Wednesday, September 13, 2017

COTW: Medicare for All Act

Senator Bernie Sanders of Vermont has introduced into the Senate, as promised, a bill to establish Medicare as the nation's single payer for health insurance. He made the announcement today in Washington, DC He has the support of one-third of Democratic Senators. But because that chamber is controlled by Repugnants, it has no chance of being signed into law during Trump's tenure. For their part, the laissez-faire handmaidens of corporate America, introduced more legislation to gut the progress so far under the Affordable Care Act. The desire to give states block grants for their own programs using the money for expanding Medicaid is consistent with their small-government ideology for everthing except the Defense Department which they consider the reason d'etre of the national government. Although consistent it would, if passed, certainly lead to migratory health care. Some states would inevitably be more generous with their health benefits than others. Desperate people, unable to recieve sufficient benefits in their own state would move to establish residence in more generous jurisdictions. Sixteen Democratic senators are co-sponsoring his bill compared to almost no support in 2013 when introduced a previous iteration. About 60 percent of House Democrats have endorsed a “Medicare for all” bill introduced by Representative John Conyers Jr., (D-MI). The change in attitude among his caucus colleagues is indication of the increasing public support for a government solution to the problem of out-of-control healthcare costs. This chart shows the shift:

More importantly than liberal support for Medicare for All is public support for the idea that the federal government owes its citizens some form of healthcare. FDR brought attention to this social policy in a 1944 speech. The idea was also endorse by President Harry Truman.  President Lyndon Johnson signed the Medicare program into law in 1966. The name "Medicare" comes originally from the name given the medical care program established for military dependents in 1956. Regrettably, due to insurance industry opposition, President Obama refused to support a single-payer option in his Affordable Care program.  Progressives have been struggling for decades to get some form of universal social medicine past conservatives who are willing to waste billions on weapons, but hardly a dime on healthcare for Americans besides themselves:

Under the proposal universal coverage would roll out over four years. Virtually all expenses would be paid with no copays or deductables by an enhanced Medicare program that now covers Americans over 65. No source of new funding for the expansion is contained in the bill, but Sanders has offered a white paper with the bill that outlines some new tax options for financing it. Importantly, the bill de-couples health insurance from employment. Employers would no longer be responsible for health benefits, but would probably have to pay higher taxes. Other advance countries experiments have shown that a single payment source with sufficient market leverage can reduce health costs. Consequently both doctors, insurance companies, drug companies and hospitals will vehemently oppose the legislation because they all get paid less than private insurance with Medicare.  Sanders and his supporters are prepared for a long fight, potentially making the legislation a key plank of the next presidential campaign.

Sanders emphasized the simplicity of the single-payer arrangement: "I think the American people are sick and tired of filling out forms,” Sanders said. “Your income went up — you can’t get this. Your income went down — you can’t get that. You’ve got to argue with insurance companies about what you thought you were getting. Doctors are spending an enormous amount of time arguing with insurers.” Sanders admits the plan will be expensive, but points out that while an American pays a few thousand less in income taxes per year compared to a Canadian, his health care costs are twice that of his northern neighbor*.

Medicare is one of America's most popular entitlements.  Because it basically works.  The program would be enhanced to include vision, hearing and dental care.  It would also cover reproductive treatments, maternity and newborn care and abortions.  The federal government would establish a national formulary for covered prescription drugs.  The Secretary of HHS would be responsible for negotiating prices with drug companies, and have the authority to require co-pays for non-generic medications.  Three trillion is a lot money, but a inefficient hodgepodge of private health insurance is a system America cannot afford any longer.

*Similar disparities exist between the United States and every other nation in the Organization for Economic Cooperation and Development (OECD) -- all 33 of which have public, universal health care systems. The United States is the lone member of the OECD without universal coverage. As of 2012, the average OECD country spends $3,268 per capita on health care and 9.5 percent of its GDP on health expenses, or about half of what the US spends.