressive House Democrats who ran on single-payer health care.

“We know the insurance companies and the pharma companies are all putting tens of millions of dollars into trying to defeat us,” said Rep. Pramila Jayapal (D-Wash.), who co-chairs the Medicare for All Congressional Caucus. “Which I take as a badge of honor — that they’re so concerned about a good policy that they’re going to put so much money into trying to defeat it.”

The rift could come into full view in the opening weeks of the new Congress, as the party long bound by a need to defend the Affordable Care Act tries to embrace a new health care vision it can carry into the 2020 presidential campaign.

House Democratic leaders already are emphasizing the need to align behind a more pragmatic agenda focused largely on shoring up Obamacare, without peering too far into the future.

“We want to continue promoting the idea of accessibility and improving the Affordable Care Act,” said incoming Ways and Means Committee Chairman Richard Neal (D-Mass.). “That should be the primary goal that we have.”

It’s a sentiment shared by the major lobbies that fought alongside Democrats against Obamacare repeal and now want to reap the benefits. These interest groups contend that, after a decade of upheaval in health care, the public would prefer simple fixes that strengthen the ACA over a headlong rush into another dramatic overhaul of the system.

But House progressives, buoyed by voter enthusiasm and a surge of single-payer support among the party’s base, have other ideas. Among their high-profile agenda items is “Medicare for All” legislation, an idea until recently on the fringes of policy debates that polling shows captivated voters during the 2018 election cycle, despite potentially staggering costs.

“It’s more of a mainstream position than it’s ever been before,” said Adam Green, co-founder of the Progressive Change Campaign Committee, which maintains close ties to House progressives. “There’s this hugely rapid advancement toward Medicare for All — single-payer — as not just an eventual North Star goal, but as something that’s increasingly possible.”

But major lobbies that fought shoulder-to-shoulder with Democrats last year are working now to derail such liberal ideas in order to preserve the status quo.

More than a dozen groups intend to press their point next year through The Partnership for America’s Health Care Future, a vehicle to combat an expanded government role in health care.

America’s Health Insurance Plans and the BlueCross BlueShield Association helped found the coalition alongside the Federation of American Hospitals, the big drug lobby PhRMA and the American Medical Association.

Since then, it’s added another 13 organizations — most representing companies with much to lose under a system that shrinks or in some cases eliminates private health care.

The Partnership, some of whose members began discussions within weeks of Senate Republicans’ failed Obamacare repeal vote in July 2017, is planning to launch a campaign featuring ads, polling and white papers playing up the private sector’s role and warning against further disruptions to the health system, people involved with the group said. Avalere, a consulting firm Democrats often leaned on to highlight the dangers of GOP repeal bills, is producing research for the coalition.

Avalere founder Dan Mendelson — a former Clinton White House official — declined to comment on the firm’s work, citing a policy of not talking about its clients.

The Partnership has also received support from Lauren Crawford Shaver, a veteran of the Obama administration’s Health and Human Services Department and Hillary Clinton’s 2016 campaign, who is running its operations out of the lobbying shop Forbes Tate Partners.

“We believe all Americans deserve access to affordable, high-quality health care. But a one-size-fits-all, government-controlled system like Medicare for All isn’t the answer,” Shaver said, predicting it would restrict choice and innovation and put “decisions regarding our health care in the hands of politicians in Washington.”

Other groups that fought Obamacare repeal are quietly working to limit Democrats’ ambitions by highlighting the practical complexities and political risks inherent in rewiring the entire national health care system — including an employer-sponsored insurance market that serves 151 million Americans.

Officials from several groups expressed confidence that public support for Medicare for All will plunge as people become more aware of the trade-offs it would require.

“We are convinced here that, whether it’s on the state basis or federal basis, incremental change is a real possibility and is doable,” said Kenneth Raske, president of the Greater New York Hospital Association, one of the loudest voices in 2017 against both ACA repeal and a state-level single-payer effort. “In New York, we have 5 percent uninsured. Why do we want to have a 100 percent solution to a 5 percent problem?”

Liberals concede their effort faces institutional roadblocks but maintain they’re undaunted by the firepower aimed their way.

The House Democrats’ progressive wing is increasingly influential, the party has a clear advantage on health care for the first time in years and polls show the once-fringe concept of a single-payer system is captivating a growing portion of the nation.

“We want to make sure we shore up protections for pre-existing conditions [and] do everything we can to make sure the Affordable Care Act is effective as possible,” Jayapal said. “But, in the end, we still have a problem with the cost of health care for ordinary people. And so that’s what we’re trying to address.”

The progressive movement’s own lobbying campaign inside and outside Congress is just getting started, she added. That gives the party time to balance shoring up the ACA with figuring out a path to universal health care that could range from incremental steps like adding a public option all the way up to a full single-payer system.

And in the meantime, progressives say they’re more concerned about courting voters than winning over big business. For as much as the industry lobbies contributed to defending Obamacare, they argue, the repeal fight demonstrated even more convincingly that Democrats can win any health care battle if the public is on their side.

“People across this country have worked through for themselves the public debate on the government’s role in health care, and America has shifted,” said Sen. Elizabeth Warren (D-Mass.), a Medicare for All supporter and likely 2020 presidential candidate. “So the importance of persuading every one of the insiders that this is going to be a great deal for them has diminished.”

https://www.politico.com…

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Comment:

By Don McCanne, M.D.

This article gives us a brief update on the politics of Medicare for All. The opposition by certain vested interests is understandable since some of them stand to have their highly lucrative roles displaced partially or completely by a system that instead places patients first.

As Sen. Elizabeth Warren states, “People across this country have worked through for themselves the public debate on the government’s role in health care, and America has shifted. So the importance of persuading every one of the insiders that this is going to be a great deal for them has diminished.”

Patients first.

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By Sara R. Collins and David C. Radley
The Commonwealth Fund, December 7, 2018

Recent national surveys show health care costs are a top concern in U.S. households. While the Affordable Care Act’s marketplaces receive a lot of media and political attention, the truth is that far more Americans get their coverage through employers. In 2017, more than half (56%) of people under age 65 — about 152 million people — had insurance through an employer, either their own or a family member’s. In contrast, only 9 percent had a plan purchased on the individual market, including the marketplaces.

Highlights

• After climbing modestly between 2011 and 2016, average premiums for employer health plans rose sharply in 2017. Annual single-person premiums climbed above $7,000 in eight states; family premiums were $20,000 or higher in seven states and D.C.
• Rising overall employer premiums increased the amount that workers and their families contribute. Average annual premium contributions for single-person plans ranged from $675 in Hawaii to $1,747 in Massachusetts; family plans ranged from $3,646 in Michigan to $6,533 in Delaware.
• Average employee premium contributions across single and family plans amounted to 6.9 percent of U.S. median income in 2017, up from 5.1 percent in 2008. In 11 states, premium contributions were 8 percent of median income or more, with a high of 10.2 percent in Louisiana.
• The average annual deductible for single-person policies rose to $1,808 in 2017, ranging from a low of $863 in Hawaii to a high of about $2,300 in Maine and New Hampshire. Average deductibles across single and family plans amounted to 4.8 percent of median income in 2017, up from 2.7 percent in 2008. In three states (Florida, Mississippi, and Tennessee), average deductibles comprised more than 6 percent of median income.
• Combined, average employee premium contributions and potential out-of-pocket spending to meet deductibles across single and family policies rose to $7,240 in 2017 and was $8,000 or more in eight states. Nationally, this potential spending amounted to 11.7 percent of median income in 2017, up from 7.8 percent a decade earlier. In Louisiana and Mississippi, these combined costs rose to 15 percent or more of median income.

Worker payments for employer coverage are growing faster than median income.

The average employee premium cost across single and family plans amounted to 6.9 percent of median income in 2017, up from 5.1 percent in 2008.

Average deductibles are also outpacing growth in median income.

In many states, even though costs are rising, people are not getting insurance that protects them more because deductibles are also increasing.

From the Conclusions

Families’ costs for employer health insurance are rising faster than median income. Moreover, even as costs climb, many families aren’t receiving higher-quality insurance. The amount they have to spend out of pocket before their insurance coverage kicks in also continues to climb. While this study only considered families with middle incomes, lower-income families with employer coverage will use an even larger share of their income for health insurance costs.

Higher costs for insurance and health care have implications. People with low and moderate incomes may simply decide to go without insurance if it competes with other critical living expenses like housing, food, and education. In 2017, average per-person expenditures on food in the U.S. amounted to 13 percent of median income and housing costs were 32 percent. People with coverage but deductibles that are high relative to income are nearly as likely as those uninsured to skip needed health care, like filling prescriptions or going to the doctor when they are sick.

Health care cost growth is the primary driver of premium growth across all health insurance markets. Policymakers will need to recognize that the increasing economic strain of health care costs facing middle-income and poor Americans is driven by multiple interrelated factors and will require a comprehensive solution.

https://www.commonwealthfund.org…

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Comment:

By Don McCanne, M.D.

When the Affordable Care Act (ACA) was crafted, the sector of the private insurance market that the legislators most wanted to protect was the employer=sponsored plans. It was perceived as the private insurance sector that was still working well and the private plans with which satisfaction was the greatest (leading to the unfortunate promise, “if you like your health plan, you can keep it”).

The disappointing conclusions of this study should surprise no serious student of health policy. The excessive growth rate in health care spending needed to be addressed in the ACA legislation, but it included only token “wish-it-would-work” policies such as accountable care organizations and other value-based policy proposals. The only measures that would actually work were those that expanded barriers to beneficial care such as excessive, unaffordable deductibles and other cost sharing, and penalties for obtaining care outside of restrictive provider networks. These concepts defeat the purpose of a program that should be designed to assist patients in accessing the care that they need.

With perpetually increasing costs, it is no wonder that employees and their families are faced with higher premiums and higher deductibles. Not only that, they are paying for the increased premium contributions of their employers through their own forgone wage increases. It is easy to see how employer-sponsored insurance is a growing burden, especially for middle- and low-income families.

It is no secret that the policy design of our current health care financing system has caused it to fall far short of the goals of reform, and the tragedy is that these defects were known when ACA was crafted. But, at this stage, instead of crying over spilt milk (more accurately, spilt blood), we should promptly move forward with enacting policy improvements that will fix our system. Those improvements, of course, would be inherent in a well designed Single Payer Medicare for All program. That strategic move would automatically bring affordable, accessible care to absolutely everyone. Burdens, such as those that the employer provided plans are placing on us, would no longer be necessary.

The authors state, “Policymakers will need to recognize that the increasing economic strain of health care costs facing middle-income and poor Americans is driven by multiple interrelated factors and will require a comprehensive solution.” Obviously, that comprehensive solution would be Single Payer Medicare for All.

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By Anne B. Martin, Micah Hartman, Benjamin Washington, Aaron Catlin, and The National Health Expenditure Accounts Team
Health Affairs, December 6, 2018 (Published Ahead of Print)

Abstract

Total nominal US health care spending increased 3.9 percent to $3.5 trillion in 2017, slowing from growth of 4.8 percent in 2016. The rate of growth in 2017 was similar to the increases between 2008 and 2013, which preceded the faster growth experienced during 2014–15—a period that was marked by insurance coverage expansion and large increases in prescription drug spending. Slower growth in health care spending in 2017 was mainly attributable to the use and intensity of goods and services, particularly for hospital care, physician and clinical services, and retail prescription drugs. Nearly all major sources of insurance and sponsors of health care experienced slower growth in 2017. On a per capita basis, spending on health care increased 3.2 percent and reached $10,739 in 2017. The share of gross domestic product devoted to health care spending was 17.9 percent in 2017, similar to the share in 2016.

Conclusion

Health care spending grew 3.9 percent in 2017, about the same rate at which the overall economy increased, and as these two growth rates converged, the health spending share of GDP stabilized. This was the first year since 2013 that this share did not increase, as 2014 and 2015 were marked by insurance coverage expansion and expensive new drug treatments that produced faster growth in health care spending, while 2016 was affected by low economic growth.

Viewed from a longer historical perspective, the rate of growth in health spending over the past decade contrasts with the experience of the prior ten-year period. Health care spending growth averaged 4.3 percent per year during 2008–17, compared to an average annual rate of 7.3 percent over the 1998–2007 period. For this most recent decade, growth in both excess medical-specific inflation and the use and intensity of health care goods and services was slow relative to historical trends, despite the fact that this period included the largest increase in health insurance coverage since the 1960s.

However, the past ten years were also marked by lower overall economic growth (which averaged 3.0 percent) and lower economywide inflation (which averaged 1.6 percent), both strongly influenced by the Great Recession. As a result, the health spending share of GDP increased by 1.6 percentage points from 2008 to 2017 (compared to a 2.6-percentage-point increase from 1998 to 2007). For a health sector that now accounts for nearly one-fifth of the US economy, future increases in health care expenditures will likely lead to policy decisions focused on affordability and sustainability.

https://www.healthaffairs.org…

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Comment:

By Don McCanne, M.D.

Health spending continues to gradually increase as a share of our gross domestic product – 1.6 percent over the past decade (though lower than the 2.6 percent increase over the previous decade). The authors state, “For a health sector that now accounts for nearly one-fifth of the US economy, future increases in health care expenditures will likely lead to policy decisions focused on affordability and sustainability.”

Those policy decisions should also address the high rates of uninsurance, underinsurance, administrative waste due to our financing model heavily dependent on a multitude of private insurers, and barriers to beneficial health care services due to restrictions of insurer provider networks and excessive deductibles and other cost sharing.

Most of these problems can be resolved simply by enactment of a single legislative package: Single Payer Medicare for All. Let’s do it.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Robert Pear
The New York Times, December 1, 2018

Older Americans have been flocking to Medicare’s private plans, which promise predictable costs and extra benefits.

But the private Medicare Advantage plans have also been getting an unpublicized boost from the Trump administration, which has in the last few weeks extolled the virtues of the private plans in emails sent to millions of beneficiaries.

The officials deny that they are steering patients to private plans, but the subject lines of recent emails read almost like advertisements. “Get more benefits for your money,” says a message dated Oct. 25. “See if you can save money with Medicare Advantage,” said another sent a week later.

“You may be able to lower your out-of-pocket costs while getting extra benefits, like vision, hearing, dental and prescription coverage,” said an email sent to beneficiaries on Wednesday.

“With Medicare Advantage,” says another email, “one plan covers all of your care.”

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said the agency was not favoring private plans over the original government-run Medicare program.

“We are not steering any Medicare beneficiary anywhere,” she said.

But Richard S. Foster, who was for many years the nonpartisan chief actuary of the Medicare program, said the emails sounded “more like Medicare Advantage plan advertising than objective information from a public agency.”

https://www.nytimes.com…

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Medicare Advantage Checkup

By Patricia Neuman, Sc.D., and Gretchen A. Jacobson, Ph.D.
The New England Journal of Medicine, November 29, 2018

The emerging role of Medicare Advantage, the private-plan alternative to traditional Medicare, is gradually changing the Medicare program in ways that have important implications for beneficiaries, providers, and spending. Fueled by policy changes adopted by both Democrats and Republicans, enrollment in Medicare Advantage plans has more than tripled since 2005, from approximately 6 million to 20 million beneficiaries.

Policymakers have articulated a number of goals for having private plans in Medicare, one of which is to provide beneficiaries access to extra benefits not available in traditional Medicare. Thanks to a number of policy and payment changes adopted over the years that have not only required plans to offer a richer set of benefits to their enrollees but also offered incentives for plans to do so, this goal has generally been achieved. Since 2011, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Advantage plans to provide out-of-pocket limits for Medicare-covered services.

Medicare payment policy requires plans to use “rebate” dollars to provide enrollees enhanced benefits or lower premiums (allowing plans to keep a portion to cover administrative costs and profit). Rebates accrue when a bid submitted by a Medicare Advantage plan for Medicare-covered benefits is below the “benchmark” (the maximum federal payment to plans in that geographic area); the federal government keeps a portion of the excess and remits the remainder (the rebate) to the plan. As a result of rebates, most Medicare Advantage enrollees receive benefits not covered by traditional Medicare.

Studies suggest that the current rebate-based method may not be an economically efficient way of providing extra benefits to beneficiaries because plans are retaining a fairly large share of the rebate for administrative costs and profit, passing on to enrollees only 54% of the rebates, on average.

Medicare has evolved into a program that provides benefits that are more generous to beneficiaries in Medicare Advantage plans than to their counterparts in traditional Medicare.

Discussion

Medicare Advantage plans are now firmly established in the fabric of Medicare. Under the assumption that Medicare Advantage enrollment will continue to climb, the Medicare of tomorrow could look much different than it does today — more like a marketplace of private plans, with a backup public plan, and less like a national insurance program. This may or may not be the program that people envision when they talk about Medicare for All.

Policymakers, both Democrats and Republicans, are generally supportive of Medicare Advantage plans because they are popular with their constituents. More and more seniors are signing up for Medicare Advantage to get the extra benefits, the financial protection of an out-of-pocket limit, and the convenience of one-stop shopping for all their coverage. Despite the substantial reductions in federal payments to plans required by the ACA, health insurers have been growing their Medicare Advantage lines of business and new insurers are breaking into the Medicare Advantage market, which suggests that it remains among the more lucrative health insurance products.

Yet, several issues are on the horizon. The current payment environment that attracts insurers and provides extra benefits to enrollees comes at a cost to taxpayers and may reemerge as an issue down the road, when federal spending becomes a more pressing policy concern. The equity issue that arises from providing stronger financial protections, with an out-of-pocket limit, for beneficiaries in Medicare Advantage than in traditional Medicare could also gain traction as an issue, particularly as seniors’ out-of-pocket spending continues to rise. With respect to quality, the wide variation across plans, a paucity of data pertaining to sicker patients, and eyebrow-raising disenrollment rates among higher-need patients appear to warrant attention and oversight. Still to be determined is how the growing role of private insurance in Medicare, and the diminishing role of traditional Medicare, is likely to affect beneficiaries’ out-of-pocket spending, satisfaction, and health outcomes over time.

https://www.nejm.org…

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Reforming America’s Healthcare System Through Choice and Competition

U.S. Department of Health and Human Services, U.S. Department of the Treasury, U.S. Department of Labor

When it comes to healthcare, Americans should expect more value for the dollars they spend. This report details many opportunities to increase the value provided throughout our healthcare system through the actions that create greater choice and competition.

For the full 114 page report:
https://www.hhs.gov…

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Comment:

By Don McCanne, M.D.

The NYT article describes CMS’s efforts to market the private Medicare Advantage plans in an effort to displace the traditional, government-run Medicare program, although CMS Administrator Seema Verma denies that they are favoring the private plans. That is a difficult assertion to accept in the face of their marketing efforts.

The NEJM article confirms that the government has continued to give the private Medicare Advantage plans a marketing edge over the traditional Medicare program by granting the private plans greater benefit packages and especially the extra financial protection of limitations on out-of-pocket costs.

The report from the Departments of HHS, Treasury, and Labor confirms that the current administration is dedicated to the ideological goal of using choice and competition in the private marketplace as a basis for reforming America’s health care system. The gradual transformation of Medicare into a market of private health plans is evidence of the support for privatization of Medicare. However this is not new since the neoliberal players in the Obama and Bush administrations were already advancing the private Medicare Advantage plans.

Under a Single Payer Medicare for All program, private plans are eliminated, leaving in place only a single publicly-financed and publicly-administered program. The adherence to market choice and competition ideology is sending us in the opposite direction, shifting control to a market of private health plans.

The people are going to have to lead, but not through exclusive alignment with either the Democrats or the Republicans. The Choice and Competition report shows where the Republicans stand, but many of the Democrats who claimed they supported Medicare for All are now indicating that they want to preserve the individual and employer-sponsored private health plans while merely adding a public option with a deceptive Medicare label. That’s no solution.

No, we the people are going to have to join together across party lines and take a firm, unified stand, telling all of our politicians that we want health care for everyone. Do you think we can pull that off? I mean, it’s for our health – all of us.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Sanjay Kishore, Micah Johnson, Don Berwick
Health Affairs Blog, December 3, 2018

Health care was the most important issue for voters in the 2018 Congressional elections, in which Democrats won a significant majority in the US House of Representatives. A major health care proposal supported by many Democrats is “Medicare for All”, which would create a publicly-financed, single-payer health insurance system for all Americans.

Many observers dismiss single-payer health care as a political non-starter, but this traditional view ignores an explosion of support for the idea in recent years. In one recent poll, over 70 percent of Americans said they would support “a policy of Medicare for All”, including 85 percent of Democrats and even 52 percent of Republicans. A subsequent poll asked “do you support providing Medicare for every American” and found nearly identical results, including majorities of support from respondents in the South, those who live in rural areas, and those who say they “lean conservative.”

What insights do the 2018 elections provide into the future political prospects of Medicare for All?

(The authors discuss the support for Medicare for All in the House of Representatives and in the Senate.)

Implications For The 116th Congress

Medicare for All will not become law in the next two years, but the incoming 116th Congress could play an important role in determining the future of the proposed reform.

First, this Congress will have an opportunity to distinguish Medicare for All from other Democratic proposals to expand public coverage. To capitalize on the popularity of Medicare for All, some organizations have released more moderate proposals with sound-alike names such as “Medicare Extra for All”; others have started to brand Medicare buy-in proposals with slogans like “Medicare Available to All” or “Medicare for Anyone.” These alternatives are essentially variations on a public option. These proposals vary in their details and scope, and their relative merits are worthy of debate in the upcoming Congress. However, they differ substantially from the actual Medicare for All bills that have been proposed in Congress for many years. The 116th Congress will have an opportunity to clarify these differences, and to build further public understanding of Medicare for All.

Second, the 116th Congress can start building consensus on key policy elements of a Medicare for All proposal, including knotty issues such as determining the covered benefits of the plan, exploring alternative revenue sources and cost controls, deciding how providers would be paid and at what prices, how to pave a practical transition pathway from current health plans, how to craft a soft landing for the employees of the current insurance industry, and more. Ideally, this exploration will help foster a deeper and more mature discussion of Medicare for All among legislators in the future.

Implications For 2020 Elections And Beyond

It is time to re-frame the public debate: the path to Medicare for All is difficult, not impossible. In a democracy, it is strange and basically untenable to insist that an idea at least nominally supported by 70 percent of the citizenry is not even worthy of serious consideration. Medicare for All, though difficult, is now within the realm of political possibility, and the surge of enthusiasm among new members in the House of Representatives is evidence of renewed public interest in expanding access to health coverage and controlling costs.

As Presidential contenders enter the 2020 primaries, Medicare for All will almost certainly become a focal point of national discourse. Instead of pretending that Medicare for All is impossible, health policy experts and Congressional leaders should deepen their knowledge of the promise and challenges of single-payer health reform, and start working seriously on the hard job of crafting the best possible version of Medicare for All.

Sanjay Kishore and Micah Johnson are fourth-year MD candidates at Harvard Medical School and Don Berwick, MD, MPP, FRCP is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and is the former Administrator of the Centers for Medicare & Medicaid Services.

https://www.healthaffairs.org…

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Comment:

By Don McCanne, M.D.

How could you ask for a more credible voice on the topic of Medicare for All than Don Berwick and two senior medical students at Harvard?

Their concluding remark: “Instead of pretending that Medicare for All is impossible, health policy experts and Congressional leaders should deepen their knowledge of the promise and challenges of single-payer health reform, and start working seriously on the hard job of crafting the best possible version of Medicare for All.”

Sage advice. Let’s go with it.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Robert Pollin, James Heintz, Peter Arno, Jeannette Wicks-Lim, and Michael Ash
University of Massachusetts Amherst, Political Economy Research Institute (PERI), November 30, 2018

Abstract

This study by PERI researchers Robert Pollin, James Heintz, Peter Arno, Jeannette Wicks-Lim and Michael Ash presents a comprehensive analysis of the prospects for a Medicare for All health care system in the United States. The most fundamental goals of Medicare for All are to significantly improve health care outcomes for everyone living in the United States while also establishing effective cost controls throughout the health care system. These two purposes are both achievable. As of 2017, the U.S. was spending about $3.24 trillion on personal health care—about 17 percent of total U.S. GDP. Meanwhile, 9 percent of U.S. residents have no insurance and 26 percent are underinsured—they are unable to access needed care because of prohibitively high costs. Other high-income countries spend an average of about 40 percent less per person and produce better health outcomes. Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.

To access the full 198 page report:
https://www.peri.umass.edu…

PERI press release:
https://www.peri.umass.edu…

Reviewer Assessments of Economic Analysis of Medicare for All:
https://www.peri.umass.edu…

PNHP’s assessment by Steffie Woolhandler, David Himmelstein and Adam Gaffney:
https://pnhp.org…

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Comment:

By Don McCanne, M.D.

This is the report that we have been waiting for: an economic analysis of Medicare for All done by the team at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst. This meticulous report concludes that “Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.”

Although it is 198 pages long, the initial 3 pages present the highlights, followed by a 13 page summary of the study. For most, that will provide the information you need, but those interested in particular policy details may want to read selected sections of the report. Those of us obsessed with health care justice for all would likely want to read the full report.

Of special note is the “Reviewer Assessments of Economic Analysis of Medicare for All.” It provides critiques by several of the most authoritative policy experts in the nation. Although some of these experts express minor reservations about some of the technical aspects of the report, as should be expected with any study of this magnitude, their overall view confirms the very high credibility of this project. There can be no question about the conclusion. We can have affordable health care for all.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Joan Alker
Georgetown University Health Policy Institute, November 28, 2018

For the past eight years, CCF has published a report tracking health coverage rates for children across the country. This year, for the first time since we began writing this report, the number and rate of uninsured children in the United States went up.

For many years, that rate has been declining thanks to bipartisan efforts to extend coverage through Medicaid and the Children’s Health Insurance Program (CHIP). But in 2017, approximately 276,000 more children became uninsured, leading to a total of 3.9 million uninsured children nationwide. The rate for children age 18 and under went up from 4.7 percent in 2016 to 5 percent in 2017, according to our analysis of U.S. Census Bureau’s American Community Survey data.

While this may not seem like a huge change, both of these increases are unprecedented in the past decade. Even more troubling, the number of uninsured children increased during a time of economic strength – in fact, at a time when one would expect the uninsured rate to go down, as more children were covered by employer-sponsored insurance in 2017.

However, coverage for children from public sources, Medicaid and CHIP, and in the individual market – inside and outside the Marketplace – decreased during this time period. That caused the number of uninsured children to go up – despite the strong economy.

I’ve written this report for eight years in a row now, and I found it even more notable that no state, except for the District of Columbia, saw any measurable progress in reducing the number of uninsured children in 2017. Never before have we seen such uniformity in state behavior. This finding underscores that even states with the best of intentions were not able to overcome the negative national currents that are affecting children’s health coverage.

Why do we think this is happening? We can’t know for sure, but here are some of our best guesses:

The majority of uninsured children are already eligible for Medicaid or CHIP but are not currently enrolled. The name of the game here is to make sure that families are aware that their child has a path to coverage and that these kids get enrolled and stay enrolled. For these families, 2017 was a year of constant news about the President and Congress wanting to take coverage away – first with the attempt to repeal the Affordable Care Act and make drastic cuts to Medicaid, all of which continued with a last gasp effort in September 2017.

Then on September 30, funding for CHIP expired and, in an unprecedented delay, Congress did not extend funding until early 2018 – again with families hearing that their state might have to close its CHIP program. At the same time, the Trump Administration began efforts to sabotage the ACA’s Marketplace including cuts to advertising, outreach and enrollment funding for navigators – who were playing an important role connecting families with public coverage, with the repeal efforts raising insurer uncertainty and driving up premiums.

The Trump Administration also began a series of actions hostile toward immigrant families. One quarter of children living in the United States has a parent who is an immigrant. For these “mixed status” families, there is likely a heightened fear of interacting with the government and this may be deterring them from signing their eligible children up for government sponsored health coverage.

As a result, the “welcome mat” for coverage has been pulled back and we see the results – more uninsured children.

With an improving economy and low unemployment rate, the fact that our nation is going backwards on children’s health coverage is very troubling. Without serious efforts to get back on track, the decline in coverage is likely to continue in 2018 and may in fact get worse for America’s children.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.

https://ccf.georgetown.edu…

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Comment:

By Don McCanne, M.D.

Imagine if everyone were automatically enrolled in a national health program for life. No resident would be uninsured. We could do this if we enacted and implemented a Single Payer Medicare for All program. Yet, because we insist on perpetuating our unstable, unsatisfactory system of financing health care, we are leaving almost 4 million children without any insurance coverage at all. Our health policy decisions border on the criminal.

Medicare for All has become a very popular concept and was used in the recent election to secure votes for proponents of reform. Yet before the next session of Congress has even begun, we are already seeing widespread efforts to suppress talk of Medicare for All and instead to support mere tweaks to our current grossly inadequate model, though some would cut coverage back even further.

Suppose Congress were to pass an alternative proposal such as a public option Medicare for Some, will all of those 4 million children be automatically enrolled? Of course not. By merely tweaking our current dysfunctional system we will perpetuate a large unnamed category of the uninsured. Perhaps we should label this group, “No Medicare for Them.” Those supporting deficient proposals should be the ones to explain to these uninsured children and their parents why, in a democracy, we support health financing policies that leave them out. In fact, someone needs to explain it to me. Why do we?

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By Nathaniel Weixel
The Hill, November 29, 2018

Momentum is building among House Democrats for a more moderate alternative to single-payer health-care legislation.

The legislation, which would allow people aged 50 to 65 to buy Medicare, is being championed by Rep. Brian Higgins (D-N.Y.), who supported House Minority Nancy Pelosi (D-Calif.) for Speaker in exchange for a commitment to work on his bill when Democrats take control of the House early next year.

“We agreed in principle to get this done,” Higgins told The Hill.

Under Higgins’s plan, anyone aged 50 to 64 who buys insurance through the health-care exchanges would be eligible to buy in to Medicare.

Rep. Frank Pallone Jr. (D-N.J.), the likely chairman of the Energy and Commerce Committee next year, said he thinks a Medicare buy-in should be on the agenda next year.

“We certainly would consider a Medicare buy-in,” Pallone told The Hill. “I think we’ve got to wait and see what the caucus wants to do and what the committee wants to do, but I’ll just say it’s certainly something we should consider.”

“Medicare for all” supporters are energized after sweeping Democratic victories in the midterm elections, however, and see the Medicare buy-in bill as too small a step.

“We are dead set against any buy-in or public option,” said Kenneth Zinn, political director of National Nurses United. “Our goal as RNs is to ensure a universal system of guaranteed health care for everyone and this does not accomplish that. I would urge Congress to reject it.”

Zinn said private insurance shouldn’t have any role in health coverage moving forward. A single-payer plan covers everyone, regardless of income, and eliminates copays, deductibles and premiums. It also eliminates private insurance.

Rep. Pramila Jayapal (D-Wash.), who is co-chair of the Medicare for All Caucus in the House, told The Hill said she has spoken with Higgins and expressed her concerns about his bill.

“We have to be careful not to perpetuate the system we have,” Jayapal said. “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.”

Jayapal added that lowering the eligibility age “would be an appropriate way to go where we’re taking a step forward towards a system that will ultimately cover everybody.”

Higgins said a Medicare buy-in is quicker and cheaper to implement than single-payer. It can also be a bridge to Medicare for all, he said.

“I support the exploration of Medicare for all, but you have to be well balanced and practical about this. Establishing a brand-new health insurance program is going to take time,” Higgins said.

Adam Green, co-founder of the Progressive Change Campaign Committee, said he supports giving everyone the option to buy in to Medicare, and thinks the legislation from Higgins will start a conversation. He wants a “buy-in for all” to be the “new floor” in the debate.

“It’s ironic that it took a conservative Democrat to jumpstart the momentum for Medicare buy-in but now that it’s there, there will be a huge push for Medicare option for all,” Green said.

“It’s jumpstarting the concept of a buy-in in 2019 and will lead to momentum of a buy-in for every family and small business.”

https://thehill.com…

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Comment:

By Don McCanne, M.D.

Many Democrats were elected after campaigning for “Medicare for All” which most of us presumed meant single payer reform. A Medicare buy-in is not single payer but rather it is merely a version of the public option. It simply adds another option to our highly dysfunctional financing system while correcting virtually none of the defects. It is not even an incremental step towards single payer since it takes us down a different pathway. If momentum seems to be building for a Medicare buy-in as a wedge to dismiss consideration of single payer, then Congress needs to hear from us – in a big way.

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