We need plans, not slogans. We need Medicare for All to be the law of the land. A serious conversation about how to pay for Medicare for All requires, first, determining how much such a system would cost. In recent years, several economists and think tanks have attempted to estimate the cost of a single-payer system in the United States.
Because nobody can actually see the future, some of this variation results from different assumptions about how parts of our health care system might work differently under Medicare for All. But most of the difference comes from policy choices. And while the Medicare for All Act is clear about some of these choices — for example, generous benefits, long-term care coverage, and virtually no out-of-pocket expenses — it is silent on a number of really important ones. How much will we pay for medical care and for prescription drugs? What do we do with the existing money that states spend on Medicaid?
How aggressively will we cut administrative costs? Aggressive choices mean a lower total cost. Less aggressive choices result in a higher total cost.
Serious candidates for president should speak plainly about these issues and set out their plans for cost control — especially those who are skeptical of Medicare for All. Their analysis begins with the assumptions of a recent study by the Urban Institute and then examines how that cost estimate would change as certain new key policy choices are applied.
These experts conclude that my plan would slightly reduce the projected amount of money that the United States would otherwise spend on health care over the next 10 years, while covering everyone and giving them vastly better coverage. The business model of private insurers is straightforward: pay out less for medical care than they take in as premiums. This model is located right in the center of our health care system, wasting huge amounts of time and money documenting and arguing over who is owed what.
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Medicare for All will save money by bringing down the staggering administrative costs for insurers in our current system. My plan will ensure that Medicare for All functions just as efficiently as traditional Medicare by setting net administrative spending at 2. In , the United States spent nearly twice as much on health care as ten high-income countries, and these costs have been steadily rising for decades, growing from 5. GDP in to But instead of resulting in better health outcomes, Americans have the lowest life expectancy of residents in high-income countries, the highest infant mortality rate, and the highest obesity rates.
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Compared to other high income countries, Americans simply pay more for health care. We pay more for physicians and nurses. We pay more in administrative costs. We pay more for prescription drugs. And in the United States, hospitals can charge new parents for holding their newborn after delivery. Meanwhile, private equity firms fight bipartisan legislation in Washington that might undermine the profitability of their investments or prevent their hospitals from sending patients surprise bills.
And health care CEO salaries continue to soar. If we expect the American people to be able to afford health care, we need to rein in these costs. Comprehensive payment reform, as part of Medicare for All, will reduce this component of health care spending. Under my approach, Medicare for All will sharply reduce administrative spending and reimburse physicians and other non-hospital providers at current Medicare rates.
My plan will also rebalance rates in a budget neutral way that increases reimbursements for primary care providers and lowers reimbursements for overpaid specialties. While private insurance companies pay higher rates, this system would be expected to continue compensating providers at roughly the same overall rate that they are currently receiving.
This is partially because providers will now get paid Medicare rates for their Medicaid patients - a substantial raise. In , hospitals that treated Medicare patients were paid about 9. Of course, as Medicare currently recognizes , not every provider situation is the same, and my Medicare for All program maintains these base rate adjustments for geography and other factors.
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In my plan for Rural America, for example, I have committed to creating a new designation under Medicare for rural hospitals due to the unique challenges health systems face in rural communities. Universal coverage will also have a disproportionately positive effect on rural hospitals.
Because people living in rural counties are more likely to be uninsured than people living in urban counties, these hospitals currently provide a lot of uncompensated care. Medicare for All fixes that problem. We can also apply a number of common-sense, bipartisan reforms that have been proposed for Medicare.
Today, for example, insurers can charge dramatically different prices for the exact same service based on where the service was performed. Under Medicare for All, providers will receive the same amount for the same procedure, saving hundreds of billions of dollars. We will also shift payment rates so that we are paying for better outcomes, instead of simply reimbursing for more services.
We build on the success of value-based reforms enabled by the Affordable Care Act, including by instituting bundled payments for inpatient care and for 90 days of post-acute care. Health care consolidation has also contributed to rising health care costs. Instead, because everyone has good insurance, providers will have to compete on better care and reduced wait times in order to attract more patients.
And I will direct my FTC to block all future hospital mergers unless the merging companies can prove that the newly-merged entity will maintain or improve care. The price of insulin has skyrocketed , forcing people to risk their lives by rationing. And as prices continue to rise , more Americans are turning to Canada in search of affordable prices. Under Medicare for All, the federal government would have real bargaining power to negotiate lower prices for patients. If negotiations fail, I will use two tools — compulsory licensing and public manufacturing — to allow my administration to ensure patient access to medicines by either overriding the patent, as modeled in the Medicare Negotiation and Competitive Licensing Act, or by providing public funds to support manufacturing of these drugs, as modeled in my Affordable Drug Manufacturing Act.
Medicare for All will also incentivize pharmaceutical companies to develop the drugs we need — like antibiotics, cancer cures, and vaccines.
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Making sure patients get important drug therapies up front that keep them healthy and cost a fraction compared to more severe treatment down the line can save money overall. But Medicare for All covers each patient for their entire lifespan. Year after year, U. And if growth rates exceed this rate, I will use available policy tools, which include global budgets, population-based budgets, and automatic rate reductions, to bring it back into line.
Through Medicaid and public health plans for state employees, state and local governments play a significant role in financing health care coverage in America. This is similar to the mechanism that the George W. Bush Administration used to redirect Medicaid spending to the federal government under the Medicare prescription drug program.
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Because we bring down the growth rate of overall health spending, states will pay less than they would have without Medicare for All. Together, these policy choices represent significant reductions in health care spending over current levels. But Medicare for All is about the same price as our current path — and cheaper over time. That money will come from four places: the federal government, state governments, employers, and individuals who need care. Under my approach to Medicare for All, most of these funding sources will remain the same, too. Existing federal spending on Medicare and Medicaid will help fund Medicare for All.
My idea is that instead of these companies sending those payments to private insurance companies, they would send payments to the federal government for Medicare in the form of an Employer Medicare Contribution. To calculate their new Employer Medicare Contribution, employers would determine what they spent on health care over the last few years and divide that by the number of employees of the company in those years to arrive at an average health care cost per employee at the company.
Companies would count part-time employees towards the total based on the number of hours they worked during a year. Under the first year of Medicare for All, employers would then take that average cost, adjust it upwards to account for the overall increase in national health care spending, and multiply it by their total number of employees that year. People who are self-employed would be exempt from making Employer Medicare Contributions unless they exceed an income threshold. When either new or existing firms exceed this employee threshold, we would phase in a requirement that companies make Employer Medicare Contributions equal to the national average cost of health care per employee for every employee at that company.
Merging firms would pay the weighted average cost of health care per employee of the two firms that are merging.
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Employers currently offering health benefits under a collective bargaining agreement will be able to reduce their Employer Medicare Contribution if they pass along those savings to workers in the form of increased wages, pensions, or other collectively-bargained benefits. New companies or existing companies who enter into a collective bargaining agreement with their employees after the enactment of Medicare for All will be able to reduce their Employer Medicare Contributions in the same way.
Employers can reduce their contribution requirements all the way down to the national average health care cost per employee. That helps make sure the system is fair but also gives employers and employees time to adapt to the new system.
There are a variety of ways to structure an employer contribution to Medicare for All. This particular approach has the benefit of helping American employers in a few ways:. Employers receive far more certainty about how their health care costs will vary over time and affect their finances. Employers can reduce their Employer Medicare Contribution by supporting unionization efforts and negotiating with workers to provide better wages and benefits — reducing costs and promoting collective bargaining at the same time.
Because my plan holds health care cost growth to GDP levels, businesses will have stable balance sheets that grow with the economy instead of crowding out other priorities. By asking employers to pay a little less than what they are already projected to pay for health care, we can get almost halfway to where we need to go to cover the cost of my Medicare for All plan. Automatic Increases in Take-Home Pay. Congratulations on the raise! Medicare for All saves people money in other ways too.
With Medicare for All, nobody would need to put money in Health Savings Accounts or medical savings accounts to try and protect themselves against the unthinkable. So where does the rest of the money come from that allows us to eliminate premiums, deductibles, copays, and most out-of-pocket spending for every American? The wealthy and their allies in Washington have worked to slash the IRS budget, leaving it without the resources it needs.
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