Editor’s Note: This is an edited excerpt, comprising the Introduction and Conclusion, from a longer essay by Mr. Atlas. Titled ‘The Costs Of Regulation And Centralization In Health Care,' it is published by the Hoover Institution as part of a new initiative, "Socialism and Free-Market Capitalism: The Human Prosperity Project."
The overall goal of US health care reform is to broaden access for all Americans to high-quality medical care at lower cost. In response to a large uninsured population and increasing health care costs, the Affordable Care Act (ACA, or “Obamacare”) aimed first and foremost to increase the percentage of Americans with health insurance. It did so by broadening government insurance eligibility, adding extensive regulations and subsidies to health care delivery and payment, and imposing dozens of new taxes. The ACA was projected to spend approximately $2 trillion over the first decade on its two central components: expanding government insurance and subsidizing heavily regulated private insurance.
Through its extensive regulations on private insurance, including coverage mandates, payout requirements, co-payment limits, premium subsidies, and restrictions on medical savings accounts, the ACA counterproductively encouraged more widespread adoption of bloated insurance and furthered the construct that insurance should minimize out-of-pocket payment for all medical care. Patients in such plans do not perceive themselves as paying for these services, and neither do physicians and other providers. Because patients have little incentive to consider value, prices as well as quality indicators, such as doctor qualifications or hospital experience, remain invisible, and providers do not need to compete. The natural results are overuse of health care services and unrestrained costs.
In response to the failures of the ACA, superimposed on decades of misguided incentives in the system and the considerable health care challenges facing the country, US voters at the time of this writing are being presented with two fundamentally different visions of health care reform: (1) a single-payer, government-centralized system, including Medicare for All, the extreme model of government regulation and authority over health care and insurance, which is intended to broaden health care availability to everyone while eliminating patient concern for price; or (2) a competitive, consumer-driven system based on removing regulations that shield patients from considering price, increasing competition among providers, and empowering patients with control of the money. This model is intended to incentivize patients to consider price and value, in order to reduce the costs of medical care while enhancing its value, thereby providing broader availability of high-quality care.
Outside a discussion of the role of private versus public health insurance are two realities. First, America’s main government insurance programs, Medicare and Medicaid, are already unsustainable without reforms. The 2019 Medicare Trustees report projects that the Hospitalization Insurance Trust Fund will face depletion in 2026. Most hospitals, nursing facilities, and in-home providers lose money per Medicare patient. Dire warnings about the closure of hospitals and care provider practices are already projected by the Centers for Medicare and Medicaid due to the continued payment for services by government insurance below the cost of delivery of those services. Regardless of trust fund depletion, Medicare and Medicaid must compete with other spending in the federal budget. America’s national health expenditures now total more than $3.8 trillion per year, or 17.8 percent of gross domestic product (GDP), and they are projected to reach 19.4 percent of GDP by 2027. In 1965, at the start of Medicare, workers paying taxes for the program numbered 4.6 per beneficiary; that number will decline to 2.3 in 2030 with the aging of the baby boomer generation. Unless the current system is reformed, federal expenditures for health care and social security are projected to consume all federal revenues by 2049, eliminating the capacity for national defense, interest on the national debt, or any other domestic program.
Second, beyond the growing burden from lifestyle-induced diseases, including obesity and smoking, that will require medical care at an unprecedented level, America’s aging population means more heart disease, cancer, stroke, and dementia—diseases that depend most on specialists, complex technology, and innovative drugs for diagnosis and treatment. The current trajectory of the system is fiscally unsustainable, and millions are already excluded from the excellence of America’s medical care.
In most nations, heavy regulation of the supply of health care goods and services care is coupled with marked centralization of payment for medical care. The United States has a far less centralized but still highly regulated system in which health expenditures are roughly equal from public and private insurance. The system is characterized by its unique private components: more than 200 million Americans, including most seniors on Medicare, use private insurance. The US system is the world’s most effective by literature-based, objective measures of access, quality, and innovation, but US health care demands reform. Health care costs are high and increasing, and the projected demand for medical care by an aging population and the future burden of lifestyle-related disease threaten the sustainability of the system.
Although the regulatory expansion under the Affordable Care Act reduced the uninsured population, it generated increased private insurance premiums, a withdrawal of insurers from the market, and sector-wide consolidation that is historically associated with higher prices and reduced choices of medical care. In its wake, American voters are now presented with two fundamentally different visions for reform that have a diametrically opposed reliance on regulation and centralization: (1) the Democrats’ single-payer proposals, including Medicare-for-All, based on the most extreme level of government regulation and authority over health care and health insurance; or (2) the Trump administration’s consumer-driven system that relies on strategic deregulation to increase market-based competition among providers and empowering patients with control of the money. Both pathways are intended to contain overall expenditures on health care and broaden access.
Intuitively, a single-payer model of health care represents a simplification, but the reality is that such centralized systems impose overwhelming restrictions on both demand and supply. Government-centralized single-payer systems actively hold down health care expenditures mainly by sweeping restrictions on the utilization and payment for medical procedures, drugs, and technology under the single authority of the central government. The overall costs of this false simplification are enormous, creating societal costs that extend beyond calculated tax payments that are required to support such a system.
The alternative approach involves rule elimination and decentralization, that is, strategic deregulation, to induce competition for value-seeking patients. Reducing the price of health care by competition, instead of more regulation, generates lower insurance premiums, reduces outlays from government programs, and broadens access to quality care. Broadly available options for cheaper, high-deductible coverage less burdened by regulations; markedly expanded health savings accounts; and tax reforms to unleash consumer power are keys to achieving price sensitivity for health care. Reforms to increase the supply of medical care by breaking down long-standing anti-consumer barriers to competition, such as archaic certificates‐of‐need for technology, unnecessary state‐based licensure of physicians, and overly regulated pathways to drug development, while facilitating transparency of price and quality among doctors and hospitals, would generate further competition and reduce the price of health care. Preliminary results from such deregulatory actions demonstrate promising results and offer an evidence-based context for the broader discussion of the role and reach of government regulation in socialism compared with free-market systems.
America’s health care system is still a mess. The Affordable Care Act, Barack Obama’s signature legislative achievement, has sparked continued increases in premiums and deductibles while failing to bend the health care cost curve down as promised.
That’s just one of the assurances ACA supporters made about the new law it failed to keep. Obama was badly misinformed when he promised people could keep the coverage they had, if they liked it, once the ACA became law. Some suggest he knew at the time this was a lie, but he’s not saying, one way or another.
Yes, there are more people insured than ever before, but many of those people still can’t afford to use that insurance because the deductibles are so high. Plans in the individual markets are canceled from one year to the next, forcing people to re-enroll in something similar or find new insurance altogether.
That’s not the way it was supposed to be. Efforts at repeal collapsed thanks to the Senate Democrats’ procedural instance any plan to replace it be adopted with 60 votes or more. So much for what the people want.
The idea getting the most attention, the Medicare-for-All proposal first put forward by Vermont Sen. Bernie Sanders and embraced by other Democrats running for the party’s presidential nomination, is a non-starter. The non-partisan Committee for a Responsible Federal Budget estimates the Sanders’ plan “has a gross cost of $30.6 trillion and, incorporating offsets, would add $13.4 trillion to deficits over ten years under our central estimate.” The plans floated by former Vice President Joe Biden, Massachusetts Sen. Elizabeth Warren, former South Bend, Indiana Mayor Pete Buttigieg, and others also don’t come close to paying for themselves.
Obamacare was supposed to increase transparency for consumers, allowing them to make better decisions about the care they received and what it would cost. That hasn’t happened either, and though President Donald Trump is pushing for action from Congress to pass laws putting price tags on all kinds of care, nothing spectacular has happened in that area either – largely because the health insurance companies are still driving the train.
They helped write the ACA and are now employing armies of lobbyists to make sure they don’t go under because of it. They’re pursuing new laws and regulations to insulate them from their responsibilities to their customers, to protect them from liability, and to avoid paying for services using a variety of what can best be called coverage loopholes.
The biggest of these has come to be known as “surprise billing,” an issue the president has taken to heart. No one likes to get a bill they didn’t expect, especially when they thought they were covered for the expense. Yet let an in-network doctor perform a procedure at an in-network hospital using an out-of-network anesthesiologist and send tissue out for analysis to a pathology lab at a nearby, affiliated and out-of-network hospital, and that’s precisely what happens.
In that case, as I recently experienced for myself, the insurance suddenly doesn’t count because you went out-of-network. That you didn’t know it and that you asked ahead of time that everything to be done “in-network” doesn’t matter so you must pay for the out-of-network services performed. It doesn’t seem fair, but it’s legal.
Congress, led by Tennessee Republican Lamar Alexander, has crafted a bill to change that. The problem with the Alexander approach is that it relies on price controls. The track record of price controls creating adverse consequences is long and storied.
The bipartisan Alexander bill requires insurers to pay the surprise bills when they arise based on the average price for the services provided. This is called “benchmarking” and it’s a bad idea because it empowers the government to make further intrusions into the health care marketplace and gets the country all that much closer to a Medicare-for-All style system.
“Price controls” and “government rate-setting” are a large part of what helped wreck the U.S. health care system in the first place. Insurers need to own their responsibilities to their customers and level the playing field on their own.
California governor Gavin Newsom on Friday announced his state spending plan to extend health care coverage to illegal immigrants who are seniors under California’s Medi-Cal program, a part of his most recent effort for statewide health care coverage.
“The Budget also moves the state toward universal coverage and furthers cost containment goals by expanding full-scope Medi-Cal coverage to low-income undocumented Californians aged 65 and above,” Newsom’s office wrote in a statement.
During his tenure, Newsom has proven his commitment to spend taxpayer money on partisan agendas. Last July, California expanded Medi-Cal coverage for low-income illegal immigrants between the ages of 19 and 26 after expanding coverage in 2016 for all children under the age of 18, including minors who are illegal immigrants. In October, Newsom signed a bill to force all public university campuses to provide abortion pills for students.
Medi-Cal is funded by the state as well as the federal government, but federal funds do not cover the cost of health carefor illegal immigrants so the taxpayer-funded coverage will come from the state’s pocket.
Only if we developed a fondness for long waiting lines and ever more insurance mandates.
he United States has a complex health-care delivery system composed of private and government-funded insurance plans. Half of all Americans receive their health insurance from their employer or their spouse’s employer. Over 40 percent of Americans receive their health insurance from the government. The remainder are either uninsured or obtain health insurance through the private individual market. The current political debate concerns how large a role the government should play in our health-care delivery system.
The United States spends far more money per person on health care than other industrialized countries. Last year, overall medical spending in the U.S. totaled $3.5 trillion or 18 percent of the national gross domestic product.
Because other countries spend less on health care, they are often used as models for the U.S. Looking to other countries to solve our health care delivery system problems, however, may not be reasonable. Other countries are smaller than the U.S. and have more homogenous populations. What the people of one country favor may not be applicable or acceptable to people living in a different society.
According to a Forbes survey, the U.S. accounts for 38 percent of life-saving and life-extending medical innovations, compared to an average of 15 percent in other countries. The U.S. also leads the world in the research and development of pharmaceuticals.
In all other industrialized countries, the demand for health care is much greater than the money budgeted for it. The results of this supply/demand mismatch are chronic shortages followed by strict rationing of health care. The rationing can take many forms — from long waits, to denying the elderly access to certain procedures, to allowing individuals with political influence to receive priority attention from providers.
Canada has a truly single-payer, nationalized system that is totally funded by taxpayers. In 2018, wait times for specialty care averaged 20 weeks. In practice, Canada has a two-tiered system in the sense that officials allow their citizens to travel to the U.S. for privately funded health care.
Great Britain established a comprehensive government health-care system in 1948 that gives every citizen cradle-to-grave coverage. About 10 percent of the population has private insurance, and many physicians combine government entitlement work with private practice. Over the past year, 250,000 citizens have waited more than six months for planned treatments within the National Health Service, while 36,000 people have waited nine months or more.
Switzerland has a comparatively large private health-care sector, and patients are responsible for 30 percent of their own health-care costs. Consequently, a certain degree of health-care consumerism exists in Switzerland, and the country has been fairly successful in holding down costs. Unfortunately, as officials increase the number of benefit mandates required in insurance plans, health-care costs are rising.
Singapore has a multi-tiered system with different levels of care depending on the patient’s ability and willingness to pay more. This is similar to the system in the U.S. before the passage of Medicare and Medicaid: private hospitals and doctors treated paying patients and charity hospitals and residents-in-training cared for low-income patients.
Is there some combination of measures from other countries that the U.S. can use in reforming our health-care delivery system? Although the overall systems vary, the common factor for all other countries is government-mandated health insurance. Even those countries that have a component of “private” health care continue to mandate that every citizen have government-approved health insurance.
While universal health insurance coverage is a worthy goal, the critical point is using the best mechanism to allow the greatest number of Americans access to health care. Simply having health insurance in no way guarantees timely access to health care. The American experience with the Veterans Administration hospital system, a comprehensive, government-controlled, single-payer health-care program, reveals unacceptable wait times and huge inefficiencies.
The United States distinguishes itself from other countries by a broader use of free markets. Just like all other economic activities, the free market offers the best solution to provide the greatest access to health care and to control costs.
Instead of looking to other countries, health-care reform in the U.S. should allow Americans to freely make their own health-care decisions and use their own health-care dollars. This would give Americans the best chance to use their right to access health care. Eliminating third-party payers, greater use of health savings accounts, price transparency, and health insurance reform would put patients, rather than the government, in charge of their own health care.
Polling shows Medicare for All unpopular when it means eliminating private insurance
Sen. Elizabeth Warren (D., Mass.) discussed her health care plan Friday, outlining a vision where everyone eventually “transitions” to a government health care plan.
“Your Medicare for All proposal would eliminate private insurance, correct? Is that right?” Des Moines Register opinion editor Kathie Obradovich asked Warren at a presidential candidate forum.
Warren, who raised her hand at last month’s Democratic debate to indicate she would abolish Americans’ private health insurance plans, briefly hesitated before answering.
“What it does is it transitions people to more complete insurance coverage, more complete health care coverage, at a lower cost, which I think is what we all want,” she said. “Everyone gets covered, but we do it at the lowest possible cost.”
“Would that also include Medicare Advantage and Medicare Part D, which have private providers within the Medicare umbrella?” Obradovich asked.
“So, the basic structure of the plan is to get everyone covered,” Warren said.
She said a “significant feature” of Medicare for All is that it would pay for “long-term care.”
“The problem we’ve got right now in the United States is that the insurance companies are sucking value out of our health care system,” she said. “Look at the basic business model. It’s charge the maximum amount you can in premiums, and pay out the least that you can in health care coverage.”
Warren supports Sen. Bernie Sanders’s (I., Vt.) single-payer Medicare for All, which Sanders said last week would cost up to $40 trillion over the next decade. Other Democrats running for president have said there should be a role for private insurance, supplemental care, or a public option to buy into a government-run program.
Polling has shown support dwindles for Medicare for All when respondents are told it would eliminate their private health plans. A poll in February found only 13 percent of Americans wanted a true single-payer system that abolished private insurance.
Ezra Klein thinks it’s “ridiculous” to ask Democratic presidential candidates whether they want to abolish private health insurance. It’s supposedly ridiculous because the correct answer isn’t yes or no, but “it depends.”
Several of the Democratic candidates have endorsed Senator Sanders’s Medicare for All bill. Klein takes up the subject:[I]f you assume both the generosity and the financing of Sanders’s plan, there’s really no reason to debate private insurance. If the government will cover everything, with no copays or deductibles or hidden forms of rationing, then there’s no need for private coverage. . . .[Sanders’s bill] doesn’t actually abolish private insurance. It outlaws “health insurance coverage that duplicates the benefits provided under this Act.” If the proposed benefits contracted during the legislative process, it would open more room for private insurers to enter the system. So even Sanders’s answer to this question isn’t truly “yes” or “no.” It depends on what’s covered, which in turn depends on how much Americans are willing to pay in taxes.
Klein then lists questions that he thinks debate moderators should be asking instead: Would your plan include cost sharing at the point of service, how would prices be determined, and so on. They’re not bad questions. But neither is the question about outlawing private insurance. In the first place, whether the Sanders proposal would change in the legislative process is irrelevant to the question of what the candidates are seeking. Their endorsement tells us the answer to that question. It is also hard to picture the Sanders proposal changing so much that anything like the private health-insurance policies that scores of millions of Americans now rely on could survive.
Several candidates — Gillibrand, Warren, Sanders, Harris, and probably a few others I’ve forgotten — have endorsed, of their own free will, making it illegal for Americans to buy the kind of insurance most of them now have. Americans should be informed about what Democratic health programs will look like. They should know as well whether they’ll have a choice about participating.
By Fox News•
Americans hate to wait. We scout out the shortest grocery line. We choose the fastest delivery option. We chafe at slow-moving internet speeds. And we don’t like to wait for health care when we or our loved ones urgently need it. But if America gets saddled with a radical new health care system called “Medicare-for-All,” a lot of waiting for health care will be in your family’s future.
When Americans got tired of waiting around in clogged emergency rooms for last-minute care, the marketplace responded. Urgent care facilities started sprouting up, offering care for non-life-threatening illnesses and injuries. Hospitals, sensing a threat to their business, now buy billboards advertising current wait times in their ERs.
But in countries where the marketplace has been supplanted by government-run health care systems like Medicare-for-All, people have no choice but to wait for desperately needed health care on the government’s timetable. Not for minutes or hours, but weeks and months.
According to a comprehensive study by the nonpartisan Fraser Institute, patients in Canada wait an average of nine weeks to see a specialist, and an additional 11 weeks on top of that to receive treatment. Even when every day counts, such as treatment of cancer, patients have to wait a month before getting radiation therapy.
Advanced-stage heart disease can trigger a heart attack or stroke at any time, but in Canada, you’ll wait about two and a half months for coronary bypass surgery unless you are already in an emergency situation. If your life is not at imminent risk, you will wait even longer for care. If you need to be treated by an OB-GYN in Canada, expect to wait 21 weeks. If you’re suffering from acute knee or back pain, you’d better stock up on ibuprofen: you could wait six months to three-quarters of a year for orthopedic surgery.
In Britain, where the government’s role in health care is even more pervasive, wait times are much worse. A 2019 study by the Royal College of Ophthalmologists found that tens of thousands of elderly patients are left struggling with near blindness due to a government cost-cutting drive that relies on them dying before they qualify for cataract surgery. According to another study by the Royal College of Surgeons, nearly a quarter of a million Britons were waiting more than six months—some even longer than nine months—to be scheduled for surgery and other medically necessary treatment.
Why do government-run health care systems—including so-called single-payer schemes like Medicare-for-All—result in long waits for needed care? Because unlike the private sector, government has zero incentive to customize care to individual needs. It achieves efficiencies primarily by doling out one-size-fits-all health care to everyone, regardless of unique circumstances.
Government is also poor at adjusting to medical innovations, new technologies and changes in epidemiology. For example, Canada has struggled to handle the rise in asthma incidence rates. The Canadian Lung Association found that the average wait time for asthma testing is four weeks, with one in four asthma sufferers waiting longer than three months to be tested. In the U.S., private insurance usually covers most of the cost of expensive MRIs to evaluate medical conditions. But in Canada, where MRIs are “free,” wait times have steadily increased, reaching 364 days in British Columbia. Not surprisingly, some Canadians have taken to paying out-of-pocket for an MRI.
Medicare-for-All and its various derivatives all have one ultimate goal: to push the private sector out of health care and replace it with more government. This means that government will be deciding what health care Americans can get and when—not doctors, not hospitals, and certainly not patients. When politicians absurdly promise to make health care “free,” what they actually mean is that government will pick up the tab and bill us later, while deciding what it will pay for and how much to pay. Those decisions obviously and inevitably will impact choice, quality and availability.
This week, on June 26-27, twenty Democratic presidential contenders will face off against one another on the debate stage. Nearly all of them publicly support Medicare-for-All or some variation. Each one should be asked: why should Americans be forced to wait longer (and ultimately pay more) for lower-quality, government-controlled health care?
Under our current law, federal charges can be brought for arson when a person willfully and maliciously sets fire to a building, structure or vessel. Federal bank robbery charges must include evidence that a person, by force or intimidation, takes or attempts to take something of value belonging to a bank, credit union, or any savings and loan association. And if a new bipartisan bill from two senators were to be enacted, a prima facie case for “unfair or deceptive” conduct would require the government to show that a person…filed for a patent.
Yes, we’ve somehow reached the point where inventing something is only OK if you don’t plan to protect that invention with a patent. Maybe the next step will be to outlaw invention altogether, but I suppose we can be thankful we’re not there yet. For now, Senators John Cornyn (R-TX) and Richard Blumenthal (D-CT) have proposed a new law where if you have discovered a way to help some sick patients and then invest capital in new research that may have the effect of helping additional sick patients, you are presumed liable under the antitrust laws if that new investment leads to a patentable invention.
To ground us in reality — sometimes you have a medicine that helps a group of people get better. In those cases, it should not only be legal, it should be encouraged to pursue additional research to see if that medicine can be improved further, or help people fight other diseases.
After making such an investment, can you hope to argue your way out against the government antitrust enforcers? Good luck with that, since you are starting with presumed guilt. But perhaps it would be wiser, before you undertake resource-intensive research, to check in with the newly installed innovation czars at the Federal Trade Commission. In this way, the FTC will decide who lives and who dies. It’s a reincarnation of the Obamacare death panels, only with FTC bureaucrats instead of bureaucrats appointed by the Department of Health and Human Services.
Companies would also be well advised to study what disease areas are most likely to elicit the sympathy or personal interest of FTC commissioners or their immediate family members and tailor their R&D budgets accordingly. If your research turns out to be insufficient to meet the FTC standards for a substantial benefit, you may not only have wasted your money, you may have committed an antitrust violation.
But what about the Constitution? Well you see, our nation’s founding fathers clearly were unaware of the all-knowing powers of the Federal Trade Commission when they specified a right to one’s own inventions (your Intellectual Property) as the only individual right described in the text of the Constitution. And the icing on this big-government cake is that the FTC can bring this new charge in their kangaroo court of FTC administrative litigation, where the FTC acts as prosecutor, judge and jury.
This bill claims to be about prescription affordability (it is titled the Affordable Prescriptions for Patients Act, or APP Act), but nothing in it makes prescriptions more affordable. The most likely direct effect on pricing will be the cost of parking near the FTC, while diminishing the property rights of American innovators. Antitrust lawyers will certainly derive some benefit, but that could increase their hourly rates if demand for their services goes up. So maybe the APP acronym is really for the Antitrust Practitioners Paradise created by this legislation.
By Christopher Jacobs • The Federalist
In talking about his single-payer bill, which he reintroduced in the Senate on Wednesday, Sen. Bernie Sanders often claims that “I want to end the international embarrassment of the United States of America being the only major country on earth that doesn’t guarantee health care to all people as a right and not a privilege.”
But his legislation would do no such thing. Understanding why demonstrates the inherent drawbacks of his government-centered approach to health policy.
Section 201(a) illustrates the catch in Sanders’ bill, and his philosophy. That section states that “individuals enrolled for benefits under this Act are entitled to have payment made…to an eligible provider” for a list of covered services. Note the wording: Sanders’ bill doesn’t guarantee access to care. Instead, it merely guarantees that people will have their care covered—if they can access it. But in government-run systems, finding access to care often proves no easy feat.
In our own country, low reimbursement rates in many state Medicaid programs can make finding doctors difficult. One 2011 study found that two-thirds of specialist physicians would not accept Medicaid patients, whereas only 11 percent of patients with Continue reading
By Jeffrey Cimmino • Washington Free Beacon
The government of Finland collapsed Friday due to the rising cost of universal health care and the prime minister’s failure to enact reforms to the system.
Prime Minister Juha Sipila and the rest of the cabinet resigned after the governing coalition failed to pass reforms in parliament to the country’s regional government and health services, the Wall Street Journal reports. Finland faces an aging population, with around 26 percent of its citizens expected to be over 65 by the year 2030, an increase of 5 percent from today.
Sipila’s reforms “intended to remove power from the 295 municipalities that currently oversee health and social care, and place responsibility within a leaner, more efficient system of 18 elected regional authorities,” according to the Journal. The prime minister also wanted patients to be able to choose from a range of public and private providers.
Sipila said “there’s no other way for Finland to succeed” besides these reforms, which could have led to $3.4 billion in savings for the government.
Finland’s aging population is increasing the financial strain on its health care system. From a BBC News report:
As an increasing number of people live longer in retirement, the cost of providing pension and healthcare benefits can rise. Those increased costs are paid for by taxes collected from of the working-age population – who make up a smaller percentage of the population than in decades past.
In 2018, those aged 65 or over made up 21.4% of Finland’s population, the fourth highest after Germany, Portugal, Greece, and Italy, according to Eurostat.
Finland’s welfare system is also generous in its provisions, making it relatively expensive. Attempts at reform have plagued Finnish governments for years.
Reuters reports that soaring treatment costs and longer life spans have particularly affected Nordic countries.
“Nordic countries, where comprehensive welfare is the cornerstone of the social model, have been among the most affected,” according to Reuters. “But reform has been controversial and, in Finland, plans to cut costs and boost efficiency have stalled for years.”
Similar problems are bedeviling Sweden and Denmark, two other countries frequently held up as models to follow on health care. Finland’s crisis in particular comes as calls for universal health care have grown louder among Democrats in the United States.
Sen. Bernie Sanders’s (I., Vt.) “Medicare for all” proposal would cost the U.S. over $32 trillion over ten years, according to an analysis by the Mercatus Center. It would also require enormous tax increases as “a doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.”
Another Democratic presidential candidate, Sen. Kamala Harris (D., Calif.), has called for eliminating private health insurance, although a spokesperson suggested she is open to multiple paths to “Medicare for all.”
Self-described democratic socialist Rep. Alexandria Ocasio-Cortez (D., N.Y.) has also called for “Medicare for all.”
The Kaiser Family Foundation found that 58 percent of Americans oppose “Medicare for all” if told it would eliminate private health insurance plans, and 60 percent oppose it if it requires higher taxes.
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:
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.
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
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