Democrats Are Having the Wrong Health Care Debate

[bluewater]

They should skip the argument over Medicare for All and find the best ways to tackle affordability.
By Ezekiel J. Emanuel
[snip]
For the other 295 million Americans who have some form of health insurance, the problem is high costs. Even with health insurance, high premiums, deductibles and co-pays, surprise hospital bills and exorbitant drug prices inhibit people from accessing care and taking their medications, threaten to drain their savings, or even force Americans into bankruptcy. Democrats need a plan to deal with this problem.

Four policies can effectively tackle the affordability issue. First, we need to address drug prices. The United States has just over 4 percent of the world’s population, and yet it accounts for nearly half of global drug spending. On average, the United States spends $1,443 per person a year on drugs. This cannot be explained by utilization; the difference is the drug prices we pay.
[snip]
Second, hospital prices are soaring and must be contained. Medicare and Medicaid set their own hospital prices, which have risen modestly in recent years. But hospital prices for the roughly 160 million Americans with private insurance have shot up as much as drug prices. In 1996, hospitals charged private insurance companies about 6 percent more than Medicare. In 2012, they charged 75 percent more than Medicare. A recent RAND study indicates that, on average, hospitals now charge private insurance companies 141 percent more than Medicare.
The main culprit behind this price escalation appears to be the mergers of hospital systems, which creates local monopolies. Researchers at Yale calculate that capping prices for inpatient care for private insurers at 120 percent of Medicare would save about 20 percent of those costs, approximately $90 billion per year. That cap may be too aggressive, but a cap of 140 percent would save more than $30 billion.
[snip]
Next, we need a policy that targets wasteful insurance billing practices. In 2010, the National Academy of Medicine estimated that about 14 percent of health care spending was related to billing and insurance-related administrative activities. Updating those numbers for today, the Center for American Progress estimates that we spend nearly $500 billion a year on billing and insurance processing. Based on comparisons with other countries, about half of that is classified as “excess” — a polite way of saying waste.
[snip]
The fourth option is to push even harder on switching from fee-for-service payment to value-based alternatives. As it stands, when physicians avoid an unnecessary test or deliver the same outcomes for less money, they suffer financially. Capitation, bundles and global budgets make doctors and hospitals responsible for both the total cost of caring for patients and the quality of their outcomes. Ultimately, it is doctors who write orders and decide on a patients’ suite of tests and treatments.
[snip]
These four simple policies can easily save more than $100 billion and, if pushed aggressively, maybe close to $200 billion per year. Americans and American businesses are crying out for affordable health care. That, along with auto-enrollment, should be what Democrats fight for in 2020.

https://www.nytimes.com/2019/08/02/opinion/democrats-health-care.html

It's not enough to just say Medicare for All is politically unattainable or would cost too much. Candidates that oppose Medicare for All must show their own math on how they would make health care affordable.

Right now, it simply is not affordable for average working families.

[msongs]

1. as an option, medicare for those who want it nt

[bluewater]

2. For the sake of discussion, would you explain how that will make health care affordable?

One major complaint against Medicare for All is the claim it will cost too much.

But, so far at least, I have not heard how alternative policies would cover everyone AND make health care affordable.

There is no free lunch, if people want health care coverage that they can actually use, it would have to be paid for somehow.

[brewens]

5. i'm leaning toward Warren right now. She needs to tell us what happens to all the money employers

pay for their employees coverage. If she says employers just pocket all that and workers make up for all of it with additional taxes, she loses my vote. I'll go out on a limb here and predict she will not say anything like that.

So what's the deal? Employers are taxed about the same amount to pay for MFA? A mandate that employers must increase workers pay by the amount they previously paid for their health coverage?

[Backseat Driver]

8. I'd hope that employers could still offer private supplemental plans

to cover that 20% that basic Medicare services don't along with those allied health services of dental, vision, hearing (devices included), long-term care, and specialized mental health drug/alcohol/autistic rehabilitation which companies would forward the claims to the single payer Medicare. Employers would still follow the tax tables with adjustments made by both employers and employees via tax year forms, whether or not eligible for the long-form tax returns. Am I confused or missing what you mean about the collection and remunerations of payroll tax costs by the parties.

[brewens]

11. I haven't assumed that MFA would have the same terms as Medicare, including the 80%

coverage. They call it MFA, but that doesn't mean it's going to be exactly the same program expanded.

What I meant was, before I recently retired, my employer I think paid about $700 bucks a month for my coverage and my contribution was $75 a month. So there was over $800 bucks going into our system we have now for my coverage every month. There is no way I could pay that $800 a month for a new plan unless I got that much of a raise. Presumably my employer could afford that if they weren't paying for my insurance. So how do I know that will work out? They keep trying to scare people by saying MFA would eliminate private insurance. So what if most of us end up with good enough coverage anyway?

So we can still allow private supplemental insurance of course. The goal should be making it tough for them to sell that. We shouldn't need it.

[msongs]

10. it is an option, could create a trend towards MFA. I am pro-choice on health care

if people choose medicare as their option, others may join them. corporate health care may just lower their prices to compete. one never knows really, even the hard core MFA proponents

[Backseat Driver]

3. Why do the Feds allow investigations of fraud go on so long that

the perps are allowed to amass huge $$ fraud?

2)Are the doc, Name, SR., alleged fraudster, related to the Name, JR, professor, historian and expert in racial matters in this situation. I also had to take a pause when I discovered that perhaps the same DC doc SR also had practice location in Delaware at this address: 1600 Pennsylvania Ave, Wilmington, DE. Wonder when and how this investigation got started a) if the MD is related to the PhD, the smirking wink via the practice address being similar to that of the WH, c) WH target via profiling (whether or not fraud causes were found).

I googled the name after reading this DU Link to story: https://democraticunderground.com/10442744

[Backseat Driver]

6. Sorry, the heat's getting to me and I didn't get all my

imaginings set out first time around; even initially forgot to add the link. Better eat some brain food quickly.

[Hoyt]

9. One thing that Medicare does poorly is detecting fraud. Medicare, unlike most private insurers, is

a "Pay and Chase" program.

Medicare contractors pay just about any claim that is properly coded. Then, over years, Medicare data analysts look for providers that bill too many medical services compared to their peers. Then, Medicare contractors select to most abusive for audit, potential recoupment, and rarely criminal charges. Those providers who aren't "too abusive," often get away with it.

Private insurers -- whatever else they might do wrong -- often require providers to submit documentation before paying services with a high likelihood of abusive billing. Also, these private insurers will boot a provider who is abusive much quicker than Medicare and Medicaid.

I know people think their doctor would never do anything wrong, but the billing system is set up to encourage a lot of providers to game the system to their advantage. The greed in healthcare -- at every level -- is hard to imagine.

[PoindexterOglethorpe]

4. I suspect a lot of Americans take a lot more drugs than they need.

It would be interesting to do comparisons with other countries. Yes, we often pay a lot more for drugs than others do, but that can hardly account to 4% of the world's population accounting for nearly have the global spending on drugs.

[Hoyt]

7. Agree with article, but saving $200 Billion out of our $3.5 B annual healthcare budget ain't much.

[Gothmog]

12. Fighting over the details of their healthcare proposals won't help them beat Donald Trump

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