This morning, he discusses Kamala Harris's stance on Medicare for All.
Harris, the Democratic Senator from California who has declared her candidacy for the 2020 presidential election, came out recently in favor of Medicare for All. Leonhardt notes:
A couple of weeks ago, one of the country’s most respected health care pollsters — Kaiser Family Foundation — conducted a survey on “Medicare for All.” And the top-line results looked great for advocates of the idea, like Bernie Sanders and Kamala Harris. |
Some 56 percent of respondents said they favored “a national plan called Medicare for All in which all Americans would get their insurance through a single government plan.” A large majority of Democrats backed the idea. Almost a quarter of Republicans did, too. |
The poll’s details, however, were a lot of less positive about Medicare for All. In fact, they showed why single-payer health care may turn out to be one of the few problematic issues for Democrats heading into 2020 — if the party isn’t careful. Harris has highlighted the tensions this week, saying on Monday night that she supported the most aggressive version of Medicare for All before moderating her position, via aides, late yesterday. |
When Kaiser pollsters were putting together their survey, they understood that not all Americans thought of “Medicare for All” as meaning the same thing. So the poll asked people whether they believed that they would be allowed to keep their private insurance plan under such a system. Almost 60 percent of respondent said yes. “In reality,” as HuffPost’s Jonathan Cohn wrote, in an analysis of the poll, “the whole point of Medicare for All would be to wipe away current insurance arrangements and replace them with a new public plan.” |
Not only that, but when the pollsters described a version of Medicare for All in which private insurance was wiped away, support plummeted. The idea flipped from being popular to unpopular: 37 percent of respondents favored it, and 58 percent opposed it. |
It seems that Harris experienced some blowback, and now is walking back her support for a true nationalized health plan. In view of the reality of the opinion surveys, Leonhardt recommends a more moderate short-term approach: opening Medicare to many more people, without mandating that everyone use it.
I don't claim any particular expertise in health care, but I do want to make one observation. Ten years or so ago, when the Obama Administration was starting to lay the groundwork for the legislative saga that eventually resulted in the plan that today is known as Obamacare, it did something that I believe was critical to the legislative success of that effort: it worked hard to enlist the support of health care stakeholder groups: the doctors, the hospitals and the insurance companies.
It's difficult, at first blush, to imagine what a Harris Administration or a Sanders Administration could offer to doctors, hospitals and insurance companies that would make a nationalized health insurance plan attractive to them. Doctors would be skeptical because a government plan would seem to limit their income. Hospitals would be skeptical because their experience with Medicare is that it pays low prices for the delivery of healthcare services. As for insurance companies: they would need to find another business to be in, as a true nationalized health plan would render them redundant.
The above observations are made from the point of view of a non-expert consumer, and corrections are very welcome. Are there ways to address these objections?
Thanks for starting off the inevitable discussion about the 2020 election with a substantive, issue-based topic.
ReplyDeleteMy first choice would be a kind of hybrid between Medicaid and Medicare--the poor get free care, and the rest of us get a plan that pays 80 (or some other) percent of everything (including drugs, dental, and vision), with insurance companies vying for coverage of the remaining 20 (or some other) percent.
Medicare, and the attendant research required at age 64 to select supplemental plans, goes away. You can keep your supplemental plan cradle to grave if it works for you. Or shop around.in the already established government marketplace, which has steadily improved (I can type in my specialists and chemo to find out which plans cover them).
One problem that I see as someone aging with a serious chronic illness is the health care industry working at cross purposes with patient needs. Health care wants more research, more therapy, more interventions, new diagnostic tools, and innovative corrective surgeries. Aging patients want fewer interventions and more palliative and in-home care.
The three biggest health care issues we face now are aging Boomers like me who will need nursing care, a stress and obesity epidemic that calls for increased mental health and lifestyle "coaching," and global warming that will change morbidity patterns and force doctors to respond nimbly.
Any plan that does not make a nod to those realities will be of limited value.
There is absolutely no doubt that eliminating all the various insurance companies and insurance products would save massive amounts of money on pure administration. A national insurance plan would also eliminate insurance brokers, who add between two and six percent to the costs of premiums alone.
ReplyDeleteA consistent payment system should be welcome to providers. But one problem (and I seldom see it mentioned) that I know that they are worried about is the Medicare reimbursement level. Medicare pays about 98 percent of costs. It pays a little less than cost by design as a means to force providers to cut costs. Providers do cut their costs, but where they make all that sweet sweet money that allows them to build new structures and buy out competitors is from private commercial insurance. Hospitals, for example, get between 135 and 145 percent of costs from private insurance.
So the key is going to be to revise the payment structure. And how much more than the current Medicare reimbursement rate should they then get?
Is it possible to get rid of insurance companies in one fell swoop without disastrous results, Patrick? As you point out, the money not only funds mega facilities, but it also employs huge numbers of people. Gradually reducing the role insurance plays in health care seems like a good idea for now.
DeleteI am less interested in seeing "Medicare for all" than "everybody covered". I think pushing Medicare for all at this point will suck too much oxygen out of the room from other urgent issued (such as the one sitting in the White House).
ReplyDeleteOne thing I don't think the article mentioned is the 56% of non elderly Americans who get their health insurance through work. Most of them want to keep this coverage. In Medicare for all the idea would be to get employers to chip in, in the form of taxes. Of course they will resist this, and try to get out of paying their share. As it stands now, there are certain advantages to corporations for providing insurance to their employees. Up to a certain dollar value, they can take it off their taxes. And they can use insurance coverage to attract and keep employees.
I would favor a public option for those who don't have employer coverage, maybe like Jean said, a hybrid between Medicare and Medicaid.
One thing I would favor is greater transparency in pricing. Of course the PTB will fight that tooth and nail, but I think it is necessary for meaningful reform. An example: I went to the local convenient care clinic for a minor issue a few weeks back. The PA spent about 5 minutes with me and wrote a prescription. Prior to being on Medicare I was used to paying a $20 copacopayy, which they would collect at the time. This time they said they would send me a statement, "because Medicare does it different". A few days later I received a bill for $193. After I picked my jaw up off the floor I called them and asked if they had submitted the charge to Medicare. They said that Medicare had denied it, and I needed to call them and tell them that my employer's insurance was no longer primary (and in fact was no longer in effect). Which I did. Eventually I got a statement saying that Medicare had allowed $85, which was applied to my deductible. It was then picked up by my supplemental plan. $193 for that level of service was ridiculous, and even more ridiculous was the fact that the only patient who would have to pay that was one who had no coverage. Medicare had negotiated the $85 fee, which still seemed like a great plenty.
Should read $20 copay, not "copacopayy". Sometimes Kindle does goofy things.
DeleteI hope that when the filled-in plans start coming, Patrick will rip off his shirt and re-emerge as unagidon.
ReplyDeleteThat is point 1. Also 2. and 3.
My point 4 is this: I think "Medicare for all" is a not-so clever way of avoiding saying "socialized medicine." See, Medicare is socialized medicine, although the Rs lost the battle to make us think of it that way. Now we can be glad we aren't paying Mama's health care costs, God bless American. But Medicare is socialized medicine. So by calling for "Medicare for all," Harris et al are avoiding the S-word. I doubt it will work, but that's what that seems to be all about. And we are off to a good, in-depth bumper sticker debate. Hard to see it not going downhill from here.
“something that I believe was critical to the legislative success of that effort: it worked hard to enlist the support of health care stakeholder groups: the doctors, the hospitals and the insurance companies’
ReplyDeleteAt that time a conservative Republican physician friend was very blunt about the difficulty of getting support from stakeholder groups. He said
1. Physicians and health care providers are simply too greedy. That is why the old system on nonprofit insurance companies did not work.
2. Adding for-profit insurance companies simply increased the greed by making insurance companies greedy in the name of regulating greedy physicians. He thought it was necessary to go back to nonprofit insurance companies.
3. The lawyers have gotten too greedy, however this physician thought caps on lawsuits were wrong, because there are cases in which physicians do commit great wrong.
My conclusion from this is that real health care cost containment requires reducing the greed of physicians, insurance companies, and lawyers. Very few stakeholders are going to be on the side of real healthcare reform.
I like the idea of Medicare for All that pays for 80 percent with supplemental plans by private non-profit insurance companies that compete for the patient’s 20%. What such non-profit insurance companies could offer patients is better advice on doctors, treatments, life style choices, etc. In order words information that would allow me as a consumer to choose less and better health care as well as more health care. Of course the more I chose the more I pay.
In the case of the indigent, the government would pay for their twenty percent treatment under a single payer system with a rationing system for limited public dollars. This would encourage people to not become indigent since they would no longer have as much choice.
I'm not sure what people are thinking when they hear the term "non-profit". The largest insurer in Chicago, with about 70 percent of the market, is the non-profit Blue Cross Blue Shield. Having fought against them in the market back in the day, it is true that their prices are marginally less than the for profit companies. But I'm talking maybe three to five percent if that.
DeleteIn fact, they run on a profit basis, using the same executives from the same business schools as everyone else. They don't post profits or give stock dividends. Instead, they post their profits to a massive reserve that is now worth billions of dollars. The Illinois branch is actually based in Texas. Some years ago, the Texans noticed the massive reserve and the courts made a move to strip them of their non-profit status. They kept it, though, by making a very large charitable donation that hardly made a dent in the money pile.
In the biz world, we look at "non-profit" as meaning "no taxes" and simply as a place that has managed to eliminate an expense.
The doctor is correct otherwise in my opinion. But I think a better plan would be to eliminate the private insurers.
Anything that would standardize medical coverage is fine with me. Just knowing what to expect or not to expect would take a lot of stress out of being seriously ill. I have no problem with SOCIALIZED medicine at any level. The more the merrier. But the mental inertia of the American public and its fear of change is massive. I'm afraid Harris and the other corporate Democrat candidates can't wait to wimp out on this matter.
ReplyDelete