The Single Payer Plan to Save Healthcare in the US
What I do not see on AB is Bernie’s Plan. Take a moment and read what his plan is before you comment. If you read the plan, you will see Bernie subsidizes the expansion of single payer based on taxes on all households, separate taxes on the rich in income and also capital, the elimination of tax subsidies to healthcare companies, taxes on inheritance, the elimination of the income subsidy to people for ESI (this is also a tax break for companies), etc. Other than a few sentences on the issue, Bernie does not address ho he is going to control rising healthcare costs (other than eliminate healthcare insurance which is not the cost driver). He does not address it in his “How Much Will It Cost and How Do We Pay For It?.”
Ezra Klein comments on the reality of Bernie’s plan “individuals will have to fight with the government rather than private insurers when their claims are denied”. Ezra adds;
“But the implication to most people, I think, is that claim denials will be a thing of the past — a statement that belies the fights patients have every day with public insurers like Medicare and Medicaid, to say nothing of the fights that go on in the Canadian, German, or British health-care systems.
What makes that so irresponsible is that it stands in flagrant contradiction to the way single-payer plans actually work — and the way Sanders’s plan will have to work if its numbers are going to add up.”
Bernie tells you how much healthcare costs today, how much it will cost in the future, and what the price tag will be in taxes, etc. Bernie superficially glances at what also needs to be done in one paragraph of a couple of sentences and never really touches upon the real issue of rising healthcare costs. The progressives and the liberals skewered Pres Obama for giving in to healthcare companies, insurance companies, and having them participate in writing the PPACA, etc. Insurance companies are more efficient in writing plans as they have the experience and what was the issue was Congress.
Yet, here we see Bernie giving in to the same issues and sidestepping one important one. We will benefit from single payer, there will be savings and efficiencies galore, more people will be covered and everything will be “almost rosy.” The one thing Bernie does not say and exists in every other single payer plan is; “those promises can only come true if the government starts saying no quite a lot — in ways that will make people very, very angry.”
Something I have said time and time again as I have written about the PPACA and defended it is the savings must come through cutting healthcare costs by attacking the industry increases. Healthcare insurance is a reflection of the increases and are passed through. Just saying “single payer” as many people think does not lower costs and Bernie sidesteps it. Ezra Klein goes on; “The real way single-payer systems save money isn’t through cutting administrative costs. It’s through cutting reimbursements to doctors, hospitals, drug companies, and device companies.” Ezra is right when he says Bernie “gestures towards this truth;” but, the gesture is hidden away in two sentences and not given the emphasis it deserves under “How Much Will It Cost and How Do We Pay For It?.”
Another expert I have talked to for years and has presented these issues too, said this:
“Reform is a process and not an event–and the process is happening.By about 2020 I think we will see results that will begin to make you & I (not to mention folks like Elliot Fisher, Don Berwick, Diane Meier, etc. happy).
Medicare is beginning to negotiate better pricing (paying hospitals and docs for value, to volume) and in 2-3 years it will refuse to pay for many overpriced drugs. (This will make many Americans angry. They think they should have any drug that they think they need–or that their doctor tells them they need (even though their doc hasn’t read any medical research in 15 years) and that the rest of us should pay for it. . But eventually, people will adjust.
As for Single Payer parrots–just ignore them. They are clueless, can’t face numbers or facts, and think that there is a simple solution to our tremendously complex healthcare problems. They also know little about history or what is happening (and has happened) in other countries. They live in their own little world. If I sound exasperated, I am. Bernie Sanders, in particular, represents soft-headed liberalism at its worst.”
There is truth to the preceding statement and Ezra Klein’s, both of whom know each other and say pretty much the same on single payer. Just saying “single payer” is not a cure-all for everything which ails us politically and medically. There are going to be times when a government run Single Payer will not pay for some operation or medicine due to it being unproven, a low success rate, etc. and simply cost. True Single Payer, the type many of us will not want, will say no to doctors, hospitals,and the healthcare industry. Single payer will provide the the type of healthcare needed by most of the country with few exceptions; but, you will find yourself in the same discussions with the program as you did with your insurance company.
I found this article by Matt Bruenig over in the links at Naked Capitalism, “How To Use Single Payer Healthcare As Trojan Horse For A Good Welfare State.” Step past the title and read what he has to say about taxation and cutting costs.
“Under this scenario, we would initially raise the tax level by 8.5 points in order to cover the half of health expenditures that are currently paid out privately. Then, over time, we would cut healthcare expenditures by 7 points (from 17% to 10% of GDP). Assuming we didn’t lower the tax level over the expenditure-slimming period, we would be able to use those 7 points of savings towards other welfare programs (child care, child allowance, paid leave, etc.). And there is a lot of stuff you can get with 7 points of GDP.”
It is a sensible argument; but, I doubt our Congress would go forward with the 2nd and 3rd sentence. I am sure these funds would end up in the GF and used to fund tax breaks. Isn’t this where we started out, a Congress which is not responsive to what its constituents really need?
Actually, run, it’s the same principle as union negotiations. There’s a single major purchaser of healthcare: the federal government. As for people who want what it wouldn’t pay for, there would of course be private supplemental insurance available, including to employers who want to provide that benefit.
You still do not get it. $84,000 per tablet for HepC is too expensive. The only insurance which will pay for this you and I could not afford. Controlling cost of healthcare is the issue. Bernie’s way to throwing more gasoline of the fire unless the gov negotiates pricing. No where does Bernie put this in bold print. It is more than just prescription drugs and it must extend to doctors and hospitals.
Saying “no” to HepC pills the burden back on the phrama companies. Do you believe they are paying that much outside of the US? No! My own dilemma was getting Nplate tablets at $5,000+ per tab. Not cheap and was not available under Medicare. There is no reason for this cost after R&D is paid.
Congress must step into this and regulate. Congress has shown no ambition to do so on both sides. The constituents have not massed in numbers to force Congress to get off there fat-legislative asses yet. This will go no where if there is no price control.
In the comments to my own post today, Mark Jamison posts a link to Dean Baker’s comment about Krugman’s column. Baker’s comment addresses this in some length, Bill. It’s at
Point 1: “Getting universal Medicare would require overcoming opposition not only from insurers and drug companies, but doctors and hospital administrators, both of whom are paid at levels two to three times higher than their counterparts in other wealthy countries. There would also be opposition from a massive web of health-related industries, including everything from manufacturers of medical equipment and diagnostic tools to pharmacy benefit managers who survive by intermediating between insurers and drug companies.”
Point 2. “The public doesn’t have lobbyists to work the other side. The best we can hope is that groups that have a general interest in lower health care costs, like AARP, labor unions, and various consumer groups can put some pressure on politicians to counter the industry groups.” This largely does not exist and as Jack says and you pointed out in another post, unions (public unions) are under attack by SCOTUS. Tea-baggers think things are fine as they are as well as many Repubs.
Pont 3. “He argues that part of the story of lower health care costs in Canada and other countries involves saying “no,” by which he means refusing to pay for various drugs and treatments that are considered too expensive for the benefit they provide.” Dean goes on to say: “In the vast majority of cases, the drugs in question are not actually expensive to manufacture.” No kidding? The companies get back variable cost and not fixed costs which exist anyway as sunk costs. Pharma wants more than this and has yet to be told “no” this is not acceptable. Until that happens, the costs will continue to rise. How many times do we have to pay for education, MRI equipment, etc.? The same applies. Sure it will piss people off; but until we say “no,” the rising costs will keep rising. Read the comments to Dean’s post. Pfzier buys its R&D by buying other companies. Why are we paying high prices for their drugs?
This is not about politics. It is about reality. Where in Bernie’s plan does he give controlling cost a major bullet point the same as what he did with raising taxes? He doesn’t and it is addressed as a part of a paragraph with two sentences. “Since” Hillarycare, where has the healthcare industry attempted to control cost? It has not except while Hillarycare was a viable plan. After Hillarycare was dead and buried (thank you Elmensdorf where ever you are), it went back to what it does best, pricing meds higher and higher. Notably as Charles Gaba pointed out which I have posted on AB, increases in healthcare costs decreased from double digits to single digits from 2008 onward. Why did it do so? PPACA and its controls came into play. We can go farther.
Insurance pays healthcare expenses. It does not control costs, except by refusing to pay. Single payer maximizes the government’s control to negotiate and/or regulate prices.
Our current fractured system does not work very well in either controlling costs or paying expenses.
Actually, insurance does try to control costs because of competition on premiums, inability to decline insureds with preexisting conditions,and limitations on administrative costs and profit (combined) in the affordable care act. This has been manifesting itself lately in the elimination of PPO’s and some hospital networks from plans offered. Typically, the networks they approve have negotiated prices with the companies.
Key word, “try”. Just like the NRA tries to control gun violence.
You toss something out here which has no basis. Go back and read what I wrote. As Charles Gaba would tell y0u the increases are far smaller than experienced since 1992 and Hillarycare. Furthermore, attack the problem and it is not insurance. It is the healthcare industry itself which Sanders has given it a pass by not proposing anything major to control costs. You skewered Obama for this and now you want to give Bernie a pass.
There is no comparison to the NRA and the PPACA has had good results.
I agree. The problem is the healthcare industry, just like the gun problem is the gun industry.
Sigh, different beasts. Show me where the NRA controls 85 and 80% of guns sold? The PPACA does such in controlling premium costs. It also has a ratio limits of what can be charged for smokers and the elderly. This just two of many items to cost control. The biggest is yet to come when Medicare starts to control the costs of pharma which has limited benefits through cost/benefit analysis which will place a greater emphasis on drugs with a proven track record.
Usually when healthcare insurance does not pay what we expect, we were out-of-network even when we thought we were in network. We(I) do not check our policies to make sure we have that type of coverage. There is an appeal board for this also.