Charles Blahous puts a price on Sanders’s proposed legislation in “The Costs of a National Single-Payer Healthcare System.” These are his key findings.
- M4A Would Place Unprecedented Strain on the Federal Budget
By conservative estimates, this legislation would have the following effects:
- M4A would add approximately $32.6 trillion to federal budget commitments during the first 10 years of its implementation (2022–2031).
- This projected increase in federal healthcare commitments would equal approximately 10.7 percent of GDP in 2022. This amount would rise to nearly 12.7 percent of GDP in 2031 and continue to rise thereafter.
These estimates are conservative because they assume the legislation achieves its sponsors’ goals of dramatically reducing payments to health providers, in addition to substantially reducing drug prices and administrative costs.
I recall a conversation on the Rush Limbaugh show many years ago. A medical school student called in to explain why he was in favor of socialized medicine. He wanted to make sure that everyone who needed medical care could get it.
Rush had an answer for that. He suggested that once he completed his training, he should give his services away for free.
The tone of the kid’s voice spoke volumes.
It seems people become doctors expect some form of reward for all the work involved.
Stephen Green offers this:
Regarding my earlier post about socialized medicine, Longtime Sharp VodkaPundit Reader™ RBJ commented:
People are self-nterested, not virtuous. I want really smart people to go into medicine because they want to make money to provide for a good life for themselves and their families.
Take away that financial incentive, and the best and brightest will find other things to do. Meaning the quality of doctors and nurses, et al., will go down.
And before that, BobB59 said, “Will they acknowledge the inevitable doctor shortage with that plan? I’m not holding my breath.”
This all goes back to my oft-stated belief that modern progressivism is a form of high-tech feudalism.
Under the old feudalism, there were serfs who worked the land, lords who lorded over them, ladies who tended to the lords, etc. Everyone knew their place and remained in their place, forever.
Progressivism “works,” such as it does, under the conceit that there are doctor-units who perform medicine, business-units who provide goods and services, teacher-units who teach, student-units who learn, etc. And — this is the vital bit — all those units perform their assigned tasks, and will continue to do so, regardless of incentives.
When all those person-units don’t conform to progressive wishes, that’s when progressives turn nasty. Which is in most instances pretty much right away.
But don’t worry, comrade. You will be made to conform. In the end, you will love Big Brother.
This is the great hidden truth about Obamacare. It was never a program for improved medical coverage. It was a program for redistributing wealth by force from the healthy to the sick. It did this by forcing nonmarket risk pools, countering the whole logic of insurance in the first place, which is supposed to calibrate premiums, risks, and payouts toward mutual profitability. Obamacare imagined that it would be easy to use coercion to undermine the whole point of insurance. It didn’t work.
And so the Trump executive order introduces a slight bit of liberality and choice. And the critics are screaming that this is a disaster in the making. You can’t allow choice! You can’t allow more freedom! You can’t allow producers and consumers to cobble together their own plans! After all, this defeats the point of Obamacare, which is all about forcing people to do things they otherwise would not do!
I chose not to argue that Obamacare was going to collapse and be repealed in its entirety, but rather, that Obamacare would not, and could not, be the program that had been promised or intended. It had already failed to deliver on key promises for coverage, affordability and of course, the infamous promise that “if you like your doctor, you can keep your doctor.” It was also dangerously unstable, requiring steady executive intervention just to keep the program from collapsing. I argued that these executive interventions, enthusiastically supported by the law’s proponents, were setting a precedent that would eventually be used against it. Worried that health care was too hostage to the vicissitudes of the markets, Democrats had instead made it the prisoner of politics.
“Essentially they’ve made it so that Republicans can undo two-thirds of this law with a stroke of the presidential pen,” I said at the close of my opening statement. “Obamacare is now beyond rescue. The administration has destroyed their own law in order to save it.” Four years later, we are watching those dominos fall.
Remember how we ended up with the particular version of Obamacare that became law. Democrats had 60 votes in the Senate, and a growing sense that they were on the verge of a second New Deal. They thought they didn’t need Republicans, and they thought they couldn’t get Republicans, so they made little effort to involve Republicans in drafting, beyond offering token concessions to a handful of liberal Republicans who might have made nice bipartisan window-dressing at the signing ceremony. Republicans, predictably, spent a year talking down the bill, and by the time it was nearing passage, a majority of the public opposed it.
Then Massachusetts — Massachusetts! — sent Republican Scott Brown to Ted Kennedy’s old Senate seat, a phenomenon that was widely (and in my view correctly) put down to a desire to block Obamacare. Rather than saying “if we’ve lost Massachusetts, we’ve lost America,” Democrats rushed a draft version of the bill into law through a parliamentary procedure that obviated the need for Brown’s vote.
This draft bill, unsurprisingly, had problems. It also overhauled almost a fifth of the economy. It also had the implacable hostility of the opposition, and a public that was pretty angry at politicians for passing it. By the end of the year, Democrats had lost control of Congress, and with it, any hope of making all the changes they’d fantasized after they passed the bill and found out what was (and wasn’t) in it.
That put Obama in the nasty situation of presiding over a program that couldn’t work as written, and couldn’t be legislatively altered. So he proceeded with the only avenue open to him: dubious executive measures that temporarily shored up the program, but weakened even further the slim foundation of political legitimacy that held it up. And here we are seven years later, watching as one by one, those supports sway or snap.
And thanks in part to the voter revolt that Obamacare triggered, those powers have now been handed over to a president who doesn’t simply take political legitimacy for granted, but seems actively hostile to it. The scramble to pass and sustain Obama’s signature initiative may have badly hurt the cause: to make the health-care system fairer, broader and more efficient.
If Obamacare dies now, in this way, the country will be worse off than if it had never passed. And I’m not just talking about the growing notion among both parties that the idea of elections is to get into power and exercise whatever power you can, by whatever means you can get away with, until voters take your toys away again.
In the worst-case scenario, large swathes of the country will have “bare” individual markets where everyone will be magnificently equal in their inability to purchase insurance. And the memory of Obamacare staggering onward for years, down a trail of broken promises and underwhelming results, will make voters reluctant to trust any politician who suggests that we embark on another such journey.
Is Obamacare beyond rescue? If not, it could certainly use some. And at this point, it’s hard to see who is going to swoop in to save the day.
The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero. Certainly, there are individuals who have benefited from various of its provisions. But attempts to claim broader effects on public health or thousands of lives saved rely upon extrapolation from past studies that focus on the value of private health insurance. The ACA, however, has expanded coverage through Medicaid, a public program that, according to several studies, has failed to improve health outcomes for recipients. In fact, public health trends since the implementation of the ACA have worsened, with 80,000 more deaths in 2015 than had mortality continued declining during 2014–15 at the rate achieved during 2000–2013.
As the New York Times explains, one way plans can save money is to “make it harder for patients to get care — so that they get less of it. Narrow network plans may do this if they don’t cover enough nearby providers, with the ones they do cover too busy to take new patients in a timely fashion.”
“Clearly this would be especially problematic if appointments with one’s preferred primary-care doctor are hard to obtain,” the story noted.
Which is precisely what’s been going on in ObamaCare. A study published in Health Affairs last year found that just 30% of the “secret shoppers” it enlisted for the study were able to get an appointment with their first pick of doctor through an ObamaCare plan in California.
Despite these narrow networks, insurers still have had to impose substantial deductibles and jack up premiums by double digits, and are still losing money on ObamaCare. Having an ObamaCare card, in other words, is no guarantee that health care will be affordable or high quality.
Would Billy Kimmel have fared as well had his parents been stuck in one of these ObamaCare HMO plans? Maybe, maybe not.
The point is that, even if your goal is to guarantee coverage to everyone with pre-existing conditions, which was Kimmel’s plea, ObamaCare’s approach is clearly not working. It is destabilizing individual insurance markets across the country and providing mediocre insurance benefits to the very people who need it most, and insurance companies continue to bail on the program leaving consumers with little or no choice of plans. It is unsustainable in its current form. There aren’t even many Democrats who would disagree with that.
Republicans think they have a better way to achieve these protections without all of ObamaCare’s adverse side effects; their plan should be judged on those merits, not on emotional appeals from rich celebrities.
I learn from my patients every day about the benefits, limitations and contradictions of their health insurance. One charming 60-year-old with severe seasonal allergies insists on seeing me every few weeks this time of year, even though I tell her she doesn’t need to — her antihistamines and nasal spray treatment rarely changes. But she worries that her allergies could be hiding an infection, so I investigate her sinuses, throat, lungs and ears. I reassure her, and her insurance (which she buys through New York’s Obamacare exchange) covers the bill.
If she was responsible for more than a small co-payment for these visits, I’m sure I would see her less often.
We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?
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The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely. But Obamacare went well beyond these essentials, by mandating an overstuffed prix fixe meal filled with benefits like maternity and mental health coverage that drove smaller insurers with fewer options out of the market. The few that remain often have a monopoly, and premiums rise.
Speaking of compassion, how about some for the 20-something construction worker who can’t afford to pay his rent because his premiums help subsidize overusers like my allergy sufferer? Why shouldn’t a patient who is risk-averse pay more for coverage she might never need, while that construction worker be allowed to choose a cheaper insurance plan that might cover only the essentials?
In addition to limiting the menu of essential benefits, the House bill would let states create high-risk pools for patients with pre-existing conditions who had let their insurance coverage lapse, and who could then be charged premiums more in keeping with their health care needs. This is the only way to make insurance affordable for most consumers; pre-existing conditions will continue to drive up premiums if everyone is compelled to pay the same price.
These risk-pool premiums can and should be subsidized by the government. A recent report from the Kaiser Family Foundation found that high-risk pools can work, but have been historically underfunded. Trumpcare should change that — though it will cost more than the House bill’s $8 billion in additional funding. Drastic cuts to Medicaid should also be reversed, which could help the bill pass the Senate.
But the bill is on the right track. Americans believe that insurance provides access to care, when in fact it is the gatekeeper that often denies care. Many think Obamacare is generous, and yet I often have to fight for essential care for my patients. We need to be more pragmatic, and less emotional, about this issue.
Jimmy Kimmel’s contention this week that a child like his would not receive lifesaving surgery for his congenital heart problem without Obamacare may tug at the heartstrings, but it is neither fair nor accurate. Employer-based health insurance, which covers 170 million Americans, including, no doubt, Mr. Kimmel, would have paid for this infant’s needs with or without Obamacare. Even if the Republican plan replaced Obamacare, and even if the infant didn’t have employer-provided insurance, the treatment would still be covered, either through a traditional plan or a high-risk pool. And at the end of the day, a federal law, the Emergency Medical Treatment and Labor Act, guarantees this kind of treatment, whether we have Obamacare or Trumpcare.
The final question concerns the skyrocketing costs of innovation, and how one-size-fits-all insurance can possibly continue to pay for it. My 93-year-old father, a retired engineer, just received a $50,000 catheter-inserted aortic valve, which was covered by Medicare. But if all such high-tech devices are covered, it will be practically impossible for any insurance company not to go belly-up. The tax-free savings accounts that the House bill would expand and make more flexible are a far better way to pay for this kind of care. Shouldn’t my father and those like him be asked to save their own money for just this sort of rainy day?
Or should we continue to overload health insurance with all our fears and expectations?
Contrary to popular belief, ObamaCare was never a healthcare bill. As healthcare, it was designed to fail, and then be replaced by single payer. It was actually an outrageous tax increase. It was designed to pull billions of dollars out of the pockets of the American taxpayer and into the hands of the feds, where it could be spent on all sorts of priorities the Left holds dear,with the side benefit of completely subsidizing healthcare for important Democrat voting groups. It may have dismally failed as healthcare policy, but it definitely succeeded as a money machine for the Obama Administration’s progressive agenda.