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It has been called “Single-Payer Health Care”, “Medicare For All”, “Medicaid For All”, and “Universal Health Care”. Australia, Canada, France, Germany, Singapore, Switzerland, and the United Kingdom all have Universal Health Plans.

America Needs Universal Health Care.

This blog post has a timeline of information about the Universal Health Care in the United States of America. It includes studies that show it can work better than our insurance-based system, ideas for implementing it, and how it would help people.

May 31, 2017: The Sacramento Bee posted an article titled: “Higher taxes on cars and dining to pay for California health care? Nurses have a proposal”. It was written by Angela Hart. From the article:

…A report by economists at the University of Massachusetts Amherst, released Wednesday, found that overall health care spending in California would fall 18 percent under the proposal from state Sent. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego.

Accounting for savings achieved with their Senate Bill 562, it would cost $331 billion per year to run a universal coverage system in which state government, with taxpayer dollars, pays for medical service and procedures – down from more than $404 billion in spending under today’s system, according to the economic analysis. It was paid for by the California Nurses Association, the bill’s lead sponsor, which also endorsed Lara in his 2018 run for state insurance commissioner.

The report proposes a complete overhaul of the state’s current health care system. People would no longer have to purchase insurance through Kaiser or Anthem Blue Cross, for example. Instead, health care payments would be reorganized under a single state-run system funded, in part, by new taxes on consumer purchases like new cars and dining out at restaurants, and business revenue.

There would be no insurance premiums. No out-of-pocket costs for prescription drugs. No more deductibles.

To make the universal health care proposal work, however, existing state and federal funding that subsidizes health care for low-income people, seniors, and people with disabilities would have to remain in place. That could be a challenge under President Donald Trump and the Republican-controlled Congress. Of the $331 billion needed to run the system, $225 billion would come from state and federal sources, a portion of which is currently spent on MediCal and Medicare.

Cost savings would come through reductions in executive salaries and administrative costs for health care billing, as well as unnecessary or inefficient medical services. The state could also negotiate with pharmaceutical companies for lower drug prices and restructure reimbursement rates paid to providers – the current fee structure pays based on the quantity and complexity of medical services provided.

Providing universal access to care would also lower costs by allowing people to see the doctor when they need to instead of delaying doctor visits because they can’t pay, the report found…

…Business groups, including the California Chamber of Commerce, and health insurers like Kaiser oppose the proposal…

September 13, 2017: Senator Bernie Sanders introduced S.1804 – Medicare for All Act of 2017 to the Senate. It was read twice and referred to the Committee on Finance.

Cosponsors of the bill included: Tammy Baldwin (Democrat – Wisconsin), Richard Blumenthal (D-Connecticut), Cory Booker (D-New Jersey), Al Franken (D-Minnesota), Kirsten Gillibrand (D-New York), Kamala Harris (D-California), Martin Heinrich (D-New Mexico), Mazie Hirono (D-Hawaii), Patrick Leahy (D-Vermont), Ed Markey (D-Massachusetts), Jeff Merkley (D-Oregon), Brian Schatz (D-Hawaii), Jeanne Shaheen (D-New Hampshire), Tom Udall (D-New Mexico), Elizabeth Warren (D-Massachusetts), and Sheldon Whitehouse (D-Rhode Island).

The purpose of the bill was to establish a Medicare-for-all national health insurance program.

Here are some key points of the bill:

  • Every individual who is a resident of the United States is entitled to benefits for health care services under this Act.
  • No person shall, on the basis of race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in, or be denied the benefits of, or be subjected to discrimination by any participating provider… or entity conducting, administering, or funding a health program or activity, including contracts of insurance.
  • Covered benefits include: hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs; ambulatory patient services; primary and preventative services, including chronic disease management; prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products; mental health and substance abuse treatment services, including inpatient care; laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn care; pediatrics; oral health, audiology, and vision services; short-term rehabilitative and habilitation services and devices
  • No cost-sharing
  • By not later than September 1 of each year, beginning with the year prior to the date on which benefits first become available…the Secretary [of Health and Human Services] shall establish a national health budget, which specifies the total expenditures to be made for covered health care services under this Act.
  • An Office of Primary Health Care will be established within the Agency for Healthcare Research and Quality. Its main function is to be the hub that coordinates everything.
  • Medicare for All will be paid for by a Universal Medicare Trust Fund. The money comes from taxes. It also comes from funding for Medicare, Medicaid, the Federal Employees Health Care Benefits program, TRICARE, and the maternal and child health program. All of those would become part of Medicare for All.
  • The bill includes a Transitional Medicare Buy-In Option and Transitional Public Option, and establishes the Medicare Transition Plan. Transitional Medicare Reforms protect against high out-of-pocket expenditures for fee-for-service benefits and elimination of Parts A and B deductibles.

July 19, 2018: Representative Pramila Jayapal (Democrat – Washington) posted a press release on her official website titled: “Rep. Jayapal, Rep. Ellison, Rep. Dingell, and Members of Congress Launch Medicare For All Congressional Caucus”. From the press release:

…The Medicare for All Congressional Caucus will help build the evidence base for Medicare for All. It will sponsor briefings on topics ranging from the basics of Medicare for All to financing universal health care systems around the world. In development is also a clearinghouse of resources for members of Congress and their staff. Additionally, the caucus will provide an opportunity for members and their staff to interact with partners and providers across the country to gain a practical understanding of how a Medicare for All system would work.

Support for Medicare for All is growing, not only among movement-builders, but within Congress. At its launch, an unprecedented 70 members had joined the caucus…

July 30, 2018: The Intercept posted an article titled: “Koch-Backed Think Tank Finds “Medicare For All” Would Cut Health Care Spending And Raise Wages. Whoops.”. It was written by Ryan Grum and Zaid Jilani. From the article:

A new study from the Mercatus Center at George Mason University is making headlines for projecting that Independent Vermont Sen. Bernie Sanders’s “Medicare for All” bill is estimated to cost $32.6 trillion – a number that’s entirely in line with 2016 projections, and is literally old news. But what the Associated Press headline fails to announce is a much more sanguine update: The report, by Senior Research Strategist Charles Blahous, found that under Sanders’s plan, overall health costs would go down and wages would go up.

The study, which came out of the Koch-funded research center, was initially provided to the AP with a cost estimate that exceeded previous ones by an incredible $3 trillion – a massive error that was found and corrected by Sanders’s staff when approached by AP for comment…

…Blahous’s paper, titled “The Costs of a National Single-Payer Healthcare System,” estimates total national health expenditures. Even though his cost-saving estimates are more conservative than others, he acknowledges that Sanders’s “Medicare for All” plan would yield a $482 billion reduction in health care spending, and over $1.5 trillion in administrative savings, for a total of $2 trillion less in overall health care expenditures between 2022 and 2031, compared to current spending.

In order to arrive at his number, Blahous looked at how “Medicare for All” could loser administrative costs and provide savings in areas like drug spending. He concluded that by empowering the secretary of Health and Human Services to negotiate for lower drug prices, Sanders’s plan would add “846 billion in additional savings over the 2022-2031” period. These savings, and others, are offset by certain other costs, like those which come from higher “utilization”, or the increased amount health care services used once everyone is insured.

Blahous’s report also acknowledges some substantial benefits to eliminating employer-sponsored insurance. He writes that these changes, “should increase worker wage net of employer-provided health benefits,” while also “relieving individuals, families, and employers of the substantial health expenditures they would experience under current law.” The report even admits that the Sanders bill would serve as a boon to states, freeing them from most Medicaid obligations…

You can read the Mercatus Report on its website.

July 30, 2018: People’s Policy Project posted an article titled: “Mercatus Study Finds Medicare for All Saves $2 Trillion”. It was written by Matt Bruenig. From the article:

The US could insure 30 million more Americans and virtually eliminate out-of-pocket health care expenses while saving $2 trillion in the process, according to a new report about Medicare for All released by the libertarian Mercatus Center…

…The report’s method are pretty straightforward. Blahous starts with current projections about how much the country will spend on health care between 2022 and 2031. From there, he adds the costs associated with higher utilization of medical services and then subtracts the savings from lower administrative costs, lower reimbursements for medical services, and lower drug prices. After this bit of arithmetic, Blahous finds that health expenditures would be lower for every year during the first decade of implementation. The net change across the whole 10-year period is a savings of $2.054 trillion…

…But even if you take the report’s headline figures at face value, the picture it pavings is the of an enormous bargain. We get to insure every single person in the country, virtually eliminate cost-sharing, and save everyone from the hell of constantly changing health insurance all while saving money. You would have to be a fool to pass that up.

August 5, 2018: The Washington Post posted an article titled: “Tossing aside skepticism, Democratic candidates for governor push for state-based universal health care”. It was written by David Weigel. From the article:

Wherever he takes his campaign for governor, Abdul El-Sayed is followed by activists handing out information about “Medicare for all.” When he grabs the microphone, El-Sayed makes a promise: He’ll bring universal health care to Michigan…

…El-Sayed, who campaigned this weekend with Sen. Bernie Sanders (I-Vt.) before Tuesday’s primary, is one of at least a dozen of Democrats running for governor this year on a pledge to do what no state has ever done: give basic health insurance to everyone, no matter the costs.

The single-payer Democrats are on the ballot in red and blue states and from California, where Lt. Gov. Gavin Newsom is the heavy favorite to win in November, to Massachusetts, where Democrat Jay Gonzalez believes the issue will give him an opening against a popular Republican governor…

…Yet while Democrats running for the House and Senate talk about Medicare for all in aspirational terms, as a post-Trump national goal, liberal candidates for governor suggest that their states could quickly become laboratories for universal coverage. After years of bristling at questions about higher taxes and “government-run health care,” they’re leading with their chins – and the proposals they invite voters to read on their websites…

…Gov. Jay Inslee (D-Wash.) the chair of the Democratic Governors Association, said that Republicans were losing on the health-care issue and that attacks on single-payer amounted to diversions…

…In Colorado, where voters soundly defeated a single-payer ballot measure in 2016, Rep. Jared Polis (D-Colo.) has said that states could band together to provide universal health care…

August 10, 2018: The Hill posted an article titled: “Fearing ‘blue wave,’ drug, insurance companies build single-payer defense”. It was written by Peter Sullivan. From the article:

…The formation of the Partnership for America’s Health Care Future is a sign of the health-care industry’s alarm over growing support for a single payer health-care law within the Democratic Party.

Health insurance and drug companies, who are often at odds on policy issues, banded together to form the group, which lobbyists say could run advertisements against single-payer plans and promote studies to undermine the idea.

Industry groups are worries that support for single-payer is quickly becoming the default position among Democrats, and they want to push back and strengthen ties to more centrists members of the party to promote alternatives…

…When Democrats controlled the White House and Congress at the outset of the Obama presidency, they stopped short of a single-payer system in creating ObamaCare, which the Trump administration and GOP-controlled Congress have worked to dismantle.

But support for a single-payer system has since gained steam, and a wide range of potential 2020 Democratic political candidates have backed Sen. Bernie Sanders’s (I-VT) “Medicare for all” bill, including Sens. Kamala Harris (Calif.), Cory Booker (N.J.) and Elizabeth Warren (Mass).

Sanders himself may make a second run for the White House, and he would be expected to put Medicare for all at the center of his campaign…

August 16, 2018: The Week posted an opinion piece titled: “The medical lobby is already peddling lies about Medicare-for-all”. It was written by Ryan Cooper. From the opinion piece:

…What’s more, Sanders’ Medicare-for-all program would be immensely superior to virtually all private insurance. The average family premium for an employer-sponsored plan has increased 55 percent since 2007, while average workers contributions have increased 77 percent. Some 81 percent of private plans now have a deductible (which must be paid before insurance kicks in for most care), at an average of $1,505. For primary care, 71 percent have co-pays (a flat fee) and 22 percent have co-insurance (a percentage charge), at $25 and 19 percent respectively. All those cost-sharing trends – and many others for speciality and emergency care, surgeries, and hospital admissions – have been getting steadily worse over time. Insurance networks are also narrowing over time, making it harder to find providers that will accept one’s coverage.

By contrast, Sanders’ Medicare-for-all would cover nearly all areas of medical treatment (including vision, dental, and hearing, though not long-term care) with no cost-sharing except for prescription drugs. Even that limited cost-sharing would be limited to $250 per year. And it would certainly be accepted by virtually every provider in the country – with the entire population in the program, they would have little choice (indeed, over 90 percent of primary care physicians already accept existing Medicare due to its large enrollment base of 59 million, and that is only about 18 percent of Americans.) Worries about out-of-network coverage would vanish. Switching onto that plan would be cause for wild celebration for the vast majority of people, not some uncomfortable burden.

September 5, 2018: Andrew Yang, tweeted: “I’m running for President on a platform of Universal Basic Income, Medicare for All, and evolution to a human-centered economy. Here’s my speech to 1,000 Democratic Activists in Iowa.” The tweet included a YouTube video of the speech.

He has information about his Medicare for All plan on his website. It involves shifting to a new healthcare system where costs will be controlled by setting prices provided for medical services. It also involves paying physicians a salary, instead of a fee-for-service payment (like we have now). The Cleveland Clinic is a good example of how Medicare for All would work.

October 10, 2018: The Washington Post posted a Fact-Checker titled: “Fact-checking President Trump’s USA Today op-ed on ‘Medicare-for-All'”. It was written by Glenn Kessler. From the Fact-Check:

President Trump wrote an opinion article for USA Today on Oct. 10 regarding proposals to expand Medicare to all Americans – known as Medicare-for-All – in which almost every sentence contained a misleading statement or a falsehood…

“Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives”…

…Sanders says he would first improve Medicare for seniors and the disabled by eliminating deductibles and covering dental, vision, and hearing aids, which are not covered under current law. Then, over the course of four years, the eligibility age would be lowered in stages until every American was covered.

On paper at least, the Sanders plan would improve benefits for seniors, not take them away…

…”I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerate Medicare.”…

Under Trump, the date for when the Medicare Hospital Insurance (Part A) trust fund will be depleted keeps advancing. The current projection is 2026, three years earlier than the projection a year earlier.

Part A is financed mainly through payroll taxes of 1.45 percent on earnings paid by both workers and employers; self-employed people pay 2.9 percent. The money raised is then credited to a pay-as-you-go trust fund, which uses the revenue raised to pay the benefits of Medicare beneficiaries.

With the baby-boom generation retiring at a rate of 10,000 people per day, that puts pressure on the long-term financing of the program because fewer workers will be supporting more retirees. If the trust fund is depleted, that means the government would not be able to cover 100 percent of estimated expenses. Yet because of Trump’s tax cut, the budget deficit is soaring even as the economy is booming, in contrast to previous periods of under 4-percent unemployment. That leaves the government less prepared to deal with the consequences of baby-boom retirements.

“Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare.”

Trump resurrects a misleading Republican talking point from the 2012 election..

…”Democrats will seek to slash budgets for seniors’ Medicare, Social Security, and defense.”

Trump may have a point about defense spending, never a favorite among the left, but the president’s $1 trillion deficits will put pressure on all aspects of government, no matter who is in power. Democrats generally have pushed to expand Social Security benefits, not cut them…

November 30, 2018: Common Dreams posted an article titled: “‘Easy to Pay for Something That Costs Less’: New Study Shows Medicare For All Would Save US $5.1 Trillion Over Ten Years”. It was written by Jake Johnson. From the article:

Confronting the question most commonly asked of the growing number of Americans who support replacing America’s uniquely inefficient and immoral for-profit healthcare system with Medicare for All.- “How do we pay for it?” – a new paper released Friday by researchers at the Political Economy Research Institute (PERI) shows that financing a single-payer system would actually be quite simple, given that it would cost significantly less than the status quo.

“It’s easy to pay for something that costs less,” Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlington, Vermont, where Pollin unveiled the paper.

According to the 200 page analysis of Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act of 2017, the researchers found that “based on 2017 US healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare For All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses.”

The most significant sources of savings from Medicare for All, the researchers found, would come in the areas of pharmaceutical drug costs and administration..

The new analysis by PERI is called “Economic Analysis of Medicare for All.”

December 11, 2018: The Guardian posted an opinion piece titled: “Universal healthcare could save America trillions: what’s holding us back?” It was written by Adam Gaffney. From the opinion piece:

If you can’t undercut a popular proposal as undesirable, make it sound impossible. That, in any event, has been the tack of opponents of single-payer healthcare, also called improved “Medicare-for-all”…

…Yet casting Medicare-for-all as an economic impossibility is becoming a Sisyphean pursuit: a slew of studies – including one released just the other week – are confirming that yes, we can afford real universal healthcare in America. But if that’s the case, why haven’t we already achieved it? Well, the real stumbling block is not that single payer advocates’ arithmetic is poor, it’s that American politics are dominated by the rich.

Still, the number smatter. On 30 November, a team of economists with the Political Economy Research Institute (Peri) at the University of Amherst published a highly credible, nearly 200-page economic analysis of Senator Bernie Sanders’ single-payer bill. The Peri study received essentially none of the media coverage lathered on the last such analysis – a flawed piece of work published by the conservative Mercatus Center last summer. But here’s the funny thing: though these two analyses came from economists from opposite ends of the political spectrum, they shared a similar finding: single-payer would reduce our nation’s healthcare spending bill by trillions of dollars over a decade (around $2tn and $5tn, respectively)…

…Going back decades, studies have found that, at worst, these costs and savings will balance out under a Canadian-style single-payer reform. “In Canada, each provincial plan provides for universal insurance coverage with no deductibles or copayments, controls on provider reimbursement, and administration by a single, public payer,” the Unites States General Accounting Office noted in an analysis of a single-payer bill way back in 1992. “We found that if these features were applied in the United States, the administrative savings could offset the added costs.”…

…There is another benefit of this system, albeit one that helps explain why we haven’t achieved it yet. A more progressive system of healthcare financing can, over time, reduce inequality not only in health, but in wealth, helping to close our nation’s disastrous economic divide. It’s not surprising, then, that billionaires don’t like it much. Nor is it unexpected that the corporate behemoths the have the most to lose are already sharpening their swords, pouring cash into a new anti-single-payer lobbying group that, as the Intercept recently reported, is maneuvering to “influence Democratic party messaging and stymie the momentum toward achieving universal health care coverage.”…

The 1992 analysis is titled: “Canadian Health Insurance: Estimating Costs and Savings for the United States“. It is on the U.S. Government Accountability Office (GAO) website.

December 16, 2018: USA Today posted an opinion piece titled: “Pig-headed Republicans are pushing America toward government-run national health insurance”. The opinion piece was written by Will Marshall. From the opinion piece:

..Hang on, don’t Republicans stand foursquare against a government takeover of the entire U.S. health care system? So they say. But the GOP’s pig-headed opposition to less drastic ways to make sure everyone has coverage is stimulating Americans’ appetite for a bigger government role in health care – and it will only be fueled by a federal judge’s ruling Friday night that the Affordable Care Act is unconstitutional.

In a recent poll commissioned by the Progressive Policy Institute, for example, voters by a margin of 54 to 46 percent, including nearly half of Republicans, favored changing “the current health system so everyone gets health care through Medicare instead of through people’s place of work or instead of buying it directly.” A more general “new government health care program” drew even more support, including 52 percent of Republicans…

The poll from the Progressive Policy Institute is titled: “America’s Resilient Center and the Road to 202o Results from a New National Survey“.

December 29, 2018: The New York Times posted an article titled “Kamala Harris: Everyone Gets Sick. And We Deserve Better. It was written by Senator Kamala Harris (Democrat – California). From the article:

…I’m so grateful my mother hand Medicare and I will fight for it to be guaranteed to all. I was among the first senators to sign on to the Medicare For All bill when it was introduced last year. There should be nothing partisan about wanting a system where health coverage and care are based not on how much money you have or where you live. We need a system with the goal of good outcomes rather than the goal of high profits. It would save countless lives, and according to recent studies, could trim as much as $15 trillion in health care costs over 10 years.

I believe that health care should be a right, but the reality is that it is still a privilege in this country. We need to change that. When someone gets sick, there is already so much else to deal with: the physical pain for the patient, the emotional pain for the family. There is often a sense of desperation – of helplessness -a s we grapple with the fear of the unknown. Medical procedures already have risks. Prescription drugs already have side effects. Financial anxiety should not be one of them…

January 7, 2019: CNBC posted an article titled: “California Gov. Gavin Newsom rips Trump in his inaugural address, pledges ‘an alternative to the corruption and the incompetence in the White House'”. It was written by Jeff Daniels. From the article:

…Newsom campaigned for governor with ambitious plans for everything from single-payer health care and affordable housing to childhood poverty and universal preschool. The promises raised cost concerns from some taxpayer groups even before Newsome took the reins Monday.

After taking office Monday, Newsome signed a “first-in-the-nation order to create the largest single purchaser for prescription drugs,” according to a press release issued by his office. He also proposed for his first budget to move the state “closer to health care for all,” including providing coverage to young undocumented immigrants through MediCal…

The press release is titled: “Governor Newsom’s Inaugural Address: “A California For All'”. It is on the State of California’s Office of Governor website.

January 7, 2019: Los Angeles Times posted an article titled: “Gov. Gavin Newsom proposes healthcare mandate, Medi-Cal expansion to more immigrants without legal status”. It was written by Melody Gutierrez. From the article:

Gov. Gavin Newsom announced sweeping proposals to tackle the state’s healthcare needs shortly after taking office on Monday, outlining a dramatic Medi-Cal expansion that would cover young immigrant adults who are in the U.S. illegally, require that all consumers in the state carry health insurance and increase subsidies for middle-class families to help those who need it.

The Day 1 announcement was as much a rebuke to the Trump administration as it was an attempt by Newsom to make good on his campaign promise to fix a fragmented healthcare system that leaves many priced out or underinsured. The governor also signed executive orders to consolidate the state’s prescription drug purchases into a state-run program and to create a new surgeon general position to look at health disparities before they manifest, as Newsom put it…

…Newsom campaigned on a universal healthcare platform and has said the issue would be among his top priorities. His announcement on Monday stopped short of the single-payer system demanded by activists that would cover all residents’ healthcare costs, but was characterized as the first step down that path.

The new governor sent a letter to Congress and the White House asking for changes to federal laws so that the state can have the regulatory freedom to overhaul California’s healthcare system and move toward single payer…

…California would be the first state to cover immigrants without legal status who are younger than 26 through Medi-Cal, the state’s health program for people with low incomes. California already covers undocumented children until they turn 19, with Newsom’s plan increasing the age cut-off to mirror that of the Affordable Care Act, which allows young adults to stay on a parent’s health insurance plan until turning 26…

…A legislative proposal last year pegged the cost of extending Medi-Cal to undocumented immigrants under 26 at $250 million a year. That cost would fall solely to California, despite the mix of federal and state money that typically comprises Medi-Cal funding because the Affordable Care Act prohibits the use of federal dollars for covering immigrants who are in the U.S. illegally…

January 7, 2019: Reuters posted an article titled: “New California governor tackles drug prices in first act”. It was written by Sharon Bernstein. From the article:

Hours into his new job, California Governor Gavin Newsom signed an executive order on Monday that could dramatically reshape the way prescription drugs are paid for and acquired in the most populous U.S. state…

…In his executive order, Newsom directed state officials to set up what he said would ultimately be the nation’s largest single-purchaser system for prescription drugs.

It directed California’s massive Medicaid system to negotiate prescription drug prices for all of its 13 million recipients, changing their benefits from a managed-care or HMO approach to one that allows the state to handle all purchases.

Medicaid is the joint federal-state program that provides health insurance for the low income.

The state would create a list of drugs to be purchased in bulk or targeted for price negotiations.

The executive order also took the first steps to allow private companies and other governmental agencies to participate in the process of negotiating drug prices with pharmaceutical companies…

January 9, 2019: Vox posted an article titled: “Bill de Blasio’s plan to guarantee health care for every New Yorker, explained”. It was written by Dylan Scott. From the article:

New York Mayor Bill de Blasio has a plan to bring “universal health care” to America’s biggest city – and, though it’s not quite single payer, the initiative shows that Democratic politicians are getting more creative about what they can do to expand health care in the Trump era.

De Blasio rolled out a new plan this week that he says would guarantee that every New Yorker, regardless of their ability to pay, the ability to visit a doctor and get affordable medical treatment in the city’s historic public hospitals system…

…For most New Yorkers, their insurance won’t change at all; they’ll get it through work, as well as Medicaid, Medicare, or the Affordable Care Act, like they always have. Instead, de Blasio’s wants to invest more money in the city’s safety net – an idea based on a successful predecessor in San Francisco – and it should help the people who don’t have insurance or a regular doctor to get medical care. It’s also a necessary, though limited, fix to a long-running crisis for the city’s public hospital network…

…Through a program called NYC Care, any uninsured New Yorker is able to visit one of the hospital system’s 70 clinics and see a primary care physician. They will be charged on a sliding scale designed to help keep health care affordable…

…The program targets the city’s 600,000 uninsured residents; about half of them are undocumented immigrants, the rest are eligible for coverage but they’re not enrolled for one reason or another. The city is providing $100 million every year to help the hospitals cover the cost of treating those people and then launching an outreach campaign to make sure the people know coverage is available to them…

…Another key component of this will be to boost enrollment for MetroPlus, the city health insurance plan that’s available through Medicare, Medicaid, and the Obamacare exchanges and offers the public hospital system – 70 clinics and 11 hospitals – as the plan’s provider network…

January 10, 2019: Jacobin posted an article titled: “Medicare For All Isn’t Too Expensive”. It was written by Jon Walker. From the article:

When opponents say Medicare for All is too pricey, they’re really saying they oppose any substantial effort to deliver universal quality care…

…The “big number problem” is the simple fact that the United States currently spends a lot of money on health care, some of which the CBO [Congressional Budget Office] considered part of the federal budget and the rest of which it treats as private spending. Redirecting or reclassifying that private spending as public spending would technically result in big increase in the federal budget…

…The CBO doesn’t follow the simple logic of only considering something part of the federal budget if the federal government directly pays for it. Nor does the CBO follow the basic logic of considering private activity part of the federal budget if federal law requires it, like an individual/employer mandate. Instead, the CBO considers health reform an “essentially government program” if it crosses some arbitrary line of regulation…

…In effect, the CBO believes the government forcing you to pay premiums to insurance companies doesn’t make those premiums a tax. But if the government also mandates that private health insurers meet a basic quality floor for their plans, then it would be…

…It is important to look at this in an international context. There is simply no industrialized country whose health care system wouldn’t be considered a government program under the CBO’s definition. Even countries that are widely regarded as government-private hybrid systems, or managed private insurance systems – such as Japan, Switzerland, the Netherlands, and Germany – have actuarial value requirements, plan standard rules and/or medical-loss ratio regulations that would cause the CBO to score the entire health insurance market as federal spending…

…What this means is that copying any of the private systems others point to as alternatives to Medicare for All would produce the same “big number problem” as Medicare for All. The ACA is basically as far as you can go while staying within the CBO’s idea of what is private – and it clearly is insufficient. Even just modest improvements to a few existing regulations in the ACA, such as requiring that a larger percentage of insurance payments go to actual medical care, would cross the CBO’s line and end up being scored as de facto nationalization.

Strip away the complexities of budget scoring, and the upshot is clear: anyone who opposes Medicare for All because it will produce a big number from the CBO is effectively saying they are opposed to all significant health insurance reforms.

January 16, 2019: The Hill posted an article titled: “Dem chairwoman plans hearing on Medicare for All proposals”. It was written by Peter Sullivan. From the article:

The incoming chairwoman of a powerful health care subcommittee on Wednesday said that she intends to hold a hearing on several “Medicare for all” proposals, potentially giving the plans a chance to be considered by key lawmakers.

“There are several Medicare for all bills that are out there, but they all have a different interpretation,” Rep. Anna Eshoo (D-Calif.), the new chairwoman of the Energy and Commerce health subcommittee, told reporters. “I think that it would be interesting to have the authors of these bills come to testify and explain what their bill does and have the members ask them questions.”..

…Eshoo said a hearing would allow lawmakers a chance to ask questions like whether the Congressional Budget Office has done an analysis, “do you scrap the Affordable Care Act,” and what happens to people’s current insurance coverage…

…In 2017, Eshoo cosponsored the main Medicare for all bill in the House, which was led by then-Rep. John Conyers (D-Mich.)…

January 18, 2019: Los Angeles Times posted an article titled: “Gov. Newsom’s healthcare initiatives will test what a single state can achieve on its own”. It was written by Michael Hiltzik. From the article:

…Newsom’s proposals for near-term reforms would be funded entirely with state funds, assuming the Legislature assents. The expansion of Medi-Cal coverage for undocumented young adults would be financed from the general state fund, according to his budget message. The expanded subsidies would be paid for from penalties assessed from residents violating a state individual mandate requiring all Californians to carry health coverage, replacing the federal individual mandate penalty that the Republican Congress and Trump administration reduced to zero as of Jan 1. (State individual mandates are in place in Massachusetts, Vermont, New Jersey, and the District of Columbia.)

State funding for these proposals can be a mixed bag. Budget constraints during a recession could prompt the Legislature to reconsider spending priorities. Paying for premium subsidies assessed on health coverage refuseniks makes theoretical sense, since the refusal of younger and healthier individuals to join the insurance poll drives up premiums in the pool. But it places the state in a policy bind, because if the mandate is successful, there will be less money for subsidies.

Newsom says he’s confident that the expenditures he’s calling for will be sustainable even in an economic downturn. The funds for more early childhood services and developmental screening under Medi-Cal, as he proposed, would come from the tobacco tax increase enacted as Proposition 56 in 2016.

More than $60 minion of the cost of expanding Medi-Cal to undocumented young adults would be covered by savings to county health centers that now have to absorb their treatment costs without reimbursement, Newsom says. And although it’s hoped that the individual mandate penalty will be a declining revenue source, he estimates the at least at first ti will bring in $500 million a year…

January 22, 2019: The Seattle Times posted an article titled: “Inslee proposes ‘public option’ health-insurance plan for Washington”. It was written by Joseph O’Sullivan. From the article:

Gov. Jay Inslee and Democratic lawmakers Tuesday announced proposed legislation for a new “public option” health-care plan under Washington’s health-insurance exchange.

The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act…

…Called the Cascade Care legislation, the plan would be offered in every county.

The proposal would have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange, according to a summary of the proposal.

The plan would be designed with transparent and consistent deductibles, copays and coinsurance, according to the summary, and would “compete on premium price, provider networks, customer services, and quality.”…

…Inslee’s proposed 2019-21 state operating budget would provide $500,000 to fund the initial work to set up the public option. After that, lawmakers and officials would have to determine how much ongoing money would be necessary…

…The legislation also proposes subsidies to help low-income families and individuals afford health insurance. It would require the state to develop a plan that would provide subsidies with the goal of having consumers spend 10 percent or less of their income on premiums..

January 25, 2019: WBUR News posted an audio segment titled: “Warren’s Tax Plan Would Aim At the Ultra-Wealthy”

January 29, 2019: HuffPost posted an article titled: “Kamala Harris Backs Medicare For All And She Isn’t Messing Around”. It was written by Jonathan Cohn. From the article:

Sen. Elizabeth Warren is pitching a wealth tax as she considers a run for president. She said Thursday night on MSNBC that under the plan, taxes would go up 2 percent for people who have more than $50 million, and 3 percent for people who have more than $1 billion…

Two big questions for Democrats who support “Medicare for All” are whether they understand how such a system would actually work – and whether they really support what is arguably its most sweeping and controversial feature.

When it comes to Kamala Harris, the answer to both questions appears to be yes.

Harris, the Democratic senator from California who is now running for president, said during a CNN forum Monday evening that she believes health care is a right – and that creating a single, government-run insurance program modeled on Medicare is the best way to achieve that…

…But the Medicare for All Act of 2017, as the legislation is formally called, envisions some dramatic changes to the U.S. health care system – including a prohibition on private insurance, except for coverage of services outside the scope of the new government plan.

The new plan would pay for just about every medically necessary service, so that wouldn’t leave much of a role, if any, for private coverage…

…The new interest in Medicare for All, which has become a top priority for progressive politicians and activists, is a byproduct of several factors – among them, frustration that the Affordable Care Act, which for all of its success at expanding access to care, has left so many Americans still struggling to pay their medical bills.

Medicare for All holds out the promise of addressing this problem, and finally reaching the elusive goal of universal coverage, by automatically enrolling everybody in the government plan and then using regulation to set prices for doctors, hospitals and the rest of the health care industry. Typically, such proposals envision people paying for coverage entirely through taxes or income-related premiums, with little or not co-payments, deductibles, and other forms of cost-sharing.

Such as system would likely be a lot easier for patients to use, as Harris suggested, and a lot more straightforward for the providers of health care, as well, because they wouldn’t have to worry about billing so many different insurers..

February 3, 2019: Politico posted an article titled: “Buttigieg: ‘Medicare for all’ wouldn’t end private insurance”. It was written by David Beavers. From the article:

South Bend Mayor Pete Buttigieg, a declared 2020 presidential candidate, on Sunday said single-payer health care is “the right place for us to head as a country,” while saying a “Medicare for All” program doesn’t necessarily require doing away with private insurance…

…”If the framework we’re using is Medicare, a lot of people who have Medicare also have Medicare supplements, Medicare Advantage, something like that,” Buttigieg added. “So if we want to make Medicare available to everybody, whether as a public option to buy in or simply establishing that as how the payer structure works in this country that’s going to be the center of gravity.”…

February 4, 2019: The Hill posted an article titled: “Medicare for All talk among 2020 Dems is a way to warm Americans to the idea, says pollster”. It was written by Julia Manchester. From the article:

Pollster Robert Griffin said on Monday that talk among Democratic candidates about instituting a single payer “Medicare for all” health policy is a way to get American voters used to the idea of implementing it across the United States.

“Some of this talk about phasing in over time is really just getting people used to the idea of if we wanted to do this as a country, this is how it might actually work,” Griffin, research director at the Democracy Fund Voter Study Group, told Hill.TV’s Jamal Simmons on “What America’s Thinking”…

February 7, 2019: Modern Healthcare posted an article titled: “New Medicare For all draft bill sets a global budget model.” It was written by Susannah Luthi. From the article:

A draft version of House Democrats’ upcoming Medicare for All bill proposes a national system that would pre-pay hospitals with lump sums while keeping a fee-for-service model for individual physicians.

The 127-page draft, obtained by Modern Healthcare and dated Jan. 14, in many ways tracks with the system laid out in the 2017 bill from Sen. Bernie Sanders (I-Vt.) who brought Medicare for All to the forefront of progressive Democratic policy. But where the Sanders bill sidestepped the question of how the system would be funded by leaving it to the executive branch, the proposal from Rep. Pramila Jayapal (D-Wash.) lays out specific details of a nationalized global budget system.

First, the bill would set up regional directors tasked with overseeing all hospitals, healthcare facilities and physicians in specific geographic areas. The HHS secretary would appoint those overseers.

The regional directors would then negotiate each year with the facilities to set a lump sun, or global budget, that the government would pay out in advance to all institutional providers, These include hospitals, nursing homes, federally qualified health centers, home health agencies, and independent dialysis facilities…

…The existing prospective payment system would serve as the baseline rate to jump-start the global budget negotiations.

Once the budget it set, hospitals and other institutions would need to stick to it for all outpatient and inpatient treatment. However, this budget would also be set up for review by the regional director four times a year…

…Some physicians, including those in certain group practices, could opt to receive a salary from a hospital or other provider subject to the global budget.

Individual physicians, including those who belong to group practices, and who don’t opt for a salary, would be paid through fee-for-service according to a fee schedule set by the HHS secretary. Like the institutional providers, physicians wouldn’t be allowed to charge their patients anything for their care.

The HHS secretary would need to update the fee schedule annually…

February 7, 2019: Barron’s posted an article titled: “Understanding Elizabeth Warren’s Wealth Tax”. It was written by Matthew C. Klein. From the article:

…Now, Sen. Elizabeth Warren (D.,-Mass.) – who is planning to run for president in 2020 – wants to add a new levy with its own distinct purpose: a yearly 2% tax on household net worth above $50 million, with a 3% rate on net worth above $1 billion.

The tax would affect about 75,000 households, with fewer than 1,000 exposed to the 3% rate on net worth above $1 billion. The magnitude of the tax would not be large relative to the typical performance fee charged by managers of hedge funds and other alternative assets, many of whom fail to deliver net results superior to that of investments in index funds. Economists Emmanuel Saez and Gabriel Zucman of the University of California, Berkley, who helped design the Warren proposal, estimate it would confiscate about 1% of the gross domestic product each year. While there is some debate about the constitutionality of a federal wealth tax, there are many scholars who believe it would be legal.

The basic argument for the tax is that it addresses an inequality in the existing system: the ultrarich pay lower effective tax rates than many other Americans because their income takes the form of rising asset values. The tax rate on capital gains is much lower than what the typical worker pays on his or her labor income, but those gains are taxed only when assets are sold, so many of the richest people minimize their tax burden even further by borrowing against their wealth.

According to Zucman, the proposed tax would raise the total effective burden at the very top of the distribution from 3.2% to 4.3%. This tax obligation would still be lower than the average burden of 7.2% of net worth paid by most other Americans…

February 19, 2019: Kaiser Health News posted an article titled: “For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It”. It was written by Shefali Luthra. From the article:

Isn’t Medicare-for-all what it sounds like? Medicare for everybody?

Not quite. But also, kind of.

Politicians talking about Medicare-for-All typically mean one of two things. It’s either a specific proposal in which every American is covered by the same, single health plan, or the general idea that anyone has the option together health care through Medicare.

The first understanding is outlined in a bill from Sen. Bernie Sanders, (I-Vt.)…

…Sanders’ bill would outlaw private insurance where it competes with the public plan and change Medicare substantially by eliminating copays and other costs sharing, while expanding the program to cover long-term care, prescription drugs, dental care and vision. (As the bill is written, it’s hard to see what would be left for private plans to cover.)

The program would phase in over four years and cover every American. And it’s worth noting that, though many countries run a single-payer system, none offers those “expanded” benefits because the expense could be enormous. Also, many single-payer programs do require a degree of cost sharing, involving small payments or deductibles.

In other cases, the “Medicare-for-all” phrase has been repurposed.

The midterms saw a wave of Democrats campaigning on it. But beyond the buzzards, what they were actually talking about was lowering Medicare’s eligibility age by giving people the option to buy in or join the program. This would leave the private insurance industry intact. It would also preserve Medicare Advantage, in which the government pays private companies to run Medicare plans…

So what other options are Democrats talking about?

Voters should get familiar with two other ideas: lowering Medicare’s eligibility age, and the “public option,” either through a Medicare or Medicaid buy-in.

These concepts are decidedly not Medicare-for-all – think “Medicare for more” or “Medicaid for more.”

Lowering the eligibility age loops more people into the current system and is seen by advocates as a potential step toward single-payer, says Alex Lawson, head of the left-leaning Social Security Works, who has been involved in drafting Medicare-for-all legislation.

The public option lets people purchase coverage through Medicare or Medicaid. It has attracted criticism from Democrats aligned with the Sanders wing, who argue it’s settling for less…

NOTE: This blog post will be updated whenever I find additional credible information about Universal Health Care.

America Needs Universal Health Care is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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