Mercatus Study Finds 'Medicare for All' Saves $2 Trillion over 10 years!
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Bernie Sanders pitches $20B hospital bailout plan: Presidential hopeful Bernie Sanders has proposed a plan to create a federal fund to assist struggling hospitals, according to CNN.
Dipshyts. A central tenant of a federal system is being able to subsidize and make public hospitals that are on the fringes like this to keep them open and functioning.I've told you before. I'm in the industry and have been in the industry for a very long time. i have family in the industry as well for a very long time. when i talk about healthcare. I can actually say I'm probably as knowledgeable about it as the so called experts. They know what they know based on what the statisticians/data scientists has told them based on the numbers. I know what i know lines up with that because I have actually done those jobs. I have actually seen physical paper claims and electronic claims go from start to finish. I see the cost of it in plain view. I also see how companies i have worked for are doing things that are not cost effective for the masses. but the way its setup now this is the way it has to work. there are other assumptions that i have made in this very thread that are less guesses and more observational and educational estimates. I know for a fact the mere fact of having 1 payer, 1 to 3 claim types max. 1 - IT SYSTEM/ Database/Software. that alone is a huuuge savings. do you know how much money is being wasted by having everyone have their own system that is SUPPOSED to talk to one another the same way and sometimes it works and other times it doesnt.Sure...
My point is touting gov cost estimates at this point in the game as if they are accurate seems silly.
The switch to MFA(merit aside) could be a wash or more expensive.
The estimates from the studies ive seen(this one included) also make some dubious assumptions.
In fact many of the assumptions have been laid out by the author of this threads study.
Do your googles.
afterlife2009
Superstar
yall believe him or is he tryna avoid getting primaried
afterlife2009
Superstar
bernie pls
mastermind
Rest In Power Kobe
I was about to post this story. So disgusting.
afterlife2009
Superstar
surprised there isn't a HL thread for the strike
afterlife2009
Superstar
Pelosi is bad
FFS...
Jhoon
Spontaneous Mishaps and Hijinks
It’s American.
Please read this everyone.
The Medicare for All Cost Debate Is Extremely Dishonest
The Medicare for All Cost Debate Is Extremely Dishonest
Biden and Buttigieg get to avoid the cost debate, though their own proposals, if successful, will almost surely cost as much as Sanders’s.
BY DAVID DAYEN
OCTOBER 22, 2019
Over the weekend in Indianola, Iowa, Elizabeth Warren announced that she would soon roll out specific details for financing Medicare for All, the culmination of a week of “but how will you pay for that” demands from the media and rival presidential candidates. That a nation with millions of uninsured people and tens of thousands of unnecessary deaths from lack of access to health care is consumed with talking about taxes, rather than the revolution in human rights that would come from universal coverage, tells you a lot about life in the United States, and why we still suffer from a broken system.
But this triumph of budgetary scolding is being applied unevenly. If we want to talk about “paying” for universal coverage, we should expand the discussion to all the candidates who claim to support it. While Joe Biden and Pete Buttigieg and others have howled about cost, there’s a deception at the heart of their own plans: either they put just as much health care costs on the federal government as the Warren-Sanders single-payer model, or they’re effectively useless.
Biden and Buttigieg have separately proposed public options that would compete with private insurance. In Biden’s plan, even those with employer-sponsored insurance could opt out and choose the public plan. Buttigieg would offer subsidies to help people pay for the public option, capping the cost of insurance at 8.5 percent of income.
Both explicitly pitch this as a cheaper way to establish universal coverage. But that claim relies on a hide-the-ball scenario. Biden or Buttigieg’s public option, over time, will either serve as a weak alternative to private coverage, with high premiums and substandard coverage. Or, backed by government bargaining power, it will outshine private insurance and gradually supplant it. Buttigieg himself talks about his plan as a “glide path” to Medicare for All.
If it doesn’t work, the public option will certainly be cheap, but it also won’t help anybody at a meaningful scale. If it does attract millions of customers, then in the long run, it would approach a single-payer system. At that point, on the “how will you pay for that” question that Biden and Buttigieg are posing, it faces the same challenges as the Warren-Sanders model.
Biden and Buttigieg take advantage of the fact that we use a bizarre and often faulty system to “score” legislation in the Congressional Budget Office, which only looks at a ten-year window for budgetary impact. If the public option is good, and it eventually becomes a kind of Medicare for All, the cost spike would all happen outside the ten-year window. So Biden and Buttigieg are either lying about how effective their public options will be, or they’re lying about how much they will ultimately cost. They can’t have it both ways.
Notice that I’m using the deficit-scold framing here. In reality, Medicare for All saves money, and maybe even more than we expect. The infamous libertarian Mercatus Center study estimated that Medicare for All would save $2 trillion over ten years, due to lower provider reimbursements, administrative costs, and drug outlays. But the CBO recently looked at a relatively modest prescription drug bargaining proposal from House Democrats, which would directly negotiate prices on just 25 pharmaceuticals per year, and found it would save $345 billion in federal spending for Medicare. If that’s the payoff on just 25 drugs, increasing bargaining power across the health care space would presumably go well beyond $2 trillion.
The problem with cost debates on health care is that much of the current system is largely submerged, set up to hide the true cost to the individual. Quick—how much does your employer-provided health care actually cost in total, beyond just the number that shows up on your paycheck and in co-pays? Most of us have no idea unless we work in a corporate HR department. When you surface these submerged payments, they feel like brand-new tax burdens. But you’ve been paying them all along.
All candidates intending to shake up the system must deal with this tension, a feat they accomplish in different ways. Biden and Buttigieg play games with the budget window to keep those costs hidden. As journalist Libby Watson has pointed out, they rely on the ignorance of the public and especially the media, who shouldn’t let them get away with it. Really, it shouldn’t be so hard to ask: “Mr. Vice President, do you expect your public option to be any good, and if so, wouldn’t you face the same cost challenge you decry in other candidates’ plans?”
Sanders has put together a menu of twelve options to finance Medicare for All, none of which he commits to and some of which, like the wealth tax, he has subsequently used for other proposals like his housing policy. But it does include an income-based premium that would replace insurance premiums and co-pays with middle-class taxes.
Warren has been far more vague thus far, refusing to offer a soundbite that she’ll raise taxes on the middle class and saying only that overall health care costs will drop (which is true, and the primary selling point for reducing the administrative burden of our current fragmented system). This has sparked enough concern that she’s now turning to specifics.
They’re not as daunting as you might think. First of all, if you think about it rationally, insurance premiums are just forced taxes paid out to private monopolies (insurance, drug companies and health care providers) instead of a public one (the federal government). When you add premiums to overall taxes, Americans pay a level commensurate with high-tax single-payer countries while getting health care far below their standard. It breaks all unwritten laws of journalism (which apparently require reporters to focus solely on federal taxes) to see things this way, but that doesn’t make it untrue.
But even as it is, state and federal governments pay about $1.6 trillion of the current $3.6 trillion annual cost of providing health care. That comes out of dedicated taxes and general fund expenditures. The answer to the “how will you pay for that” question could be “first of all, we already pay for almost half.”
The more costs you wring out of the system by breaking up entrenched health care monopolies, eliminating middleman payments, setting drug prices like every other nation does, and forcing down reimbursement, the more you reduce that remaining $2 trillion per year. The Mercatus study shrinks it to $1.6 trillion; with a dedicated effort, you could probably drop well below that.
As to the rest, there are plenty of approaches. An employer head tax achieves the semantic distinction of “not raising taxes on the middle class,” and would likely cost at or below what companies spend currently on health care. You could add modest co-pays and reduce that even further, or a health care “premium fee” on a sliding scale. Sanders’s menu includes several taxes on the wealthy. We have a military budget that in no way needs to be as large as it is. You don’t even have to get that creative to hit the number.
None of this will probably matter to media trolls looking for an “I will raise your taxes” soundbite. But they’re letting their slip show by absolving the Bidens and Buttigiegs of the world from having to answer that question, while doing the Republicans’ work for them through relentless, nonsensical right-wing framing. The truth is that we can have nice things in America. We just have to tune out the noise.
The Medicare for All Cost Debate Is Extremely Dishonest
The Medicare for All Cost Debate Is Extremely Dishonest
Biden and Buttigieg get to avoid the cost debate, though their own proposals, if successful, will almost surely cost as much as Sanders’s.
BY DAVID DAYEN
OCTOBER 22, 2019
Over the weekend in Indianola, Iowa, Elizabeth Warren announced that she would soon roll out specific details for financing Medicare for All, the culmination of a week of “but how will you pay for that” demands from the media and rival presidential candidates. That a nation with millions of uninsured people and tens of thousands of unnecessary deaths from lack of access to health care is consumed with talking about taxes, rather than the revolution in human rights that would come from universal coverage, tells you a lot about life in the United States, and why we still suffer from a broken system.
But this triumph of budgetary scolding is being applied unevenly. If we want to talk about “paying” for universal coverage, we should expand the discussion to all the candidates who claim to support it. While Joe Biden and Pete Buttigieg and others have howled about cost, there’s a deception at the heart of their own plans: either they put just as much health care costs on the federal government as the Warren-Sanders single-payer model, or they’re effectively useless.
Biden and Buttigieg have separately proposed public options that would compete with private insurance. In Biden’s plan, even those with employer-sponsored insurance could opt out and choose the public plan. Buttigieg would offer subsidies to help people pay for the public option, capping the cost of insurance at 8.5 percent of income.
Both explicitly pitch this as a cheaper way to establish universal coverage. But that claim relies on a hide-the-ball scenario. Biden or Buttigieg’s public option, over time, will either serve as a weak alternative to private coverage, with high premiums and substandard coverage. Or, backed by government bargaining power, it will outshine private insurance and gradually supplant it. Buttigieg himself talks about his plan as a “glide path” to Medicare for All.
If it doesn’t work, the public option will certainly be cheap, but it also won’t help anybody at a meaningful scale. If it does attract millions of customers, then in the long run, it would approach a single-payer system. At that point, on the “how will you pay for that” question that Biden and Buttigieg are posing, it faces the same challenges as the Warren-Sanders model.
Biden and Buttigieg take advantage of the fact that we use a bizarre and often faulty system to “score” legislation in the Congressional Budget Office, which only looks at a ten-year window for budgetary impact. If the public option is good, and it eventually becomes a kind of Medicare for All, the cost spike would all happen outside the ten-year window. So Biden and Buttigieg are either lying about how effective their public options will be, or they’re lying about how much they will ultimately cost. They can’t have it both ways.
Notice that I’m using the deficit-scold framing here. In reality, Medicare for All saves money, and maybe even more than we expect. The infamous libertarian Mercatus Center study estimated that Medicare for All would save $2 trillion over ten years, due to lower provider reimbursements, administrative costs, and drug outlays. But the CBO recently looked at a relatively modest prescription drug bargaining proposal from House Democrats, which would directly negotiate prices on just 25 pharmaceuticals per year, and found it would save $345 billion in federal spending for Medicare. If that’s the payoff on just 25 drugs, increasing bargaining power across the health care space would presumably go well beyond $2 trillion.
The problem with cost debates on health care is that much of the current system is largely submerged, set up to hide the true cost to the individual. Quick—how much does your employer-provided health care actually cost in total, beyond just the number that shows up on your paycheck and in co-pays? Most of us have no idea unless we work in a corporate HR department. When you surface these submerged payments, they feel like brand-new tax burdens. But you’ve been paying them all along.
All candidates intending to shake up the system must deal with this tension, a feat they accomplish in different ways. Biden and Buttigieg play games with the budget window to keep those costs hidden. As journalist Libby Watson has pointed out, they rely on the ignorance of the public and especially the media, who shouldn’t let them get away with it. Really, it shouldn’t be so hard to ask: “Mr. Vice President, do you expect your public option to be any good, and if so, wouldn’t you face the same cost challenge you decry in other candidates’ plans?”
Sanders has put together a menu of twelve options to finance Medicare for All, none of which he commits to and some of which, like the wealth tax, he has subsequently used for other proposals like his housing policy. But it does include an income-based premium that would replace insurance premiums and co-pays with middle-class taxes.
Warren has been far more vague thus far, refusing to offer a soundbite that she’ll raise taxes on the middle class and saying only that overall health care costs will drop (which is true, and the primary selling point for reducing the administrative burden of our current fragmented system). This has sparked enough concern that she’s now turning to specifics.
They’re not as daunting as you might think. First of all, if you think about it rationally, insurance premiums are just forced taxes paid out to private monopolies (insurance, drug companies and health care providers) instead of a public one (the federal government). When you add premiums to overall taxes, Americans pay a level commensurate with high-tax single-payer countries while getting health care far below their standard. It breaks all unwritten laws of journalism (which apparently require reporters to focus solely on federal taxes) to see things this way, but that doesn’t make it untrue.
But even as it is, state and federal governments pay about $1.6 trillion of the current $3.6 trillion annual cost of providing health care. That comes out of dedicated taxes and general fund expenditures. The answer to the “how will you pay for that” question could be “first of all, we already pay for almost half.”
The more costs you wring out of the system by breaking up entrenched health care monopolies, eliminating middleman payments, setting drug prices like every other nation does, and forcing down reimbursement, the more you reduce that remaining $2 trillion per year. The Mercatus study shrinks it to $1.6 trillion; with a dedicated effort, you could probably drop well below that.
As to the rest, there are plenty of approaches. An employer head tax achieves the semantic distinction of “not raising taxes on the middle class,” and would likely cost at or below what companies spend currently on health care. You could add modest co-pays and reduce that even further, or a health care “premium fee” on a sliding scale. Sanders’s menu includes several taxes on the wealthy. We have a military budget that in no way needs to be as large as it is. You don’t even have to get that creative to hit the number.
None of this will probably matter to media trolls looking for an “I will raise your taxes” soundbite. But they’re letting their slip show by absolving the Bidens and Buttigiegs of the world from having to answer that question, while doing the Republicans’ work for them through relentless, nonsensical right-wing framing. The truth is that we can have nice things in America. We just have to tune out the noise.
Yang is for a public option but the perspective of businesses needs to be in the M4All debate. He needs to say this stuff in the next debates.
In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital ｜ Kaiser Health News
McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community. Hackler, a lawyer who sues patients on behalf of the...
nordot.app
In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital
2024/01/19McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.
Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.
It’s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.
Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.
“There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.
In recent years, major health systems in Virginia, North Carolina, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.
But with some 100 million people in the U.S. burdened by health care debt, medical collection cases still clog courtrooms across the country, researchers have found. In places like McAlester, a hospital’s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits failed in the Oklahoma Legislature in 2021.
In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.
McKee said she wasn’t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.
“This affects a large number of people in a small community,” said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. “The impact is great.”
Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.
Recent times have been tougher for McAlester, now home by one count to 12 marijuana dispensaries and the state’s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.
The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.
“I’m trying to find ways to get the entire community better care and more care,” said Shawn Howard, the hospital’s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital’s physical therapy department. “This is my hometown,” he said. “I am not trying to keep people out of getting care.”
The hospital operates a clinic for low-income patients, whose webpage notes it has “limited appointments” at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.
In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.
While audits show few McAlester patients get financial aid, many get taken to court.
Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she’d reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She’d gone to the emergency room for chest pain.
Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He’d gone to the emergency department for what turned out to be gastritis and didn’t have insurance, he said.
“Everyone in this town probably has a story about McAlester Regional,” said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. “It’s not even a secret.”
The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.
“It’s a good-old-boy system,” said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with KFF Health News. Now, she said, she avoids the hospital if her children need care.
Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.
At the center of the McAlester hospital’s collection efforts for decades has been Hackler & Hackler.
Donald Hackler was city attorney in McAlester for 13 years in the ’70s and ’80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.
Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the McAlester News-Capital newspaper, which named her “Woman of the Year” in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.
For years, the Hacklers’ debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn’t respond to an inquiry for interview.
Hackler declined to speak with KFF Health News after her recent court appearance. “I’m not going to visit with you about a current client,” she said before leaving the courthouse.
Howard, the hospital CEO, said he couldn’t discuss the lawsuits either. He said he didn’t know the hospital took its patients to court. “I had to call and ask if we sue people,” he said.
Howard also said he didn’t know Deborah Hackler. “I never heard her name before,” he said.
Despite repeated public records requests from KFF Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.
McAlester Mayor John Browne, who appoints the hospital’s board of trustees, said he, too, didn’t know about the lawsuits. “I hadn’t heard anything about them suing,” he said.
At the century-old courthouse in downtown McAlester, it’s not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.
After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital’s favor.
“All I can do is follow the law,” said McLaughlin. “It doesn’t mean I like it.”
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “ KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
© Kaiser Health News
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