Medicare for All

[lpetrich]

Medicare for All - that's a proposed single-payer medical-insurance system that extends Medicare-like coverage to all US citizens.

Jayapal Introduces Medicare for All Act of 2021 Alongside More Than Half of House Democratic Caucus After Millions Lose Health Care During a Pandemic - Congresswoman Pramila Jayapal

Legislation guarantees health care to everyone as a human right by providing comprehensive benefits including primary care, vision, dental, prescription drugs, mental health, long-term services and supports, reproductive health care, and more with no copays, private insurance premiums, deductibles, or other cost-sharing

WASHINGTON — Today, U.S. Representatives Pramila Jayapal (WA-07) and Debbie Dingell (MI-12) introduced the Medicare for All Act of 2021, transformative legislation that would guarantee health care to everyone in America as a human right at a moment in which nearly 100 million people are uninsured or underinsured during a pandemic. Endorsed by 300 local, state, and national organizations and co-sponsored by more than half of the House Democratic Caucus including 14 committee chairs and key leadership Members, the landmark bill provides comprehensive benefits to all with no copays, private insurance premiums, deductibles, or other cost-sharing.

The Medicare for All Act of 2021 is being introduced in the House of Representatives one year to the day that the COVID-19 virus was first confirmed in all 50 states and the District of Columbia. This devastating public health crisis, which has taken the lives of more than 540,000 Americans, has only underscored how the country’s current health care system leaves millions behind. As unemployment skyrocketed to historic levels during the pandemic, millions of additional families lost their health care and the country experienced the highest increase in the number of uninsured Americans ever recorded.

“While this devastating pandemic is shining a bright light on our broken, for-profit health care system, we were already leaving nearly half of all adults under the age of 65 uninsured or underinsured before COVID-19 hit. And we were cruelly doing so while paying more per capita for health care than any other country in the world,” said Congresswoman Jayapal. “There is a solution to this health crisis — a popular one that guarantees health care to every person as a human right and finally puts people over profits and care over corporations. That solution is Medicare for All — everyone in, nobody out — and I am proud to introduce it today alongside a powerful movement across America.”

“A system that prioritizes profits over patients and ties coverage to employment was no match for a global pandemic and will never meet the needs of our people,” said Congresswoman Dingell. “In the wealthiest nation on earth, patients should not be launching GoFundMe pages to afford lifesaving health care for themselves or their loved ones. Medicare For All will build an inclusive health care system that won’t just open the door to care for millions of our neighbors, but do it more efficiently and effectively than the one we have today. Now is not the time to shy away from these generational fights, it is the time for action.”

I'm not sure that I'm completely happy with that. I'd like some consideration of the German system, of multiple private medical insurers that cover people independent of their state of employment. Sort of like Obamacare taken to its ultimate conclusion. It may be called Bismarckcare after the one who introduced the German system, the late 19th cy. German leader Chancellor Otto von Bismarck.

 

[lpetrich]

Deconstructed: Medicare for All Just Got a Massive Boost

This week New Jersey Rep. Frank Pallone, the chair of the powerful House Energy and Commerce Committee, gave the legislative push for single-payer health care a major boost by announcing that he would be co-sponsoring the proposed Medicare for All bill and holding a hearing on it sometime in the current term. Rep. Pramila Jayapal, chair of the Congressional Progressive Caucus, and Dr. Abdul El-Sayed join Ryan Grim to discuss the prospects for universal health care in the United States.

Ryan Grim interviewing Pramila Jayapal:

RG: Right. It’s almost as if our system was built exactly backwards for the pandemic, because the people who were most likely to keep their jobs and therefore, the most likely to keep their insurance also were the ones in the white collar jobs that could go into their basements and into their home offices, and work on Zoom. And the people that were most likely to lose their insurance were the ones who were going to be, you know, thrown out into the maw of the economy bringing things to those people who are staying in their homes. So it makes sense then that you see those disproportionate numbers of people testing positive and dying, who didn’t have insurance. Because that’s a much higher number than the overall population that was uninsured, right?

PJ: That’s right. No, that’s exactly right. We had been saying for some time that it was disproportionately black, brown, indigenous, poor workers who were uninsured, but the numbers of underinsured were also enormous, as you know: 87 million people that were uninsured or underinsured before the pandemic ever hit.

She then got into the experience of countries that have single-payer systems - they did a good job of surviving this pandemic.

After a long discussion with PJ of the internal politics of Congress about M4A, RG turned to Abdul Al-Sayed.

RG: So when you talk about how Medicare for All will interact with the health care system, as you talk to people — other doctors, nurses, people in the pharmaceutical industry — other people in the health care system, what are their objections to it? What are their concerns? And how do you kind of try to allay those?

AA: It’s a fear of loss. We are so used to the broken system that we have, and so used to watching the systems that provide us the basic means of a dignified life or, for those of us who work in health care, our weekly bread, we’re so used to watching these things get undermined from beneath us that anytime we talk about what could be better, even if you’re talking about a system that is so fundamentally broken at its core, like our health care system, there is this fundamental fear of loss. So people are so busy protecting the brokenness that we have.

I’ll tell you what, though. I think that’s changing quickly, particularly among doctors. And the reason why is because, as Sandeep Jauhar who wrote a great book called “Doctored” notes, doctors have gone from being knights to knaves to pawns. There was a time when most doctors worked for another doctor, or own their own businesses as partners in health care practices. And today, that’s no longer the case. The median doctor now is forced into working for a major corporation. So in a lot of ways, doctors have gone from being business owners to being line workers.

 

[lpetrich]

H.R.1976 - 117th Congress (2021-2022): To establish an improved Medicare for All national health insurance program. | Congress.gov | Library of Congress

Its sponsor: Rep. Jayapal, Pramila [D-WA-7] (Introduced 03/17/2021)

It currently has 113 sponsors, including 112 original ones. All of them are Democrats and some of them are well-known progressives like AOC and Katie Porter.

Two years ago, in the previous numbered Congress, PJ introduced
H.R.1384 - 116th Congress (2019-2020): Medicare for All Act of 2019 | Congress.gov | Library of Congress

It had 118 cosponsors, 106 original, also all Democrats.

Neither bill has a Senate companion bill.

The most recent bill does not have details, so one has to consult the earlier bill for likely details. The summary of the earlier bill:

This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS).

Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, and long-term care.

The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program.

Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs or the Indian Health Service.

The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs.

Individuals who are age 18 or younger, age 55 or older, or already enrolled in Medicare may enroll in the program starting one year after enactment of this bill; other individuals may buy into the program at this time. The program must be fully implemented two years after enactment.

 

[Rhea]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

 

[Harry Bosch]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

As an entrepreneur, I 100% agree with you.

 

[Loren Pechtel]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

We did basically that with the ACA. It's just it exposes the true cost of health care and people don't want to pay it.

 

[southernhybrid]

I would love to see a workable UHC for our country, but we must be honest about how difficult this transition and cost will be. Our current system is overloaded with an excessive desire for profit, including in many cases, outright greed. This has lead to unnecessary tests, procedures and surgery, as well as often the over prescribing of medications.

Our current system, if you can call it that, lacks continuity like I've never seen in my life. There is almost no communication between medical providers, quality is often below par, especially when it comes to our long term facilities.

Additionally, there is a looming shortage of nurses, from CNAs to RNs. Even with PAs and APRNs taking over most of the primary care, there is still an expected shortage of physicians. COVID isn't helping this situation, as the true stress of working in healthcare is becoming more obvious to the public. Besides that, it's not easy to be admitted to nursing or medical school.

Hospitals would likely deteriorate if they were to lose a good base of their income, due to the high reimbursement rates offered by private insurance companies they receive, as opposed to the reimbursement from Medicaid and Medicare. How do we fix that?

Plus, we would be paying for the cost, which one way or the other, we already do. It would just be through tax increases, most likely starting with the lower middle class, who would pay a small increased rate, progressing to a much higher rate at the top of the scale.

What I'm saying is that it's complicated, and I've yet to hear a reasonable plan from anyone inside or outside of government. I just hope we can gradually improve what we have and eventually offer decent healthcare to all Americans. The rich will always buy their healthcare. I'm sure there will always be concierge physicians for them. Fuck em.

And, Medicare as it currently stands isn't exactly cheap for most older adults since most of us rely on SS for a high percentage of our income. One must be below the poverty line to qualify for additional help from M'caid. Medicare has premiums, copays etc. We have a mess on our hands and solutions are yet to be found.

Give me yours............if you have one. I really don't know how to fix it. I just know it won't be easy.

 

[Rhea]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

We did basically that with the ACA. It's just it exposes the true cost of health care and people don't want to pay it.

I disagree. When you look at the prices that large corporations have negotiated, THAT is the price of healthcare and it is not what the individuals are paying in ACA. We still do not have equal access to a baseline level of health care.

 

[ideologyhunter]

If you look at a bar graph of what health care costs in modern democracies, the bar grows from a pencil to a yardstick when it gets to the U.S. We have accepted a free market, corporate-dominated health care establishment, but it ill serves much of our population. How many of us would face financial meltdown, if we received any number of diagnoses?
Most developed nations see health care as different from a market commodity or service, and they can't understand our system at all, with its inequities and astounding costs. I don't know how a nation's health care system evolves into a model that resembles Medicare for All. It's academic to me, because I don't think I'll live to see any such thing in the states.

 

[Rhea]

I guess it needs to start with people recognizing what the current situation actually entails. There is a LOT of misinformation out there, including how we stack up to the rest of the world.

 

[ideologyhunter]

There is a LOT of misinformation out there, including how we stack up to the rest of the world.

Right, particularly with the trope that Canadians and Brits loathe their health care, can't get in to see a doctor, envy our system, yada yada. This, as far as I can gather, is almost completely unrepresentative of the case. Yet you'll hear/see it again and again on right wing media and from right wing pols. I guess if I was able to run my campaign on payouts from insurance companies and pharma I'd try to please them. (Not really, but that's the reality with our GOP pals.)

 

[Loren Pechtel]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

We did basically that with the ACA. It's just it exposes the true cost of health care and people don't want to pay it.

I disagree. When you look at the prices that large corporations have negotiated, THAT is the price of healthcare and it is not what the individuals are paying in ACA. We still do not have equal access to a baseline level of health care.

Huh? What do you mean, the prices the large corporations have negotiated? Large corporations pay an awful lot for healthcare, that's why COBRA is such a sticker shock.

 

[Rhea]

I disagree. When you look at the prices that large corporations have negotiated, THAT is the price of healthcare and it is not what the individuals are paying in ACA. We still do not have equal access to a baseline level of health care.

Huh? What do you mean, the prices the large corporations have negotiated? Large corporations pay an awful lot for healthcare, that's why COBRA is such a sticker shock.

I mean that what my corporation pays for my healthcare is less than what I would pay for the same healthcare. The market always gives better prices to bulk purchasers. Always.

And yes, my company pays a lot for health care, but it’s because they offer cadillac plans. But if you try to shop independently for that same plan, you will pay even more.

The market always charges less to bulk purchasers. This is not a controversial statement.
And that’s why we need a single payer to negotiate. Government can do this bettter than individuals or free market.

 

[bleubird]

As of 2020 59.9% are employed by small businesses.How many offer little or no health insurance?

 

[Loren Pechtel]

I disagree. When you look at the prices that large corporations have negotiated, THAT is the price of healthcare and it is not what the individuals are paying in ACA. We still do not have equal access to a baseline level of health care.

Huh? What do you mean, the prices the large corporations have negotiated? Large corporations pay an awful lot for healthcare, that's why COBRA is such a sticker shock.

I mean that what my corporation pays for my healthcare is less than what I would pay for the same healthcare. The market always gives better prices to bulk purchasers. Always.

Of course the company pays less--the fact that it's offered through the employer means the primary insured at least is not disabled. You have a somewhat filtered market.

And yes, my company pays a lot for health care, but it’s because they offer cadillac plans. But if you try to shop independently for that same plan, you will pay even more.

Around here at least there are no individual cadillac plans.

The market always charges less to bulk purchasers. This is not a controversial statement.
And that’s why we need a single payer to negotiate. Government can do this bettter than individuals or free market.

Of course--less handling cost. It's not that big a factor, though, on something like insurance.

 

[Alcoholic Actuary]

I would so love to see a healthcare program available that will decouple healthcare from employmwent. I feel that entrepreneurship would TAKE OFF if start-ups did not have to plan for their own health insurance or that of their workers. Employer=based health is a great boon to large employers, and create a very uneven playing field and a near hostage-like situation for employees.

We did basically that with the ACA. It's just it exposes the true cost of health care and people don't want to pay it.

I disagree. When you look at the prices that large corporations have negotiated, THAT is the price of healthcare and it is not what the individuals are paying in ACA. We still do not have equal access to a baseline level of health care.

I disagree with your disagreement. A negotiated price is NOT the price of healthcare. If I get an MRI at the hospital, the charge is $2000. If I get it at the independent imaging facility across the street from the hospital it's $900. Apparently no one really knows the true 'cost of healthcare' - and negotiated prices are a bug, not a feature. We are currently in some alternate reality where we think the cost of healthcare is whatever the insurance company tells us it is. Could you imagine the same parallel where your auto insurer tells you that the cost to repair your flat tire is $2000 and your deductible of $250 applies - because that's what they negotiated with the auto mechanic? Well, that's our healthcare system in a nutshell.

aa

 

[Swammerdami]

I mean that what my corporation pays for my healthcare is less than what I would pay for the same healthcare. The market always gives better prices to bulk purchasers. Always.

Way back in the 1990's I told Hillary that if she wanted to help the Uninsured (e.g. me), she should legislate that we get the same price as (at least average) insurer price.

Doesn't go very far, but it would have been a very nice help for us uninsured. Does it go against "free market ideals"? Oh my God! It's the "free market ideals" that have F**k** U.S. Health so totally. ANY solution to the dismal system requires deviation from those "ideals."

Case in point: If anyone can determine the typical prices for erlotinib in U.S. (insurer-paid vs self-paid) please PM me the answer.

 

[Loren Pechtel]

I disagree with your disagreement. A negotiated price is NOT the price of healthcare. If I get an MRI at the hospital, the charge is $2000. If I get it at the independent imaging facility across the street from the hospital it's $900. Apparently no one really knows the true 'cost of healthcare' - and negotiated prices are a bug, not a feature. We are currently in some alternate reality where we think the cost of healthcare is whatever the insurance company tells us it is. Could you imagine the same parallel where your auto insurer tells you that the cost to repair your flat tire is $2000 and your deductible of $250 applies - because that's what they negotiated with the auto mechanic? Well, that's our healthcare system in a nutshell.

aa

What has happened is the government fucked up Medicare reimbursements and private insurance followed along.

Yes, an MRI in the hospital legitimately costs more to provide. It's not that their machines are more expensive, it's that their machines are more available. While I have never had an MRI I have had a few CAT scans over the years, lets look at the situation.

Case 1--looking if there was anything abnormal anatomically with my digestive system. It was scheduled many days out. The facility that did it can schedule their machines and radiologists so as to keep them busy all the time (assuming there is enough demand.)

Case 2--urgent care (kidney stone). I already knew there were stones in there and thus it was basically just confirming that I had diagnosed it correctly and if so, whether it was small enough (my information was several years old, the old imagery would be meaningless in figuring out how big it was) to pass naturally. I was in the machine perhaps 15 minutes from when the doc ordered it and this was in the middle of the night. There's no way that CAT and radiologist were being used anything like full time. The CAT might see as much load as the outpatient one (as it is available 24/7, in the only urgent care I'm aware of that's open 24/7) but the radiologist who read it certainly isn't kept busy, yet they have to pay them anyway. They also have to pay the technician (while the operators aren't doctors it's not a position you can hire off the street for--the people doing it have to know radiation safety and have to be able to read the image well enough to evaluate if they have to reshoot because the patient wasn't still enough) who ran the machine anyway.

The problem is the government looked at the situation (hospital) rather than the true issue (STAT order). Now we have hospitals owning a lot of non-hospital facilities because they get reimbursed more that way.

 

[Rhea]

There are a lot of problems. But we can look at this and see hat the “free Market” is not equipped to solve them.

 

[Metaphor]

Let's watch the Democrats stuff this up again, even as they control the house, the senate, and the presidency.