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Tag Archives: single payer health care


Medicare-for-All’s Bitter Pill

By Wesley J. Smith • National Review
bamacare failed. There is no denying it anymore. The supposed “signature achievement” of the 44th president isn’t just opposed by Republicans. The Affordable Care Act has now been jilted also by many Democrats, who, like so modern-day Lotharios, have abandoned their once-burning ardor for state insurance exchanges to pursue “single-payer” health care.

Some readers are yelling, “That was the plan all along!” Yes, but the stew is not fully cooked. I doubt President Obama and the Pelosi Congress of 2009 and 2010 planned for their party to move so radically this soon. Oh well. With burning hatred for everything Trump as the accelerant — and with polling popularity of Bernie Sanders’s “Medicare-for-all” legislation of last year serving as a justification — much of the Democratic party now unapologetically embraces outright socialized medicine.

The newly filed 120-page “Medicare for All Act of 2019,” authored by Pramila Jayapal (D, Wash.), already has 106 co-sponsors — nearly half of the Democratic caucus — and it seeks to yank America hard toward the port side of the political spectrum. The bill — which resembles Medicaid more than it does Medicare — would transform our entire health-care system into an iron-fisted centralized technocracy, with government bureaucrats and bioethicists controlling virtually every aspect of American health care from the delivery of medical treatment, to the payment of doctors, to even, perhaps, the building of hospitals. It would obliterate the health-insurance industry and legalize government seizure of pharmaceutical manufacturers’ patents if they refuse to yield to government drug-price controls.

Here are some of the plan’s most destructive features:

It Would Drown the Country in Red Ink: True to its title, the bill promises comprehensive and encompassing “free” health care for everyone, including primary care, hospital and outpatient services, dental coverage, vision, audiology, women’s reproductive health services, long-term care, prescription drugs, mental-health and substance-abuse treatment, laboratory and diagnostic services, ambulatory services, the list goes on and on. Last year’s version of the plan authored by Bernie Sanders (I., Vt.) — which didn’t include coverage for dental and long-term care — was estimated to add $32 trillion to the budget over ten years. It is also not irrelevant that the current Medicare — which is far more limited — is scheduled to go broke in 2028.

Yes, There Would be Rationing: The bill creates a Physician Practice Review Board “to assure quality, cost effectiveness, and fair reimbursements for physician-delivered items and services.” The term “cost-effectiveness” is code for rationing, which the law acknowledges by prohibiting the use of assessment methods of determining “any value or cost-effectiveness that discriminate against people with disabilities.”

Private Payment for Covered Health Services Would Effectively Be Banned: The bill requires that all covered medical services be provided without any out-of-pocket cost to patients. The only fee to which a doctor, hospital, or other service provider would be entitled would be that paid by the government. Kiss the health-insurance industry goodbye.

Doctors and Hospitals Would Become Government Contractors: The state would not, strictly speaking, employ doctors directly. But doctors would be coerced into becoming government contractors by the requirement that they sign a “participation agreement” to be eligible to receive payments from the government. The participation agreement forces medical professionals and institutions to:

  • Accept the government fee as payment in full.
  • Allow the government to inspect their books for a variety of purposes and bury themselves in administrative duties, such as filing periodic reports.
  • Accept other provisions regulators may impose later — which, as we saw with Obamacare, could be onerous and intrusive and aimed as much at effecting social change as providing access to medical treatment.

Doctors who object to the provisions of a participation agreement would have little choice if they wanted to continue their careers, since they could be compensated for services only if they were deemed “qualified providers,” a status restricted to those who sign the agreement. (This is known in law as a “contract of adhesion,” meaning providers have no bargaining power or ability to negotiate terms.) If an individual provider’s agreement were revoked, he or she would be ineligible to be hired by a hospital or medical group, because their participation agreements require that they not employ any provider whose participation plan was “terminated for cause.”

Private-Pay Health Care Would Be Destroyed: What about doctors who wish to operate concierge practices, that is, accept cash directly from patients? Outside of the few non-covered fields such as cosmetic surgery, good luck! The doctor cannot have signed a participation agreement, since qualified providers “may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.” That means the doctor’s entire practice would have to be made up of people who opted not to be covered by the government, a very small pool of patients — the few very wealthy who could afford to foot their entire medical expenses out of their own pockets, and I suppose, “medical tourists” who travel to the U.S. for the purpose of obtaining treatment.

The Bill Seeks to Remove Profit in the Health-Care Sector: True to its socialist roots, the would eliminate profit in health care. Indeed, the bill states quite explicitly:

It is the sense of Congress that tens of millions of people in the United States do not receive healthcare services while billions of dollars that could be spent on providing health care are diverted to profit. There is a moral imperative to correct the massive deficiencies in our current health system and to eliminate profit from the provision of health care.

To enforce the “sense of Congress,” the bill forbids bureaucrats who determine the medical fees that will be paid to providers — which includes institutions as well as doctors and group practices — from taking into account the costs of “marketing” the “profit or net revenue of the provider, or increasing the profit or net revenue of the provider” or “incentive payments, bonuses, or other compensation based on patient utilization of items and services, or any financial measure applied with respect to the provider.” You think doctors have trouble receiving adequate compensation from Medicare and Medicaid now? Just you wait!

The Government Could Steal Pharmaceutical Patents: The bill requires the government to negotiate the price of medicines with drug companies. The bargaining power in that negotiation would — as with participation agreements — be all with the government. If a company refused to agree to the government’s price, the bill states, “The Secretary shall authorize the use of any patent,” by another company “for purposes of manufacturing such drug for sale under Medicare for All Program,” with compensation paid to the patent-owning company in an amount determined by the bureaucracy. How willing would pharmaceutical executives be to green-light the billions in investments required to develop new medicines knowing that the government could simply seize their patent and license another company to manufacture the drugs if they refused to sell it at a price the government demands?

Illegal Aliens Would Receive Free Health Care. Eligibility to receive benefits is not limited to citizens and aliens here legally. Rather, the bill reads: “Every individual who is a resident of the United States is entitled to benefits for health care services under this Act.” Illegal aliens living here are residents. Talk about a migration magnet. The only limitation on coverage for aliens is a provision that forbids eligibility to anyone traveling here “for the sole purpose of obtaining health care items and services provided under the program.” That’s much less than meets the eye. If an illegal alien traveled here to work, to escape violence, or to be with family, the exclusion clause would not apply. Further demonstrating the intent to cover those here illegally, enrollment in the program would be automatic “at the time of birth in the United States (or upon establishment of residence in the United States).” Residency could conceivably be established by a state driver’s license — now widely allowed illegal aliens — or even a utility bill. And get this: Unlike today’s Medicare identifier, the new Medicare Card would specifically not include a Social Security number, which many illegal aliens don’t possess.

Women Would Receive Free Abortion: Currently, the “Hyde Amendment” prohibits federal funding of abortion. That rare bit of culture-wars comity would be destroyed by the bill, which provides: “Any other provision of law in effect on the date of enactment of this Act restricting the use of Federal funds [i.e., Hyde] for any reproductive health service shall not apply to monies in the Trust Fund [the government entity that would be established to pay health-care costs].”

The Medicare for All Act of 2019 won’t become law while there is a Republican Senate and president. But the 107 co-sponsors in the House have put the country on notice. If the Democrats take over the government in 2021 as they — and some Never Trump Republicans — hope, by 2022, the United States health-care system will become a wholly controlled subsidiary of the United States government, bereft of liberty, increasingly sclerotic, managed by unelected bureaucrats churning out thousands of pages of onerous regulations, a centralized authoritarian mess from which the country’s health-care system would never recover.


Harris’s Call to Eliminate Private Insurance Is ‘Major Slip-Up’ That ‘Will Haunt Her’

Washington Free Beacon

Washington Free Beacon editor in chief Matthew Continetti said Wednesday that Sen. Kamala Harris’s (D., Calif.) denunciation of private health insurance could haunt her presidential campaign.

At a town hall event on CNN Monday (watch here), Harris said there are a host of problems associated with private health insurance, including delays and costs, and she said, “Let’s eliminate all of that.” After liberal commentator Richard Fowler downplayed the radicalism of Harris’s comment, Continetti answered affirmatively when co-host Bill Hemmer asked if the comment will “stick to her.”

“Yes, [it will stick to her], and it would stick to her if she became the Democratic nominee,” Continetti said. “I think Senator Harris had a pretty good rollout: She had that big rally in Oakland, she had the good fundraising number in her first day. This is a major slip-up for her, which will haunt her if she makes it to the general election.” Continue reading


Eliminator

National Review

Kamala Harris has a big idea for your health-care plan: elimination.

The early contenders for the 2020 Democratic presidential nomination are working feverishly to out-radical each other. Senator Elizabeth Warren has come out with a confiscatory wealth tax that in practice proved too oppressive for Sweden and Denmark, both of which abolished theirs years ago. Harris, not wanting to be outflanked on her left, has now called for the abolition of private health insurance, a proposal that would go well beyond even the practice in single-payer systems such as those of the United Kingdom and Canada.

CNN’s Jake Tapper asked her whether under her “Medicare for All” proposal people would be permitted to keep their insurance if they like it. Harris, unlike Barack Obama, offered no such concession. Instead, she offered this: “Let’s eliminate all of that. Let’s move on.”

Move on to what? Continue reading


Checking In On New York’s (Health Care) State Of Mind

By Sally C Pipes • Investor’s Business Daily

Every year for the past four years, the liberal State Assembly has approved the New York Health Act, which would establish a statewide single-payer plan. But the bill always died in the State Senate, where Republicans have held the majority since 2011. These Republicans united with the centrist members of the Independent Democratic Conference to oppose single-payer.

Most of those Independent Democrats, as well as a handful of Republicans, lost their elections to progressive challengers in 2018. So when the new Democratic majority is sworn in this January, there may be enough single-payer proponents to radically reform New York’s health care system. State Senator Gustavo Rivera, a Bronx Democrat, has pledged to put forward a new single-payer bill in January. Assembly Member Richard Gottfried, a Democrat from Manhattan, confidently predicted the legislature is “on track” to pass the proposal. Continue reading


Poll: People Care More About High Health Costs Than About Pre-Existing Conditions

By Christopher Jacobs • The Federalist

Now they tell us! A Gallup poll, conducted last month to coincide with the midterm elections and released on Tuesday, demonstrated what I had posited for much of the summer: Individuals care more about rising health insurance premiums than coverage of pre-existing condition protections.

Of course, liberal think tanks and the media had no interest in promoting this narrative, posing misleading and one-sided polling questions to conclude that individuals liked Obamacare’s pre-existing condition “protections,” without simultaneously asking whether people liked the cost of those provisions.

Overwhelming Concern about Premiums

The Gallup survey asked the public whether it viewed each of four scenarios as a major concern for them. Among those: “Your health insurance plan will require you to pay higher premiums or a greater portion of medical expenses,” and “you or someone in your immediate family will be denied health insurance coverage for a pre-existing medical condition.” Continue reading


The Risks of Medicare for All

by Doug Badger • National Review

Critics of American health care often ask why ours is the only highly developed country without a taxpayer-funded universal health-care system.

It is a question meant to answer itself: There is no good reason, so the U.S. should fall in line with European financing methods. That is the view of advocates of “Medicare For All,” a proposal backed by most House Democrats.

But the question deserves more than a rhetorical response. Health care is financed differently in the United States because it evolved differently. Private arrangements among hospitals, doctors, employers, and labor unions to finance medical insurance developed and matured over the course of decades, abetted by government policy that treats employer-sponsored health benefits differently than wages for tax purposes. That generally did not happen in Europe.

The American approach offers several advantages that often are overlooked. Continue reading


Waiting Times For Canada’s Single-Payer Health Care System Hit Record High

by Ali Meyer • The Free Beacon

Waiting times for medically necessary health care services under Canada’s single-payer system have hit a record high, according to a report from the Fraser Institute.

Sen. Bernie Sanders (I., Vt.) has touted Canada’s single-payer system, saying it is a model the United States should follow. He introduced a “Medicare for All” plan this past September.

“The issue that has got to be studied is how does it happen that here in Canada they provide quality care to all people, and I don’t think there is any debate that the quality of care here is as good or better than the United States, and they do it for half the cost,” Sanders said.

Sen. Elizabeth Warren (D., Mass.) cosponsored Sanders’s bill, saying she believes the measure will bring high-quality and low-cost care to Americans. Sen. Kirsten Gillibrand (D., N.Y.) wrote a provision in Sanders’s bill allowing Americans to buy into a public plan during the transition to single-payer.

The Fraser Institute found that patients under Canada’s single-payer system this year waited an average of 10.9 weeks—roughly two-and-a-half months—from the time they had a consultation with a specialist to the time at which they received treatment. Physicians consider 7.2 weeks to be a clinically reasonable wait time. Continue reading


Study Suggests Medicaid Is A ‘Persistently Inferior’ Form Of Health Coverage

By Christopher Jacobs • The Federalist

How many individuals would knowingly want to enroll in a form of health coverage with “persistently inferior” outcomes? It’s a good question, as a new study released last week suggests that Medicaid provides those persistently inferior outcomes in the nation’s largest state, raising more questions about the program that represents the bulk of the coverage expansion under Obamacare.

What This Study Looked Into

The study, published in the Journal of the American Medical Association Oncology, used a California data registry to compare cancer survival outcomes across multiple forms of insurance and nearly two decades (1997-2014). The study classified patients based on four forms of insurance: Private coverage; Medicare; other public coverage, about three-quarters (74 percent) of whom were Medicaid patients; and the uninsured. Continue reading


The Public Preference for Single-Payer Is Oh So Fragile

By Jim Geraghty • National Review

I’m headed up to New York City today, appearing on CNN to discuss Senator Bernie Sanders’ latest proposal for “single-payer” health care and on CNN International to discuss – well, something, possibly the Sanders proposal, perhaps something else.

The coverage of health care rarely suggests that public support for single payer is a mile wide but an inch deep. But this Kaiser poll from July is usefully illustrative. It found that a majority (55 percent) supports “single-payer,” but when respondents hear the argument that it would give the government “too much control,” then 61 percent oppose it.

When you mention the tax increases, 60 percent oppose single-payer. This concept does not enjoy ironclad support from the masses. Continue reading