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Why are we celebrating the pending demise of Medicare for All?

March 12, 2021

Topics: Quote of the Day

We need 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.

By F. Douglas Stephenson
Common Dreams, March 11, 2021

President Biden, the Democratic Party and America’s neoliberal vision of world order is rooted in an economic philosophy of privatization and financialization. Administrative costs (and immense profiteering) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

Biden and many Democrats have spent their careers defending the financial sector, including big insurance and big pharma, whose leading policy is also to maintain and further privatize basic health care financing and infrastructure. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy “reform” written and put into his hands by the credit-card companies. As a budget hawk, he’s rejected “Medicare for all” as if it is too expensive for the government to afford.

Although health insurance affordability for the majority of US citizens remains a very large problem, Pres. Biden’s latest health insurance plan wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of health insurance by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system. Profiteering continues unabated as private insurance sells us services we don’t need/want, such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

When compared to an improved, single payer Medicare for All (M4A) insurance plan, Biden’s plan is disappointing and at best a bandaid approach. We need 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:

  1. 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 system.
  2. 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.
  3. Fragmentation results in dysfunctional financing of health care. Biden would perpetuate fragmentation whereas M4A would bring an end to it.
  4. 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.
  5. 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.
  6. We need 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.
  7. 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 follow up with more permanent measures. M4A would be a single program—permanent throughout life.
  8. Employer-sponsored insurance can create problems such as job lock, which many conservatives and progressives believe 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.

The highly respected British medical journal, “The Lancet,” recently summarized the health insurance situation in the USA:

“Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal/revise the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68,000 lives and 1·73 million life-years every year compared with the status quo.”

https://www.commondreams.org…


Providers Blast Medicare Spending Cuts in COVID Relief Package: The American Rescue Plan triggers automatic cuts as a deficit control measure that will result in $36 billion in Medicare spending cuts in fiscal year 2022.

By Jacqueline LaPointe
RevCycleIntelligence, March 11, 2021

Leading healthcare industry groups are praising the package’s many healthcare provisions, particularly policies that support healthcare coverage for more Americans and widespread vaccination. But these benefits will come at a cost to healthcare providers, the groups are saying.

Implementation of the American Rescue Plan will trigger automatic spending cuts as a deficit control measure, resulting in $36 billion in Medicare spending cuts in fiscal year 2020 alone, AMGA (American Medical Group Association) states.

“Cutting billions from the Medicare program now would undermine healthcare providers who have heroically rallied all year to care for their patients and communities,” Jerry Penso, MD, MBA, president and CEO of AMGA, said in the statement yesterday.

https://revcycleintelligence.com…


Comment:

By Don McCanne, M.D.

The American Rescue Plan Act of 2021 – a much needed $1.9 trillion economic stimulus bill – was signed into law by President Joe Biden this week. But as the celebration dies down, we should address what some may say are the “intended” consequences of this bill. It’s a godsend to the private insurance industry, and, further, it doesn’t just move the concept of a single payer Medicare for All program to the bottom of the policy heap, it actually dumps the heap into a shredder as the private insurance industry capitalizes on control of health care financing in America.

For providers who are celebrating, they should remind themselves of the pending automatic spending cuts in Medicare. Nice penalty for a job well done.

We really can fix this so everyone – the patients and their partners in the health care delivery system – can fare well. We merely need to enact and implement a single payer, improved Medicare for All program. Do you think we can get it done before the sunset of the two year provisions in the economic stimulus plan? It will be an uphill struggle when the Biden administration keeps dismissing us with the claim, “We’ve already fixed health care!” Yes, for the private insurers, but we can do much better by targeting the patients instead.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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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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