What appears to be an authorless article appeared in The Economist that attempted to do a hit job on Medicare for All. The article titled "Could 'Medicare for all' become a real thing?" For those who do not know what Single-Payer Medicare for all is, visit this page for an explanation.
Dr. Anand Bhat, an advocate for good health care for all Americans deconstructed the article that was clearly an attempted hit job. As Medicare for All garners more support, these false seemingly informative articles will spontaneously emerge. We must be aware and refute them at every turn. We cannot allow the fallacies to cauterize as we did during the Affordable Care debate.
Anand Bhat MD FACP is an internal medicine physician who studied medicine at the University of Texas Medical Branch and health policy, planning,andfinance at the London School of Hygiene & Tropical Medicine and the London School of Economics.
The rebuttal on Medicare for all fallacies follows
PICTURE if you can Bernie Sanders, the democratic-socialist senator, as a young lad of four. That is how old Mr Sanders was in 1945 when Harry Truman announced his vision for single-payer health care, in which the government pays all costs. Lyndon Johnson, backed by crushing congressional majorities, resurrected the idea in 1965 when he signed laws creating Medicare, government-run insurance for the elderly, and Medicaid, a programme for the very poor and disabled. Now at the age of 77, Mr Sanders would like at last to enact a single-payer system under the banner of “Medicare for all”.
The idea is now rather popular. When polled, nearly 75% of Americans declare a favourable view—as do 87% of self-identified Democrats. Ahead of the mid-terms, fealty to the idea has become a litmus test for progressive voters. The popularising of Medicare for all is largely owing to Mr Sanders’s evangelising during the 2016 presidential primaries, when the idea was lampooned by Hillary Clinton as unworkable. Since then, five likely Democratic presidential contenders—Cory Booker, Kirstin Gillibrand, Kamala Harris, Mr Sanders and Elizabeth Warren—have endorsed Medicare for all. Should one of them win, the expectation that he or she would act on the slogan will be enormous.
First, though, Democrats need to decide what Medicare for all actually means. The details of health policy resemble brain surgery; the appeal of a slogan is that nobody ned bother with the stultifying details. Some Democratic politicians and left-of-centre think-tanks have put forward more modest proposals under the aegis of Medicare for all. They include: allowing more people to qualify for Medicaid (government-provided insurance for the poorest), lowering the age requirements for Medicare and introducing a so-called public option, a state-run insurer to compete with existing private ones. These are more accurately labelled as “Medicare for more”, says Sara Collins of the Commonwealth Fund, a health think-tank. The virtue of these ideas is that they are incrementalist and would require less federal spending than a fully fledged single-payer system. Their chief shortcoming, as Robert Blendon, a professor of health policy at Harvard puts it, is that “terms like public option don’t raise the blood pressure of the public”.
[Dr. Anand Bhat Rebuttal] Here we have some evasion by ignoring the fact that Bernie has a specific bill in the Senate and the house has a specific bill HR 676 for years. If he/she wants to talk about Bernie (Economist is anonymous), they should talk about his bill and not what other Democrats may be saying.
As a result none of these proposals has received as much attention as the detailed plan put forward by Mr Sanders, which goes the full monty. Medicare would become the single payer of all insurance claims. It would be free at the point of use. Premiums, deductibles and other payments would be nearly eliminated. It would also up-end the health-care system by doing away with employer-sponsored insurance. The majority (56%) of working-age Americans are enrolled in these schemes; 71% of those covered by them say they are content. Unlike the other Medicare-for-all pitches, if you like your plan, you most certainly cannot keep it.
[Dr. Anand Bhat Rebuttal] I do not know why they emphasize that 71% of 56% of working age Americans are happy with their plans. This clearly ignores the elderly and the too young to work or dependents on the employer-sponsored insurance. Or the fact that most people are not happy with their health care system.
To fund all this, federal spending would need to increase by an estimated $32.6trn over ten years. If the government used its power to reduce the costs of drugs and of administration this could, according to an estimate by the Mercatus Centre, a think-tank, result in $2trn less health spending overall otherwise.
[Dr. Anand Bhat Rebuttal] This is the key lie by a Koch Brother study/ $32.6 trillion over ten years is designed to make the number so big it scares everyone. No one talks about their ten year salary or their ten year company or department budget. The Economist says federal spending $32 trillion over ten years. What does that mean?
American health spending is $3.3 trillion per year (allsources). Medicare spending is $672 billion and Medicaid spending (state and federal) is $564 billion. So excluding VA, CHIP, prisons, military, and IRS tax breaks we are already over a trillion dollars of current government spending. Overall the federal and state and local governments spend 48% of health care spending. Medicare for All would eliminate private health insurance spending YOU ALREADY PAY FOR via premiums or reduced wages instead by a Medicare tax. Instead of paying Blue Cross every paycheck you would pay a bigger Medicare tax (you already pay Medicare tax right now, but it is only for the elderly). For 95% of people, this will save you money. It also makes the increase NOT $3.3 trillion but a mere $1.76 trillion which would be (using their ridiculous 10 year budget) $17.6 trillion increase in federal revenue. However, this is LESS money out of your paycheck than paying Aetna or Blue Cross.
They then point out that this would save $2 trillion over 10 years ($200 billion annually). So instead of annual health spending being $3.3-$3.4 trillion, it would be around $3.2 trillion.
The benefits would be much, much better than what we presently have with reduced or eliminated co-pays and deductibles and fewer administration costs. No "in network" and "out of network" nonsense either. It can also fund a 2-year salary guarantee to people who would lose jobs in billing so transition costs are funded in the savings.
It would still be hard to get through. “While the taxes are upfront and real, belief in savings down the line requires some faith,” says Larry Levitt of the Kaiser Family Foundation, a health-policy think-tank. Republicans derided the much more modest Obamacare as spendthrift socialisation of American health care. Even Democratic-led states that pondered enacting single-payer on their own balked when the cost became apparent. Efforts in Vermont, Mr Sanders’s own home state, stalled once it became clear that an 11.5% surtax on payrolls and premiums up to 9.5% of income would be needed to fund single-payer insurance. Public support drops sharply once voters are reminded that taxes would have to rise to pay for Medicare for all.
The problems identified by Mr Sanders are nonetheless real. America is alone among large, developed countries in lacking universal coverage. Even after Obamacare, 12% of adults are uninsured. For this Americans pay 17% of GDP, the most in the OECD club of mostly rich countries. Government-run health programmes can reduce costs by eliminating administrative costs, private profits and using their dominant positions to keep prices low. But none of the European systems from which Mr Sanders draws his inspiration are purely single-payer. Many use a mix of public programmes and supplementary private insurance to ensure universal coverage. Cost-sharing, along with subsidies to those who cannot afford it, are the norm.
[Dr. Anand Bhat Rebuttal] This is EXTREMELY misleading. Sander's program is copying Canada, Taiwan, and South Korea. There are no single-payer insurance systems in Europe that use a single government insurance. France and Germany use a third system called social health insurance which is complicated but not at all comparable to Canada. To compare Sanders program to France or Germany which has lots of (by American standards) very minute co-pays is ridiculous. We have very high out of pocket costs compared to Europe.
Nor is Medicare itself so simple. As currently constituted, Medicare coverage is separated for hospitals (Part A), other medical costs (Part B) and prescription drugs (Part D). Part C allows for privately run Medicare Advantage plans that offer supplemental service and replace Parts A and B. Got all that?
[Dr. Anand Bhat Rebuttal] Medicare Part A and B may change. Medicare Advantage provided through contractors costs more by all GAO studies for the same benefits. Private companies delivering government programs cost more for the same benefits (11%). Part D was designed very corruptly during the Bush Administration and should have been publicly run and be automatically enrolled with the other Medicares. This should be automatic.
For most Americans enrolled in the programme, none of these services is actually free at the point of use, as Mr Sanders’s bill proposes. The agency that administers Medicare issues regulations that hospitals say impose billions in additional compliance costs. Coding procedures for billing purposes is now a cottage industry employing 206,000 people—and is projected to grow at 13% over ten years. “Arguably it has too much coverage in some dimensions. It pays for every treatment under the sun as opposed to Medicaid or the Canadian system. But it’s completely lacking in catastrophic coverage,” says Amy Finkelstein, a health economist at MIT who recently won a MacArthur genius grant. Medicare does provide health-care at decent cost, but it is nothing like as efficient as its devotees claim.
A more pragmatic agenda would focus on boosting competition in health-insurance exchanges and reversing the cuts, regulatory changes and work requirements imposed by the Trump administration. Even this would take a lot of legislation. If Democrats finished all that, they could then allow customers to buy Medicare coverage from the government (the non-coercive, “public option”). The difficulty with this agenda is that it does not fit onto a bumper sticker. The advantage is that it might one day get through Congress.
[Dr. Anand Bhat Rebuttal] Again no leading organizations were consulted or Bernie Sanders's office from what I can read here. Physicians for National Health Plan (the founder was President Obama's doctor) has more research and facts from very reliable publications for every single claim they make. Dental care would also be covered as well. The waste is that high with our system.
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