Health Care Special Interests Four Hundred Billion - Consumers Zero

That's the Congressional health care score card for December.

As the year winds down and must pass year-end spending bills are completed––and with that any chance of attaching and approving health care legislation––the special interests have won big and consumers have lost big.

Employers, unions, and insurance companies won big with the repeal of the "Cadillac" tax on high cost benefit plans at a cost of $200 billion over ten years as well as the repeal of the health insurance tax (HIT), and the 2.3% medical device tax sales tax.

The total cost for repealing just these things will add about $400 billion to the deficit over a decade and are part of a mammoth $1.4 trillion spending bill larded up for lots of different interests.

Buttigieg and Biden Spend What They Would Gain Repealing the Republican Tax Cuts on Health Care

Shouldn't any gain from repealing the Republican tax cuts on the wealthiest go toward fixing the debt and deficit problems these tax cuts have contributed to?

Democratic presidential candidates Joe Biden and Pete Buttigieg both rely on repealing some of the Trump tax cuts––particularly those for the "rich"––to pay for their very similar and incremental health care plans that rely upon making a government-run public option available to consumers.

On one level that notion can be attractive to Democratic voters turned off by the 2017 Republican tax cuts.

But when those tax cuts were passed, the Congressional Budget Office (CBO) estimated those cuts would add $1.6 trillion over ten years to the deficit. The Democrats were apoplectic over the Republican irresponsibility of it all.

Greed Outranks Compromise in Congressional Attempts to Fix Surprise Medical Bills

There are few things in our health care system that are more unfair than surprise medical bills. Consumers think they have good coverage and are getting treatment in their health plan network only to get a huge unexpected bill in the mail because it turned out that something like the anesthesiologist at their recent surgery wasn't covered.

How were they to know that? As you're sitting on the gurney about to be rolled into surgery do you need to do a provider roll call asking each to confirm their network status?

The worst of these examples often has to be with air ambulances sending patients bills for tens of thousands of dollars they had no reason to expect. As the patient lays there with burns over 60% of their body and they need to be transferred to the regional burn center, are they supposed to say, "Before you put me on the helicopter, what is this going to cost?

Now, every politician I know of says that all of this needs to end.

But, they are yet to end it.

The Trump/Republican 2020 Health Care Plan

The Republicans don't yet have a health care plan less than a year before the 2020 elections.

But based upon their 2017 Obamacare repeal and replace efforts, as well as a major document recently issued by the House Republican Study Committee, what might a Republican plan look like?

Elizabeth Warren Backs Into the Public Option and Effectively Takes Medicare for All Off the Table for Democrats in 2021

Medicare for all is dead because Democratic voters aren't buying it.

Fixing Obamacare and adding a public option is the health care policy territory first staked out by Democratic Presidential candidate Joe Biden.

Writing about Biden's plan recently on this blog, I said:

IF the Democrats capture the White House, keep the House, and take over the Senate, no matter who they elect as President, this Biden health care outline, not Medicare for all, will likely be the plan Democrats embrace in 2021.

Not even I thought Elizabeth Warren would act so quickly to move off her only days-old detailed Medicare for all plan and onto about the same place all of the leading Democratic candidates, save Bernie Sanders, sit on health care––just fixing Obamacare and adding a public option.

Medicare for All––the Bernie Sanders and Elizabeth Warren Health Care Plans

The Question That Single-Payer Medicare for All Advocates Need to Answer

You are probably thinking that question is, How are you going to pay for it?

Ultimately, yes.

But, I will suggest there is another critically important issue that is part of the overall question about how it will be paid for––What will your plan do to our existing health care system?

Medicare and Medicaid cost less than commercial insurance because Medicare and Medicaid pay providers––doctors, hospitals, and other health care providers–– a lot less for their services.

Advocates argue their single-payer Medicare for all health care system will overall cost us all a lot less. They are right that their systems can be a lot less expensive by expanding Medicare to everyone––primarily because government payment rates are so much smaller.

But here's the hitch––paying Medicare rates on behalf of all patients would literally bankrupt the system we have.

The Public Option's Silver Lining?

Joe Biden's Health Insurance Plan Would Fix the Individual Health Insurance System and Have the Potential to Politically Stabilize the Entire Private Health Insurance Market for Decades to Come

Biden's Public Option

In a prior post, I argued that the Biden health plan directly takes on the most problematic parts of Obamacare by making individual market coverage affordable––and would therefore make the individual insurance system much lower in cost and therefore financially sustainable.

A lower cost individual market would also make the entire private insurance market more politically sustainable––if people find their coverage affordable why move to a complete government takeover such as Medicare for all?

As part of his plan, Biden also calls for a "public option."

Joe Biden's Health Insurance Plan Would Fix the Individual Health Insurance System

IF the Democrats capture the White House, keep the House and take over the Senate, no matter who they elect as President, this Biden health care outline, not Medicare for all, will likely be the plan Democrats embrace in 2021

The Biden health care proposal directly takes on the big things that haven't worked in Obamacare.

Obamacare is "Stable" at an Incredibly Unstable Place

The Democrats Want to Move Beyond Obamacare Because We Have No Other Choice

 

Before I start talking about the presidential candidates' health care plans, let's review just exactly where we are with the Affordable Care Act (Obamacare).

There is Now No More Support for a Medicare For All Single-Payer Health Care Than There Was in 1977, or 1993, or 2009

Buy HMO Stocks––They're a Bargain

The more things change the more they stay the same.

With many of the Democratic presidential candidates' flirtation with Medicare for all, the topic is once again front and center going into the 2020 presidential campaign.

Just like it was when Jimmy Carter ran on a Medicare for all platform in 1976––and it turned out there weren't the votes for it in 1977 even though Carter had a filibuster-proof 61 Democrats in the Senate and a whopping 292 Democratic House seats. In fact, Carter failed to move any significant health care legislation.

In 1993, the Clintons didn't even try to move a single-payer plan even though the Democrats controlled 57 Senate seats and 258 House seats because only about half of the House Democrats favored a single-payer system.

The same for 2009 when both Hillary Clinton and Barack Obama ran on health care platforms during the primaries that looked a lot like the eventual Obamacare because again only about half of the House Democratic caucus favored a single-payer program.

Now in 2019 we are in the very same place we were in 1977, 1993, and 2009––only about half (118 as of September 6th) of the House Democratic caucus now supports the Medicare for all proposal introduced by Progressive Caucus Chair Pramila Jayapal (D-WA).

Is the Drug Industry an Existential Threat to the Private Health Insurance Business?

At a time when many Democrats are calling for a single-payer health insurance system, are the drug companies inadvertently driving the system on a course to that end?

Consider this.

Where Does The Health Insurance Reform Debate Go From Here?

See my post at Forbes