Category Archives: Health Reform

Even Libertarians Admit Medicare for All Would Save Billions

Source: Matt Bruenig, Jacobin, July 30, 2018

A new study from a libertarian think tank admits that Medicare for All would save a whopping $300 billion. …. The report’s methods are pretty straightforward. Blahous starts with current projections about how much the country will spend on health care between 2022 and 2031. From there, he adds the costs associated with higher utilization of medical services and then subtracts the savings from lower administrative costs, lower reimbursements for medical services, and lower drug prices. After this bit of arithmetic, Blahous finds that health expenditures would be lower for every year during the first decade of implementation. The net change across the whole ten-year period is a savings of $303 billion. ….

Related:
The Costs of a National Single-Payer Healthcare System
Source: Charles Blahous, George Mason University, Mercatus Working Paper, 2018

The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A), would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022, rising to early 12.7 percent of GDP in 2031 and further thereafter. Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.

The Case for Single-Price Health Care

Source: Paul S. Hewitt and Phillip Longman, Washington Monthly, Vol. 50 no. 4/5/6, April/May/June 2018

We could largely solve the cost crisis simply by making Medicare prices universal.

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Their Own Medicine
Source: Fran Quigley, Washington Monthly, Vol. 50 no. 4/5/6, April/May/June 2018

Patient activists were once at the forefront of lowering the cost of life-saving medication. To solve today’s prescription drug crisis, they’ll have to find their voice again.

Healthcare for All

Source: Dissent, Spring 2018
(subscription required)

Articles include:
Crisis and Opportunity
Adam Gaffney
The left will not live forever on the sidelines of political power. When we have an opportunity to remake our healthcare system, we must be sure to seize it.
Introducing the special section of our Spring issue.

How to Win Medicare for All
Josh Mound
For a progressive program of government-provided healthcare to make it into law, survive, and thrive, it must be popular.

Undocumented, Uninsured, Unafraid
Beatrix Hoffman
In the fight for healthcare for all, single-payer and immigrant rights activists face serious obstacles, but also the opportunity to demonstrate the benefits of true universalism.

Cashing in on Despair
George Karandinos
Profiteering is distorting the response to the opioid epidemic as much as it shaped its origin.

The Class Politics of Teeth
Mary Otto
Inequalities in oral health and dental access reflect our deepest social and economic divides.

Single-Payer or Bust
Adam Gaffney
By providing a single tier of coverage to all, with automatic enrollment, comprehensive benefits, and no cost-sharing, single-payer provides a distinct—and more egalitarian—vision of universality.

Health Insurance Reform In The USA—What, How, And Why?

Source: Theodore Joyce, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The U.S. Congress failed to repeal and replace the Affordable Care Act (ACA). Will the country limp along with a politically unsupported ACA or is this an opportunity for a serious discussion about health insurance reform in the United States? In this Point/Counterpoint, Adam Gaffney, a physician and instructor in Medicine at the Harvard Medical School and a member of the Cambridge Health Alliance, argues for a national insurance program that provides first-dollar coverage to all Americans. Dana Goldman, the Leonard D. Schaeffer Chair and distinguished Professor at the University of Southern California, and Kip Hagopian, co-founder of Brentwood Associates and Managing Partner at Apple Oaks Partners LLC, also argue for universal coverage, but one consistent with standard principles characteristic of automobile or home insurance. These widely differing approaches to health insurance reform could not be more timely or more cogently argued.

Related:

It Is Time For Universal Coverage Without Breaking The Bank
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

….So what can be done now that “repeal and replace” has failed? There is a call for bipartisan solutions, but proposals are often short on details. What specifics we do get involve modest reforms to reduce cost-sharing and stabilize the existing markets. This is not enough; we need fundamental reform, and five goals should undergird a bipartisan plan:
• make coverage universal and progressive;
• build on, but do not replace, the private insurance system;
• keep it affordable and sustainable; reduce incentives for adverse selection (avoidance of bad health risks); and
• create incentives for prevention and long-term investment…..

Health Insurance Reform In The United States—What, How, And Why?
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

Last summer, Republican efforts to repeal the Affordable Care Act (ACA)—seven-years in the making—dramatically collapsed. Yet, if the failed Senate vote in July marked a pause in conservative reform efforts, it only further animated the health care reform debate on the left side of the political spectrum.

In this article, I argue that one of the reform models under discussion—single-payer national health insurance (NHI)—is the most potent and realistic policy solution. First, I make the case that universal coverage is economically feasible. Second, I examine why achieving universal coverage remains paramount. Third, I describe how universal coverage can be quickly and effectively achieved via NHI enrollment. Fourth, I discuss benefit design, emphasizing the importance of comprehensive benefits, and first-dollar coverage. And finally, I explore the role of the public and private sectors, arguing that health care coverage must remain entirely within the public sphere if the goal of universal health care is to be, at long last, attained…..

Medicare-For-All: Not Our Only Option For Universal Coverage
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The failure to meet ambitious but attainable goals—cover everyone, control costs—has created opportunity for radical reform. Dr. Gaffney advocates for universal health coverage via the burgeoning “Medicare-for-All” approach that has dominated the progressive health reform landscape for decades. As appealing as it may be from the outside, the strategy ignores several key health policy realities, namely the proper amount of insurance, the historic limitations of Medicare, the pitfalls of cutting costs by reducing administration, and the rising pressure of private markets in international health insurance…..

Universal Underinsurance Is Not The Same As Universal Health Care
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

I begin my response to Dana Goldman and Kip Hagopian’s admirably clear reform proposal on a point of agreement. Today, 28 million Americans remain uninsured according to the United States Census Bureau. The three of us clearly agree that this status quo is unacceptable, and that universal coverage is attainable, affordable, and right.

Beyond that, however, it becomes clear that we have very different visions for the future of American health care……

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans

Source: Lina Walker, Jane Sung, Claire Noel-Miller, and Olivia Dean, AARP Public Policy Institute, Fact Sheet, September 2017

The Graham-Cassidy (GC) bill, as proposed on September 13, 2017, threatens to make health care unaffordable and inaccessible for millions of older Americans. The bill eliminates two sources of financial assistance—premium tax credits and cost-sharing reductions—critical to ensuring that low- to moderate-income older adults are able to afford the coverage they need. For a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year if they wanted to keep their current coverage. The bill may also allow states to charge older adults age 50–64 significantly higher premiums than under current law on the basis of their age by waiving federal protections that limit the practice known as age rating…..

Graham-Cassidy ACA Repeal Bill Would Cause Huge Premium Increases for People with Pre-Existing Conditions

Source: Sam Berger and Emily Gee, Center for American Progress, September 18, 2017

With only two weeks left to move forward with a partisan health care repeal bill, some Senate Republicans are trying one last time to rip coverage from millions of Americans. Their latest effort, introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), would make devastating cuts to Medicaid and cut and eventually eliminate funding that helps people in the individual insurance market afford coverage, leading to at least 32 million fewer people having coverage after 2026.

Those who did not lose coverage would see their premiums increase significantly. In the first year, premiums would increase by 20 percent. But the increases would be even greater for people with pre-existing conditions because the bill would let insurers in the individual market charge a premium markup based on health status and history, which could increase their premiums by tens of thousands of dollars…..

Organizational Restructuring in US Healthcare Systems: Implications for Jobs, Wages, and Inequality

Source: Eileen Appelbaum and Rosemary Batt, Center for Economic and Policy Research (CEPR), September 2017

From the summary:
The healthcare sector is one of the most important sources of jobs in the economy. Healthcare spending reached $3.2 trillion in 2015 or 17.8 percent of GDP and accounted for 12.8 percent of private sector jobs. It was the only industry that consistently added jobs during the Great Recession. In 2016, the private sector healthcare industry, which is the focus of this report, added 381,000 private sector jobs, the most of any industry. It is a particularly important source of employment for workers without a college degree, most of whom, as we document in this report, earn low wages.

This report describes how organizational restructuring is affecting the job opportunities and wages of healthcare workers. We focus on changing employment and wages in hospitals and outpatient clinics, where the most profound restructuring is occurring. Over the last decade or more, hospitals have restructured the organization of care delivery in response to major technological advances, regulatory changes, and financial pressures. This restructuring has occurred at two levels: the consolidation of hospitals and providers into larger healthcare systems on the one hand; and the decentralization of services and the movement of jobs to outpatient facilities on the other. Outpatient care facilities include a wide range of services — from primary care centers to specialized units such as urgent care centers, ambulatory surgery centers, free-standing emergency rooms, dialysis facilities, trauma and burn units, and other specialty clinics. These organizational changes began before the 2010 passage of the Patient Protection and Affordable Care Act (ACA), but have accelerated considerably since then, and are likely to continue even as the ACA is revamped in the future.

This shift to outpatient care centers offers benefits to patients — convenience as well as opportunities for preventative care — and most healthcare providers and unions have supported the move to more community-based care. But in this report, we show that workers are bearing the costs of this organizational restructuring.

Related:
Supplement
Press release

Cassidy, Graham State Estimates Irrelevant to Assessing Their Health Bill’s Effects

Source: Aviva Aron-Dine, Edwin Park, Matt Broaddus, Center on Budget and Policy Priorities, September 18, 2017

From the summary:
In rolling out their revised bill to repeal the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham released estimates purporting to show that most states would see large funding gains under their proposal. But these estimates do not compare states’ funding under the proposal to what states would receive under current law, the relevant comparison. Instead, they show how each state’s funding under the proposed block grant would change over time. In reality, the Cassidy-Graham plan would cut federal funding for coverage programs by about $80 billion in 2026 compared to current law, leading to cuts in most states, and would cut federal funding by about $300 billion in 2027, with funding cuts in all states.

A Brief History of American Health Reform

Source: Colin Gordon, Jacobin, July 25, 2017

In order to win universal health care, we have to understand what — and who — we’re up against. ….

….In health care, private providers and private financing mechanisms were well ensconced long before any meaningful public intervention. The stakes are very high and, historically, a diverse array of private health interests have spent lavishly on political campaigns, and haunted congressional hearings and anterooms. But what has shaped health policy, and stymied reform for the last century, is not so much the combined clout of private interests as it is the tangle of compromise and competition that’s emerged from the scrum as they jockey for influence over policy, for advantage over each other, and for unfettered access to public spending.

Over the last century, the terms of that corporate compromise have been altered through changes in medical care, and changes in the ways medical care is sold, underwritten, packaged, subsidized, regulated, and consumed. The influence of private interests has persisted but, from the first consideration of “health security” in the Progressive Era to the tortuous repeal of the Affordable Care Act over the last few months, which interests have weighed in — or prevailed — has shifted.

Tracing those shifts (sometimes subtle, sometimes profound) is important not just to our understanding of the history, but also to our efforts to win a more just health system…..

The Better Care Reconciliation Act: Economic and Employment Consequences for States

Source: Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen, Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, July 2017

From the abstract:
Issue: A draft Better Care Reconciliation Act (BCRA) has been introduced in the U.S. Senate as an alternative to the American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, 2017. The Congressional Budget Office estimates the BCRA would raise the number of uninsured by 22 million by 2026.

Goal: To determine the consequences of the draft BCRA on employment and economic activity in every state. This report updates an earlier analysis of the effects of the AHCA.

Methods: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies.

Findings and Conclusions: While the draft BCRA and the AHCA would have similar effects on the number of uninsured Americans, the BCRA would lead to significantly larger job losses and deeper reductions in states’ economies by 2026. A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply. By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy. Employment in health care would be especially hard hit with 919,000 fewer health jobs, but other employment sectors lose jobs too. Gross state products would be $162 billion lower in 2026. States that expanded Medicaid would be especially hard hit.

Related:
Interactive map
Press release
Appendices