States' Attempts at Medicare-for-All Proposals Haven't Ended Well

[question everything]

(snip)

Legislators in Vermont, Mr. Sanders’s state, backed Medicare for All before figuring out a detailed financing plan, and the final numbers were too high to sell politically. Colorado weighed its own version of guaranteed health care, but public support fell as the industry ramped up an opposition effort. The plans’ fates in Vermont and Colorado show the obstacles the Democratic presidential candidates face in selling voters in the general election.

“It’s incredibly and eerily similar,” said Kenneth Thorpe, a former assistant secretary at U.S. Health and Human Services who was hired by the Vermont legislature to work on its defunct state plan. “This is the newest shiny object, but to go from here to there is going to be enormously difficult. Who are the winners and losers, and how big are they?”

(snip)

Vermont is the closest test case to the candidates’ Medicare-for-All proposals because it went the furthest in pursuing a single-payer health-care approach. The idea found support in the progressive state, where only 29% of registered voters are Republican or lean toward supporting the GOP, according to the Pew Research Center. Vermont in 2011 elected as governor Democrat Peter Shumlin, who ran on a single-payer campaign. Analysts had already estimated that guaranteed statewide health coverage in Vermont would save employers and employees $200 million in the first year, even if they were taxed to pay for the new system. But no specific funding plan was worked out before the legislature passed a bill calling for the launch of a guaranteed health-care system. State officials eventually in December 2014 released a financing proposal that would have seen businesses pay an 11.5% payroll tax increase and called for a 9.5% jump in income tax. The plan came to a crashing halt.

(snip)

Medicare for All’s price tag is likely to be high because health-care costs are so high in the U.S. Paying for it would be equivalent to a 32% payroll tax or a 25% income tax, according to a new report by the nonpartisan Committee for a Responsible Federal Budget. Another option to pay for the plan outlined by the group would be a public premium equivalent to $12,000 per person for everyone not on public insurance.

Other states that pursued a guaranteed universal health system struggled to surmount the opposition that often assailed the cost of various proposals. Colorado in 2016 appeared poised to adopt such a system, which Mr. Sanders had backed, and supporters were able to get it on a ballot measure... Voters rejected the measure by 79% to 21%.

More..

https://www.wsj.com/articles/states-attempts-at-medicare-for-all-proposals-havent-ended-well-11572957714 (paid subscription)

[comradebillyboy]

1. The state legislatures bump up against the cost and back away...

[Thekaspervote]

2. Indeed the cost for mfa is staggering

[Moostache]

3. Dishonest premise at best...

WARNING - semi-coherent rant to follow....this may not all make sense as it is free-flowing rant.....

Healthcare costs in a FOR PROFIT system are always going to seem impossible to deal with at first - until you excise the FOR PROFIT portion of the cost structure...and follow that up with blunt, honest conversations about lifestyles, diets, access to food, access to treatment, access to physical fitness facilities, ability to exercise at all, end of life options and much, much, much more.

Start with a premise - access to healthcare for citizens of the United States is a RIGHT, not a PRIVILEGE.
From there, ask the questions and get REAL answers - How much does HEALTHCARE really cost? (NOT how much do we pay today...and NOT how much are we CHARGED today for everything involved from insurance to claims to forms to regulations and more...just identify the cost of actual treatment and care...)

What do most people ALREADY pay for their health insurance? In co-pays? Deductibles? Employee Contributions? Employer Contributons (ie. non-wage compensation)?

How much of THAT total is actually spent on doctors, nurses, paramedics, lab technicians and specialists?
How much is spent on a Byzantine system of paperwork, insurance claims adjusters and efforts to deny coverage?
How much is spent on company profits, CEO vacation homes and 8 figure bonus checks, or 10 price points for the same procedure in a 3 zip code radius, etc.?

Ask the follow up questions and start having the difficult conversations, but do so HONESTLY:
- how can healthcare access best be managed - as a for-profit operation or as a non-profit, government run operation?
- how can paperwork and privacy and access to medical records in a digital age be leveraged and improved and contribute to cost controls?
- how much should our healthcare system be switching from disease treatment to disease PREVENTION and early detection?
- how much better would American lives be if we were not watching drug advertisements every 15 minutes, encouraging us to "ask your doctor about X,Y,Z wonder drug"? (as if average people with no medical background belong in the prescription business AT ALL)...
- how much money is spent on end of life care to extend a person's life by days or weeks at the cost of $10,000's or more?
- how much better would it be to have those discussions with doctors and family BEFORE crises hit? (and NO, that's not a FUCKING DEATH PANEL either!!!!)

Is M4A easy to start? Of course not...
Is M4A even likely to be our next step? Probably not...

But if we once again START the discussion with fear mongering and negotiated starting points that don't FORCE for-profit racketeers to confront the reality that THEY are a big part of the cost problems in the first place, well then we are right back at Obamacare and no progress is made.

We either believe in this, and are willing to fight to propagandists and scaremongers to make it better, or we should simply shut up about it and stop acting like we care. This is NOT an easy thing to achieve by any means, but it is impossible to achieve if we run away from every fight and every roadblock and every special interest backed desire to maintain the status quo.

If you are in healthcare, and your job is not directly related to the distribution of services, tests or treatments...maybe you shouldn't stay too comfortable forever...put another way, if we had a system of "private car buying" that required everyone to pay through the nose to support a bloated system of insurance appraisers and non-mechanics who filed the paperwork at a 15% a year premium, would everyone want to fight to save THAT kind of graft? Then why is it so for healthcare delivery and access?

[BeyondGeography]

6. Reccing this post

If we want to make HC a wholly public-owned good, which is the only path toward quality universal care at a cost that compares to every other country in the western world, it will take unity of purpose and a concerted war on FUD to even begin to make it happen.

The current feeding frenzy over MFA would be a lot easier to take if it took the direction you are taking here rather than the search for near-term partisan advantage. If you think that's self-serving coming from a Warren supporter, guess what: ANY plan that threatens current profit-driven stakeholders grip on this "business" will inspire the same level of opposition:

The CEO of America's Health Insurance Plans said a healthcare plan proposed by Democratic presidential candidate and former Vice President Joe Biden is not much different than "Medicare for All," which the industry strongly opposes, according to The Hill.

In an interview with The Hill, AHIP CEO Matt Eyles spoke out against Mr. Biden's healthcare plan, which aims to strengthen the ACA while also introducing a public health insurance option. Mr. Eyles said the public option, which would be similar to Medicare, would lead to too much government involvement in the healthcare system.

"If you're creating a government-run option that essentially leverages price controls, and relies on a government-administered system, that doesn't create what would be a competitive playing field," Mr. Eyles told the publication. "We're viewing Medicare for All and all of these other … variations on it, as similarly bad."

https://www.beckershospitalreview.com/payer-issues/ahip-comes-out-against-biden-s-healthcare-plan.html

[Hoyt]

4. California, Colorado and Vermont legislators studied single payer, and didn't have guts

to tell voters how much taxes would have to increase to pay for it. So they abandoned it. Sure, a tax is supposed to replace what we are already spending now, but they knew it wouldn't sell.

The only way to achieve MFA -- other than forcing it down voters' throats -- is to offer a Public Option with generous subsidies that people and employers can compare to other insurance plans. I believe a lot of people will try the PO. If anywhere near as good as we hope, people will gravitate to it quickly.

[empedocles]

5. The deliberative process is working on the Dem side as well as the 'con side

[SoCalNative]

7. The issue is

that they cannot just attempt to put the system in place as is. There needs to be government price controls implemented as to what will be charged, not what they will pay, but what is allowed be charged for treatments and medications, and what doctors are allowed charge for their services. Then a low annual deductible of no more than $400-$500 per person instituted. No co-pays for office visits or prescriptions.

This is how they do it in many other countries in the western world and this is how it must be instituted here.

[Gothmog]

8. NYT has a good history of why this law failed in Vermont

A deep-blue state’s failure to enact a single-payer system shows why a national version is unlikely to succeed. www.nytimes.com/2019/10/09/opinion/bernie-sanders-single-payer.html

Link to tweet

And so, at the end of 2014, Mr. Shumlin admitted defeat. “I have learned that the limitations of state-based financing, the limitations of federal law, the limitations of our tax capacity and the sensitivity of our economy” make single-payer “unwise and untenable at this time,” he said. “The risk of economic shock is too high.”

The Vermont plan was done in by high taxes, distrust of government and lack of political support. Any effort by a Sanders administration to enact a single-payer system at a national level would probably be doomed by similar problems.....

But if it couldn’t work in Vermont, with a determined governor, an accommodating legislature and progressive voters, Mr. Sanders will have a tough time explaining why it will somehow succeed on a vastly larger scale. Vermont represents a practical failure on friendly turf, and that is what makes it such a powerful counter to Mr. Sanders’s proposal.

“If Vermont can pass a strong single-payer system and show it works well, it will not only be enormously important to this state, it will be a model,” Mr. Sanders said in 2013.

As it turns out, it was a model. But instead of showing us how it would work, it showed us why it would fail.

[PhoenixDem]

9. K&R n/t