Medicare For All Viability with Prof. Jeannette Wicks-Lim | Connecting Point | April 8, 2019

Medicare For All Viability with Prof. Jeannette Wicks-Lim | Connecting Point | April 8, 2019



>>MEDICARE FOR ALL IS ONE THE HALLMARKS OF SOME POLITICAL
CANDIDATES’ CAMPAIGNS, LIKE BERNIE SANDERS – WHO BELIEVES
THAT UNIVERSAL HEALTH CARE SHOULD TAKE THE PLACE OF PRIVATE
INSURANCE. OPPONENTS OF THE PLAN
HAVE SAID IT COULD COST AS HIGH AS 32 TRILLION DOLLARS OVER TEN
YEARS, AND CAUSE THE RATIONING OF HEALTHCARE. BUT RESEARCHERS FROM THE
POLITICAL ECONOMY RESEARCH INSTITUTE OF UMASS AMHERST HAVE
LOOKED AT THE FINANCIALS OF MEDICARE FOR ALL AND BELIEVE IT
COULD ACTUALLY LOWER HEALTH CARE COSTS. CAROLEE MCGRATH SAT DOWN
WITH JEANETTE WICKS-LIM, ONE OF THE RESEARCHERS, TO LEARN MORE.>>FOR THIS STUDY WE WANTED TAKE
A LOOK AT A PROPOSAL THAT WAS PUT OUT BY SENATOR
BERNIE SANDERS TO CREATE THIS MEDICARE FOR ALL PROGRAM AND
WHAT WE WANTED TO DO IS DO BASIC ECONOMIC ANALYSIS OF THAT
PROPOSAL AND REALLY TO ASK THE BASIC QUESTIONS THAT WE NEED TO
ANSWER TO FIGURE OUT WHETHER OR NOT THIS WAS SOMETHING THAT WAS
WORTH PURSUING, YOU KNOW, SO QUESTIONS LIKE, HOW MUCH WOULD
COSTS GO UP UNDER A PROPOSAL LIKE THIS? HOW MUCH SAVINGS COULD WE
REASONABLY EXPECT UNDER A PROGRAM LIKE THIS? AND WHAT IT WOULD LOOK LIKE TO
TRANSITION FROM WHAT WE HAVE NOW TO THIS NEW MEDICARE FOR ALL
PROGRAM.>>SO OVERALL WHAT WE FOUND —
FIRST QUESTION, COST — HOW MUCH WOULD COSTS GO UP? WE WANTED TO LOOK AT WHAT
PROPORTION OF THE POPULATION CURRENTLY IS UNINSURED OR
UNDERSHUNNED SO THAT’S PEOPLE UNDERINSURED OR HAVE INSURANCE
BUT DON’T USE MEDICAL CARE BECAUSE THEIR COPAYMENTS ARE
PROHIBITIVELY HIGH SO THEY AVOID CERTAIN SERVICES OR AVOID
GETTING PRESCRIPTIONS. SO WITH UNIVERSAL ACCESS TO
CARE, OF COURSE, HEALTHCARE SPENDING WILL GO UP PARTICULARLY
FOR THE UNINSURED AND THE UNDERINSURED SO WE ESTIMATED —
WE LOOKED AT HOW MUCH WE WOULD EXPECT HEALTHCARE SPENDING TO GO
UP AND WHAT WE LOOKED AT NOW IS WE SPEND 3.3 TRILLION DOLLARS ON
HEALTHCARE NOW TODAY UNDER OUR CURRENT SYSTEM, AND IF WE
PROVIDE A UNIVERSAL ACCESS WITHOUT CHANGING ANYTHING JUST
SAYING EVERYBODY IS GOING TO GET HEALTHCARE NOW, THE HEALTHCARE
THAT THEY WANT, SPENDING WOULD GO UP ABOUT 12%. AND WE TRIED TO BE VERY GENEROUS
IN THAT ESTIMATE ‘CAUSE WE DIDN’T WANT TO UNDERESTIMATE THE
COST INCREASE AND THEN WE LOOKED AT — WELL, WHAT — WHAT KIND OF
COST-SAVINGS COULD WE REASONABLY EXPECT FROM HAVING A MEDICARE
FOR ALL PROGRAM? AND BASICALLY THE IDEA IS THAT
UNDER THE MEDICARE FOR ALL PROGRAM WE WOULD BE CUTTING OUT
INEFFICIENCIES IN THE WAY WE ADMINISTER OUR PAYMENTS FOR
HEALTHCARE.>>A LOT OF PEOPLE WOULD SAY,
WOW, THE GOVERNMENT IS GOING TO CUT OUT INEFFICIENCIES? IMPOSSIBLE. HOW IS THAT GOING TO WORK?>>WELL, WE KNOW IT ALREADY DOES
IF YOU LOOK AT MEDICARE AND THE ADMINISTRATIVE SPENDING WITHIN
MEDICARE. IT’S ABOUT 2% OF ITS OVERALL
SPENDING ON THAT PROGRAM. IF YOU LOOK AT THE PRIVATE
INSURANCE INDUSTRY AND YOU SEE HOW MUCH SPENDING THEY HAVE
TOWARDS ADMINISTRATION AS OPPOSED TO PAYING FOR SERVICES,
IT’S ABOUT 12%. SO THERE CLEARLY — THERE’S A
BIG DIFFERENCE IN HOW MUCH IS SPENT SO JUST ADMINISTERING
PAYMENTS AND PATRPERWORK AND TH KIND OF THING AND THERE WOULD BE
A DIFFERENCE LIKE THAT BECAUSE THE PRIVATE INSURANCE INDUSTRY
IS PROVIDING HEALTH INSURANCE, YOU KNOW, FOR PEOPLE TO GET
HEALTHCARE IN ORDER TO EARN A PROFIT; WHEREAS, WITH MEDICARE
THE WHOLE POINT OF PROVIDING THE MEDICARE INSURANCE IS TO PROVIDE
INSURANCE IN ORDER — IN ORDER TO PROVIDE INSURANCE SO THERE’S
A WHOLE LAYER OF SPENDING THAT DOESN’T HAVE TO HAPPEN WHEN IT’S
WITHIN MEDICARE AS OPPOSED TO WITHIN THE PRIVATE SECTOR. AND THE SECOND PLACE THAT WE
WOULD HAVE A BIG SOURCE OF SAVINGS IS IN OUR
PHARMACEUTICALS AND THIS IS SOMETHING PEOPLE HAVE HEARD A
LOT ABOUT IN THE NEWS IS THAT THERE ARE DIFFERENT WAYS THAT
THE ECONOMY — THE COUNTRY’S ECONOMIES CAN DEAL WITH THE
PHARMACEUTICAL INDUSTRY. SO IF YOU LOOK OTHER COUNTRIES
LIKE FRANCE OR GERMANY, THEY USE THEIR GOVERNMENT TO NEGOTIATE
PRICES ON THEIR PHARMACEUTICALS. THE U.S. DOESN’T AND IT REALLY
STANDS OUT HOW MUCH PEOPLE PAY FOR BRANDED PRESCRIPTION DRUGS. IF YOU LOOK AT THE LIST AT WHAT
SOME OF THE TOP-SELLING BRAND NAME DRUGS, U.S. PAYS DOUBLE
WHAT YOU SEE IN, LIKE, FRANCE OR GERMANY. SO THERE’D BE A BIG COST-SAVING
JUST BY HAVING A MEDICARE FOR ALL PROGRAM WE WOULD BE
NEGOTIATING WITH THE PHARMACEUTICAL COMPANIES AND
SAYING, YOU KNOW, HERE’S WHAT WE THINK IS A REASONABLE PRICE FOR
THE PRICES YOU’RE OFFERING AND LET’S NEGOTIATE AND THERE WOULD
BE A LOT OF MARKET POWER THAT THE MEDICARE FOR ALL IN THAT
SITUATION A LOT OF BARGAINING PROGRAM TO GET THE PRICES DOWN.>>ONE OF THE PROPOSALS THAT’S
BEING FLOATED FOR MEDICARE FOR ALL WOULD DEFINITELY HAVE
PRIVATE INSURANCE COULD ONLY SUPPLEMENT COVERAGE OFFERED AND
I THINK PEOPLE WOULD BE REALLY CONCERNED ABOUT THAT. THERE’S A LOT OF PEOPLE WHO DO
LIKE, YOU KNOW, THEIR EMPLOYERS INSURANCE CURRENTLY. SOME PEOPLE WHO DON’T HAVE IT
AND I KNOW YOU’RE TRYING TO COVER EVERYBODY. BUT SHOULDN’T PEOPLE BE ABLE TO
HAVE THAT CHOICE?>>FROM WHAT I EXPERIENCED IN MY
OWN LIFE AND WHEN YOU’RE TALKING TO PEOPLE ABOUT HEALTHCARE IS
WHAT PEOPLE REALLY WANT TO HAVE CHOICE OVER IS WHO ARE THEIR
PROVIDERS; RIGHT? WHO AREDENTIST THEY SEE —
>>THAT WAS A BIG ISSUE WITH OBAMACARE. I THOUGHT OBAMACARE WAS SUPPOSED
TO TAKE CARE OF ALL THIS?>>OBAMACARE IS A DIFFERENT
PROGRAM ALL TOGETHER BECAUSE THE HEALTH INSURANCE INDUSTRY HAS
REMAINED INTACT — THE PRIVATE —
>>YOU WANT TO GET RID OF THE –>>WE WOULD BE REPLACING THE
PRIVATE HEALTH INSURANCE INDUSTRY. THAT’S THE PAYMENT MECHANISM FOR
OUR HEALTHCARE SO REALLY YOU SHOULD THINK OF THESE THINGS AS
TWO DIFFERENT AREAS OF OUR ECONOMY, DIFFERENT TYPES OF
ACTIVITIES. THERE’S HEALTHCARE PROVISION,
OUR DOCTORS, OUR CLINICIANS, OUR DENTISTS AND SUCH AND OUR HEALTH
INSURANCE WHICH IS JUST THE MECHANISM BY WHICH WE PAY FOR
THOSE SERVICES. SO UNDER THE ACA THE OBAMACARE,
THE IDEA OF THE HEALTH INSURANCE — I’M SORRY,
HEALTHCARE VERSUS HEALTH INSURANCE — THOSE THINGS CHANGE
SOME BUT NOT THE HEALTH INSURANCE THROUGH THE PRIVATE
INDUSTRY. THAT REMAINED INTACT. WITH A MEDICARE FOR ALL JUST
LIKE YOU WERE SAYING THE MEDICARE FOR ALL PROGRAM WOULD
REPLACE THE PRIVATE INSURANCE INDUSTRY, NOT THE HEALTHCARE
PRIORS.>>RIGHT, AND I THINK PEOPLE ARE
CONCERNED ABOUT THE RATIONING OF HEALTHCARE AND I THINK THOSE
ARGUMENTS CAME UP IN CONVERSATION WITH OBAMACARE AS
WELL.>>THERE’S A LEGITIMATE CONCERN
ABOUT — [INAUDIBLE]
>>YOU KNOW IS MY 89-YEAR-OLD MOM GOING TO BE GETTING THE CARE
THAT SHE NEEDS OR ARE THEY GOING TO BE LOOKING AT SOMEBODY WHO’S
65 AND GIVE THE CARE TO HER? I MEAN, HOW DO YOU MAKE THOSE
DECISIONS?>>THE WAY THE HEALTH INSURANCE
WORKS IN GENERAL WHETHER IT’S PRIVATE HEALTH INSURANCE VERSUS
A PRIVATELY OFFERED HEALTH INSURANCE THERE ARE GOING TO BE
DECISIONS, LIKE, WHAT CARE SHOULD BE PROVIDED? HOW MUCH SHOULD WE PAY AND THE
PROVIDER BE REIMBURSED AT? THE KEY DIFFERENCE BETWEEN THE
MEDICARE FOR ALL AND THE PRIVATE INSURANCE HEALTH INSURANCE
INDUSTRY IS THERE’S AN ADDITIONAL LAYER OF EXPENSES
THAT THE PRIVATE HEALTH INSURANCE INDUSTRY HAS WHICH IS
THE PROFIT MOTIVE THAT THEY HAVE BECAUSE THEY’RE A PRIVATE SECTOR
INDUSTRY ‘CAUSE THEY NEED TO EARN A PROFIT AND THEY HAVE THAT
INCENTIVE TO REALLY REDUCE COSTS AND THEY ALSO HAVE TO MARKET
THEMSELVES IN A WAY THAT’S DIFFERENT BECAUSE THEY’RE
COMPETING ACROSS A BUNCH OF DIFFERENT PRIVATE SECTOR HEALTH
INSURANCE INDUSTRY SO THERE’S MARKETING THAT’S INVOLVED. SO I DON’T KNOW YOUR EXPERIENCE,
YOU KNOW, WHEN I THINK ABOUT MY EMPLOYER AND I THINK ABOUT WHEN
I HAVE TO PICK MY HEALTH INSURANCE PLAN, THE ONES WE HAVE
OVERWE HAVE A HEALTH INSURANCE FAIR WHERE YOU GO AND THERE’S
LIKE A RANGE OF HEALTH INSURANCE PROVIDERS AND THEY’RE ALL THERE
SORT OF MARKETING THEIR PLANS SO THERE’S THAT EXTRA LAYER OF
EXPENSES THAT THE HEALTH INSURANCE, THE PRIVATE HEALTH
INSURANCE INDUSTRY — THAT’S REFLECTED IN THAT MORE SPENDING
THAT THEY DO ON ADMINISTERING OR MARKETING THEIR PRODUCTS THAT’S
DIFFERENT THAN MEDICARE FOR ALL BECAUSE THAT WOULD — THEY WOULD
NOT BE REQUIRED TO DO THE SAME SORT OF THING.>>BUT THEY’RE STILL GOING TO BE
LOOKING AT COSTS.>>OF COURSE.>>THEY’RE STILL GOING TO BE
LISTEN, THERE’S ONLY SO MUCH MONEY THROUGH TAXES FOR THIS
WHO’S GOING TO GET THE CARE AND I THINK THAT REALLY FRIGHTENS A
LOT OF PEOPLE.>>BUT THAT’S NO DIFFERENT THAN
WHAT WE HAVE NOW WITH THE PRIVATE HEALTH INSURANCE. THEY ARE ALSO LOOKING AT
COSTS –>>BUT TO TAKE —
[TALKING SIMULTANEOUSLY]>>AND I THINK IT’S SCARY FOR
SOME PEOPLE AND IF YOU LOOK AT THE VA AND THE PEOPLE WOULD LOOK
AT THE VA AND THE PROBLEMS THEY’VE HAD OVER THE YEARS AS A
REAL REASON NOT TO DO THIS. WHAT’S YOUR RESPONSE?>>WELL, THE — I THINK WHERE WE
CAN LOOK TO SEEING EXAMPLES OF WHERE THIS KIND OF SYSTEM WORKS
IS REALLY LOOKING AT OTHER COUNTRIES BECAUSE — I MEAN,
AGAIN, WE’RE SAYING EARLIER ON THE CONVERSATION BEFORE WE
CAME — THE U.S. REALLY STANDS OUT IN SEVERAL DIMENSIONS OF ITS
HEALTHCARE, WHICH, ONE, IS THAT IT HAS WORSE HEALTH OUTCOMES. IF YOU LOOK AT THE RATE OF THAT
COULD BE AVOIDED BY MEDICAL CARE WE RANK 35th AMONGST COUNTRIES
WHICH THESE 34 OTHER COUNTRIES HAVE LOWER RATES THAN THAT, ALL
HAVE SOME SORT OF UNIVERSAL ACCESS TO HEALTHCARE. THE U.S. SPENDS 17 OF OUR GDP SO
17% OF OUR RESOURCES IN THIS COUNTRY IS SPENT IN HEALTHCARE. WE HAVE WORSE HEALTH OUTCOMES
THAN OTHER COUNTRIES THAT SPEND BETWEEN 9 AND 11.

2 comments

  1. Excellent discussion. In the current medical system, physicians and clinics can choose to participate in Medicare and Medicaid. Some choose not to participate due to unsustainably low reimbursements; these provider choose to accept and negotiate only with private insurers. The vast majority that do agree to accept these government reimbursed insurances do so as only a portion of their overall patient load, the rest (often the majority) being private insurance patients. Under Medicare for All, where doctors & clinics & hospitals would receive 100% of their reimbursement through the system, the low reimbursements would not be sustainable and they would negotiate for higher rates (and with great leverage, similar to teachers unions). Upshot: extreme pricing pressure from every provider (hospitals, outpatient clinics, doctors, pharmaceutical companies, etc). Mandating their participation in Medicare For All would only double down on the clinician and bed shortage already in place. The house of cards almost immediately collapses.🃏

  2. She makes some good points in favor of a Single Payer program. Only one small problem, it's unconstitutional. Nowhere does the US Constitution give the Federal government the authority to make a sweeping national health care program and do away with private insurance. I think Federal judges would strike it down. Parts of Obamacare – far from a universal program – have already been struck down.

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