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President Biden’s health care tweaks will perpetuate expensive mediocrity

March 1, 2021

Topics: Quote of the Day

The Biden administration is trying to make the health care law more generous and closer to its original design, but may disappoint progressive allies hoping for more.

By Sarah Kliff and Margot Sanger-Katz
The New York Times, February 27, 2021

Tucked inside the stimulus bill that the House passed early on Saturday are a series of provisions to make the private plans more affordable, at least in the short term.

The legislation, largely modeled after a bill passed in the House last year, would make upper-middle-income Americans newly eligible for financial help to buy plans on the Obamacare marketplaces, and would increase the subsidies already going to lower-income enrollees. The changes would last two years, cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.

Republican critics of the law contend that Democrats are seeking to install long-sought permanent policies through a temporary stimulus plan.

Those close to the effort say its ambitions — and its limits — reflect the preferences of those leading the way. Mr. Biden, who was involved in the passage and rollout of Obamacare as vice president, ran on the idea of expansion, not upheaval.

But the Biden health project still faces challenges, and it may disappoint his allies. The new proposed spending, which would bring the law’s subsidies in line with early drafts of the Affordable Care Act, is temporary.

And for many Democrats, the overhauls do not go as far they had hoped.

Mr. Becerra has previously supported a single-payer system. He faced questions about his commitment to that idea from Senator Bernie Sanders, who has repeatedly introduced Medicare for All legislation, and from Republican senators who oppose the idea. In each case, he responded similarly: The Affordable Care Act is the president’s focus, and his own as well.

“I’m here at the pleasure of the president of the United States,” Mr. Becerra said. “He’s very clear where he is — he wants to build on the A.C.A. That will be my mission.”

Pramila Jayapal, a Democratic congresswoman from Washington State, who led a joint Biden-Sanders policy task force during Mr. Biden’s presidential campaign, says she is heartened by the measures the administration is taking — but concerned that the current efforts don’t yet match the promises made to progressives during the campaign.

“I believe we’re going to do so many things in this package, and I do think it’s a good package,” she said. “But I believe we haven’t done enough to help everyone who has fallen into the cracks.”

https://www.nytimes.com…


Comment:

By Don McCanne, M.D.

Once Joe Biden was assured of the Democratic nomination for president, he made it very clear that he would reject legislation for single payer Medicare for All, disappointing most progressives, and build on the Affordable Care Act instead. We should take a look at what we want out of our health care system and what some of Biden’s temporary Bandaid approaches will do as compared with single payer Medicare for All (M4A).

  • We want a system that is truly universal – everybody in, nobody out. Biden’s proposal will add more participants to the current program, but still leave millions out. M4A is truly universal.
  • We want a program that is affordable for each individual and for society as a whole. Biden’s plan will add significantly more spending to the program while leaving it still unaffordable for too many individuals. M4A would achieve all goals of financing reform without significantly increasing spending.
  • We should end fragmentation of the financing system which results in tremendous inequities. Biden’s plan would perpetuate fragmentation. M4A would end fragmentation, creating a program that serves everyone equitably.
  • Health care coverage should be stable and permanent throughout life. Biden’s proposed fixes would be temporary, many expiring in two years. It is likely that legislators would develop reform fatigue in this session and fail to followup with more permanent measures. M4A would be a single program – permanent throughout life.
  • We won’t attempt to itemize the multitude of problems with employer-sponsored insurance, such as job lock, but many conservatives and progressives believe that it should be terminated. Biden would perpetuate it since it involves less government involvement – predominantly private spending with a tax benefit. M4A would end employer-sponsored insurance, and, for many, M4A would be better.
  • Medicaid carries the stigma of being a welfare program which results in legislative underfunding and neglect. Biden would attempt to expand Medicaid in those states that have underutilized it. M4A would terminate the program and move everyone into a universal, comprehensive and equitable program.
  • Fragmentation results in dysfunctional financing of health care. Biden would perpetuate fragmentation whereas M4A would bring an end to it.
  • The U.S. system is uniquely characterized by profound administrative waste, especially by the private insurers and the administrative burden they place on the health care delivery system. Biden’s proposals would add more administrative burden along with the costs they entail. M4A is specifically designed to greatly reduce this burden and its associated costs.
  • The privatization of public programs such as Medicare through Medicare Advantage and Medicaid through private managed care programs have proven to provide poor value for the taxpayer (obscured by cherry picking and lemon dropping) and should be eliminated. Biden would continue these programs, whereas M4A would eliminate them.
  • Patients should have free choice of their professionals and health care institutions. Biden would continue health plans with restrictive networks that take away free choice. M4A allows choices within the entire health care delivery system.
  • Facing out-of-pocket costs at the time health care is received results in impaired access to beneficial care. Biden would continue these financial barriers to care, whereas M4A would basically eliminate them.

The list is endless. As Abdul El-Sayed, M.D. and Micah Johnson, M.D. say in their book, “Medicare for All: A Citizen’s Guide,” we want universal coverage, comprehensive coverage, pricing power, administrative efficiency, progressive financing, and public accountability.

Do we want one system that works well for everyone, or do we want to continue with an overpriced, dysfunctional system that leaves so many out? When Becerra and Jayapal are reluctantly willing to yield to Biden’s wishes, for lack of an alternative that he will accept, we have a problem. President Biden needs to hear our message, loud and clear, so that he will understand that single payer Medicare for All is an imperative. No more expensive mediocrity!

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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