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By gulfsouthb32553561, Aug 5 2019 02:24PM

President Donald Trump says he wants health reform that will be better than Obamacare, better than what we had before Obamacare, and better than the Democrats’ “Medicare for All.” And he’s not alone.

Numerous surveys show that health reform remains a top priority for Americans, who are concerned about high costs, access, and choice.

To address these problems, health reforms should focus on making it as easy as possible for people to access innovations such as:

Personal, “portable” health insurance that travels with them from job to job and in and out of the labor market.

Round-the-clock communication with their personal physicians by phone, email, and Skype.

Telemedicine, so they can even “visit” the doctor from home—avoiding traffic, long waits, and unneeded emergency room visits.

Centers of excellence that specialize in chronic health conditions (including preexisting conditions) and actively compete for patients.

Accounts owned and controlled by patients who are willing to manage their own care, including most forms of chronic care and even routine surgery.

Government should not mandate these changes. If employees and their employers like the arrangements they now have, they should be able to keep them.

But government needs to get out of the way, cut red tape and conflicting requirements, and quit interfering with the opportunity for people to have better options.

The Trump administration has already implemented executive actions that have brought us closer to all five of these goals. But to complete the reforms, Congress needs to enact legislation.

Here are some particulars.

1. Personal and portable health insurance.

In an ideal world, most people would own their own health insurance and take it with them as they traveled from job to job and in and out of the labor market.

Some employers may have better insurance than is available on the open market. But others might prefer to make a cash contribution to help employees pay their own premiums rather than provide insurance directly.

Some employers were actually doing that before Obamacare. They used an account called a health reimbursement arrangement, providing tax-free funds employees could use to buy their own health insurance.

But with Obamacare came regulations and threats of steep employer fines that effectively deep-sixed this option.

Thankfully, the Trump administration is reversing course. Beginning next January, employers will be able to use health reimbursement arrangements to help employees obtain their own coverage with the administration’s blessing.

The Council of Economic Advisers estimates this change will affect 11 million workers. But it would affect far more if states cleaned up their individual markets to make them a more attractive option.

Congressional action should codify what the administration has already done and expand the reform in several ways.

In particular, states need broad authority to authorize insurance products that meet their residents’ needs, rather than meeting Obamacare’s expensive mandates.

Congress also needs to give states the freedom to make reforms that would lower costs and expand access to care.

2. Round-the-clock medical care.

Concierge doctors used to be available only to the rich. Today, “direct primary care” is far more affordable.

Atlas MD in Wichita, for example, provides all primary care along with 24/7 phone and email access and generic drugs for less than what Medicaid pays. It helps patients gain access to specialist care and diagnostic tests, with minimal waiting.

The cost: $50 a month for a middle-aged adult and $10 a month for a child.

There are 790 direct primary care practices like Atlas in the United States. Typically, they provide round-the-clock access to a physician via phone, email, and Skype.

These practices have a number of attractive features—and an excellent track record: They expand access to care, improve the quality of care, reduce overall health care spending, and report high levels of patient satisfaction.

This development has the potential to radically transform the way medicine is practiced in the United States. The only things standing in the way are unwise public policies.

A number of employers are creating access to direct primary care as an employee benefit. However, under current law they cannot put tax-free dollars into an account and let employees use the money to select a direct-pay doctor of their choosing.

The Trump administration has directed federal agencies to see if health reimbursement arrangement accounts and health savings accounts (see below) can be used as vehicles to overcome the current regulatory obstacles.

In addition, the administration hopes to make Medicare more open to direct primary care.

Under the arrangement, Medicare would pay a fixed monthly fee to a physician or physician group instead of the traditional fee-for-service payments. In return, the physicians would provide virtually all primary care.

The fees would range from $90 to $120 a month, depending on the patient’s age and medical complexity.

While this is a good start, more is needed to make direct primary care widely available to Medicare patients. The reason: Most direct primary care doctors have opted out of all third-party insurance arrangements, including Medicare.

These doctors cannot contract with a Medicare patient unless they are in Medicare. Further, once in Medicare, doctors won’t be free to engage in the type of innovation that makes direct contracting so successful.

Congress can and should eliminate this catch-22.

3. Access to telemedicine.

The ability to deliver medical care remotely is growing by leaps and bounds. It promises to lower medical costs, increase quality, and reduce the time and travel cost of patient care.

For example:

After hip and knee replacements at Tallahassee Memorial HealthCare, patients are transported to rehab facilities, nursing homes, and even their own homes—where follow-up observations are made with video cameras.

A nurse at Mercy Virtual Hospital in St. Louis can use a camera in a hospital room in North Carolina to see that an IV bag is almost empty. She can then call and instruct a nurse on the floor to refill it. The telemedicine cameras are powerful enough to detect a patient’s skin color. Microphones can pick up patient coughs, gasps, and groans.

The problem? Medicare doesn’t pay for any of this. And since private insurers and employers tend to pay the way Medicare pays, the entire country is missing out on incredible advances in telemedical technology.

This is not an accident. Federal law (the Social Security Act) allows Medicare to pay for telemedicine only under strictly limited circumstances. For the most part, doctors can examine, consult with, and treat patients remotely only in rural areas, and even there, patients can’t be treated in their own homes.

The Centers for Medicare and Medicaid Services is acting aggressively to change this.

As of Jan. 1 of this year, doctors in Medicare Advantage plans and accountable care organizations can now bill Medicare if they use phone, email, Skype, and other technologies to consult with patients remotely to determine if they need an in-office visit. Patients can be anywhere, including their own homes.

Doctors can also bill Medicare to review and analyze medical images patients send them. And they can bill for telemedical consultations with other doctors.

But these are still baby steps. Congress needs to liberate telemedicine once and for all.

4. Access to centers of excellence.

On the Obamacare exchanges, there has been a race to the bottom as health plans try to attract the healthy and avoid the sick. Increasingly, enrollees have been denied access to the best doctors and the best facilities.

In Dallas, Texas, for example, no individual insurance plan includes Southwestern Medical Center, which may be the best medical research center in the world.

In Texas generally, cancer patients with Obamacare insurance don’t have access to MD Anderson Cancer Center in Houston. This pattern is repeated all over the country.

The most successful Obamacare insurers are Medicaid contractors. The plans that have survived in the exchanges look like Medicaid managed care with a high deductible. The networks include only those doctors who will accept Medicaid fees coupled with all the hassle of managed-care bureaucracy.

Before Obamacare, most states had risk pools for the small number of people who entered the individual market with an expensive preexisting condition and were denied access to ordinary insurance coverage.

The risk pool plans looked like garden-variety Blue Cross plans, with access to almost all doctors and hospitals. While some risk pools had problems—such as being over-subscribed and unable to take new customers—those problems were discrete and addressable.

Obamacare threw out this model in favor of a D.C.-designed solution. The result? Access to care for people with preexisting chronic conditions has seriously deteriorated. That needs to change.

Entities such as Cancer Treatment Centers of America need to be able to enter the individual market, restrict enrollment to patients who have cancer, and receive a premium that covers their expected costs.

Instead of expecting every health plan to be all things to all patients, we should encourage specialization. We need focused facilities for such chronic conditions as cancer care, diabetic care, and heart disease.

To make the market work better, medical records need to travel with the patient from plan to plan, and insurers need to be able to design better risk-adjustment mechanisms rather than being forced into federal government-designed systems.

How can these changes be made? Here, it is even more critical that government clear away today’s barriers and let private markets function.

Some of this is already being done by executive rule-making and through waivers. The president has taken aggressive steps in this direction, giving states new authority to experiment.

This has already led to lower costs in seven states. In Maryland, premiums that had been expected to rise 30% actually fell by 13% thanks to state reforms.

Congressional action will almost certainly be needed to complete the task. Ideally, states should be given broad authority to reform their private individual markets, with one important proviso: Conditions must get better for people who have health problems.

“Better” means lower premiums, lower deductibles, and broader networks of providers. And people who are sick or in low-income households must be free to use their existing subsidies to pick the right plan for them, rather than being warehoused into Medicaid or Obamacare.

States must not only show unmistakable progress in this respect, but also establish as a goal a market in which sick people can get access to the doctors they need—without raising costs for everyone else, as Obamacare does today.

It doesn’t take new federal mandates and programs to reach these goals. Rather, the Trump administration’s regulatory relief has amply demonstrated that we move in the right direction when states are allowed to escape existing mandates that have distorted market incentives and led to our current problems.

Congress could help empower the states to carry out needed reforms by enacting the Health Care Choices Proposal, developed by the Health Policy Consensus Group and supported by more than 100 conservative leaders across the country.

This proposal would block-grant Obamacare funds to the states and give them wide discretion to reform their individual health insurance markets.

The Center for Health and the Economy estimates that this proposal would lower health care premiums by as much as a third, would insure about the same number of people as Obamacare, and would better protect people with preexisting conditions and high health costs.

5. Patient power.

How can we control health care costs and at the same time improve quality and create greater access to care? Here is one answer: Give patients control over more of their health care dollars.

Roughly 25 million people now manage some of their own health care dollars through health savings accounts, which they own and control.

The evidence shows that these patients are conservative shoppers in the medical marketplace—saving money without any deterioration in the quality or access to care. However, the potential for these accounts is much greater.

Right now, patients use health savings accounts primarily to pay small medical bills below their deductibles. But these accounts could and should be used in just about every aspect of medicine, including expensive surgery, chronic illness, custodial care, and emergency-room visits.

For example, there is mounting evidence that patients suffering from diabetes, heart disease, cancer, and other chronic illnesses can (with training) manage a lot of their own care as well as—or better than—traditional doctor therapy can.

If they are going to manage their own care, they will do an even better job if they are also managing the money that pays for that care.

In addition, there is no reason why patients could not manage almost all the money used for primary care, including routine doctor visits and most diagnostic tests—spending from a health savings account that they own and control.

If patients control the money, it will flow toward cost-saving options. They will substitute less expensive phone and email consultations for doctor’s-office visits; they will shop for better prices on everything from blood tests to mammograms; and they will opt for walk-in clinics and free-standing emergency care instead of hospital emergency rooms when appropriate.

On the East Coast and the West Coast, Uber-type doctor visits at nights and on the weekends are an increasingly popular alternative to the emergency room. A doctor house call costs about $100, and the doctor usually arrives within an hour. Emergency rooms typically charge about five times more.

Give patients control of the money and you will see this service all over the country.

Health savings accounts can also help control the cost of expensive surgery.

For example, WellPoint (Anthem) in California limited the amount it would pay for hip and knee replacements to $30,000 for its CALPER enrollees. Patients could get the procedure done at any hospital, but if the cost was greater than that amount, they had to pay out of their own pockets.

This experiment had a dramatic effect, bringing down the cost of surgery across all of California.

But the impact would have been even more dramatic if WellPoint had deposited $30,000 in the account of every patient who was a candidate for surgery. That way, if a patient found a hospital whose cost was, say, $28,000, the patient would enjoy a $2,000 “profit.”

Both insurers and their enrollees would do better still if they considered traveling for care.

Health City Cayman Islands offers high-quality hip and knee replacements for one-half to one-third less than what the procedures cost in California. Employers have found employees not very receptive to medical travel.

But let the patient have $30,000 in a health savings account with the opportunity to save $10,000 or more, and the willingness to travel is likely to soar.

To take advantage of the full potential of health savings accounts, we need three policy changes:

People should be able to use completely flexible health savings accounts, wrapping them around any health insurance plan and using them to pay for any medical costs the plan does cover.

They should be able to use their health savings accounts to pay premiums as well as out-of-pocket expenses.

Health plans should be allowed to have “shared savings programs,” where enrollees who choose better and cheaper care get to keep their share of their savings in their health savings account.

The Trump administration recently made a major announcement with respect to the first of these changes. Going forward, employees with health savings accounts will be exempt from the high-deductible requirement for the treatment of chronic disease.

This means that the employer or insurer will be able to provide first-dollar coverage for some services without running afoul of health savings account regulations.

***

The reform agenda proposed here would radically transform the U.S. health care system by empowering patients, liberating markets, and removing government obstacles to lower-cost, higher-quality, more accessible health care.

It builds on emerging successes by innovators empowered by the president: doctors trying new ways of delivering care, states trying new ways of healing broken private markets, and patients demanding better care at lower costs.

The president should build on these successes and work with Congress to clear away the barriers blocking these innovators from spreading their wings. That’s the way to provide better care at lower costs.

By gulfsouthb32553561, Aug 5 2019 02:21PM

Fine, but you should know exactly what you’re giving up in the bargain.

These “debates” are to serious policy discussions as a kazoo is to an orchestra. You can say a kazoo is an instrument, and you can say that these truncated thoughts are proposals, but you’ll invite smirks.

This is not a slam on Democrats. The Republican “debates” in 2016 were no better. When a stage is sardined with candidates, there is no alternative to keeping answers short. If the voters had longer attention spans, we could arrange four or five nights of less manic encounters, which would give candidates the chance to explain themselves. But since we don’t, we have unedifying and demeaning soundbite-ping-pong matches.

It isn’t clear that they merit the intense media interest they generate. Must Biden prove he’s not too old? Must Cory Booker “have a moment” after a lackluster first debate? Maybe. Then again, Donald Trump performed abysmally in the 2016 debates. He didn’t know the issues and made excruciating errors. His great skill, if you can call it that, was in lobbing juvenile taunts at his rivals. Yet he was acclaimed the winner by the viewers.

Several candidates this week stressed that the Democratic party is veering too far to the left, which was refreshing, if probably futile. The undertow pulling the party left is very strong. As recently as 2009, the public option in health care was considered too extreme, which is why President Obama omitted it. Now, it’s the moderate position compared with Medicare for All, which is endorsed by Bernie Sanders, Elizabeth Warren, Andrew Yang, Bill De Blasio, Julián Castro, and, with some reservations, Kamala Harris and Pete Buttigieg.

As usual, Bernie Sanders and Elizabeth Warren were in full outrage mode about the corporate villains who are sucking us dry. It isn’t a sign of our political maturity that the most successful politicians now are demagogues who find some target to blame — foreign competition, immigrants, greedy corporations, millionaires, and billionaires. Warren claims that “giant corporations” and billionaires will foot the bill for her MFA, which rivals Trump’s claim that Mexico would pay for his wall. Sanders pointed to the nation across the river from Detroit to shame Americans about health care’s not being treated as a “yooman right” in this country.

This seems like a good time to review what Canada’s single-payer health-care system does and doesn’t do.

It’s true that all Canadian citizens and legal residents (though not illegal immigrants) get “free” health care, but only in the sense that you don’t get a bill after seeing a doctor or visiting a hospital. Medical care is subsidized by taxes, but the price comes in another form as well — rationing. A 2018 report from the Fraser Institute, a Canadian think tank, found that wait times between seeing a general practitioner and a specialist average 19.8 weeks. That’s the average. There are variations among specialties. Those waiting to see an orthopedist wait an average of 39 weeks, while those seeking an oncologist wait about 3.8 weeks.

Canada has the same modern medical technology that the U.S. offers, but Canadians must wait more than a month for a CT scan, more than ten weeks for an MRI, and almost a month for an ultrasound.

Imagine the anxiety of learning that you need an MRI to find out whether the mass in your breast is anything to worry about and then being told that the next available appointment is in ten weeks. In addition to the psychic price, Canadians who had to wait for treatment expended an average of $1,972.00 out of pocket last year, owing to lost wages and other costs. The Fraser Institute also calculated the value of the lost productivity of those waiting for treatment — nearly $5,600 per patient, totaling $5.8 billion nationally. Wait times to see physicians in the U.S. have been creeping up in recent years — perhaps in response to increased demand following Obamacare — but remain much shorter than those in Canada or other OECD countries with nationalized health services.

When there’s an artificial shortage of a good or service, a black market usually follows. I have heard from several Canadians that paying doctors bribes to jump the line is not uncommon. But Canada has another pressure reliever: 90 percent of Canadians live within 90 miles of the U.S. border, and medical centers in Buffalo, Chicago, Rochester, and elsewhere receive tens of thousands of Canadian patients every year.

Advocates respond that Canadians are happy with their system, and that’s fine. It’s their choice. But Americans tend not to be so docile about delays. And in any case, the Democrats’ pretense that we can provide Medicare for All and receive the same level of care we’ve become accustomed to is applesauce. You want the Canadian system? Fine. Just know what you’re giving up.

By gulfsouthb32553561, Jun 17 2019 02:10PM

The Trump administration unveiled this week a final rule that will dramatically improve workers’ ability to access health insurance of their choice.

The new rule will significantly expand the permitted uses of tax-advantaged health reimbursement accounts, or HRAs.

Today, these special employer-based accounts, in which funds can be rolled over year to year, are used by employees to cover medical expenses, including out-of-pocket costs and services uncovered by traditional insurance.

But with this rule, for the first time in the history of these tax-free accounts, the administration would allow employees to use them to pay premiums for individual health insurance.

The liberal Left continue to push their radical agenda against American values. The good news is there is a solution.

This change will not only expand health insurance coverage, but will also lower health care costs.

The rule is the product of the combined efforts of the U.S. departments of the Treasury, Health and Human Services, and Labor. It will take effect on Jan. 1, 2020.

A Big Change for Workers Whose Companies Don’t Offer Insurance

With this regulatory initiative, the Trump administration is making a major change in health care financing.

Employers who do not, or cannot, offer health insurance at the place of work, would henceforth be able to deposit tax-free funds into health reimbursement accounts on behalf of employees who wish to use those funds to buy health insurance plans in the individual insurance markets.

While announcing the final rule, administration officials said they expected that the new rule, within a five-year period, could encourage as many as 800,000 businesses to sponsor health reimbursement accounts to fund individual coverage for more than 11 million workers.

This change is a major component of the Trump administration’s efforts to repair Obamacare’s damage to the badly battered individual and small group health insurance markets.

Trump administration officials expect regulatory relief would be most beneficial to small business employers and their workers, a class of Americans hit particularly hard by the dramatic Obamacare premium and deductible increases in the small group market.

In recent years, there has been a serious decline in the number of small and mid-size firms offering their workers group health care coverage.

Not surprisingly, administration officials expect that most of the firms that will take advantage of the new rule will have fewer than 20 employers. The new rule thus holds potential to reverse the decline in health coverage among small business employees.

For current and future employers who already offer health reimbursement accounts alongside traditional group health insurance, the new rule would create an “excepted benefit HRA.”

It would allow employers to provide their workers an additional $1,800 yearly (indexed to inflation) in their health reimbursement accounts to reimburse them for certain medical expenses, including dental and vision benefits.

In the case where an employee would turn down the offer of a job-based health insurance plan, for one reason or another, this health reimbursement account funding could be used to offset employees’ premiums if they chose to instead buy a new short-term, limited duration health plan, which can be renewed for three years.

These plans have broad networks, and are much less expensive than the pricey Obamacare health plans.

Beyond the shrinkage of employer-sponsored coverage among small firms, there has also been little choice in terms of health care plans for small business employees.

Trump administration officials highlight data that shows that among small businesses (with fewer than 200 employees), 81% offered only one health plan. Among larger firms, with 200 or more workers, 42% of employers offered only one health plan. One choice is, of course, no choice.

The new health reimbursement accounts rule has the potential to rectify this problem, and expand employees’ choices well beyond the limited options they have today.

With this change, the Trump administration expects the individual health insurance market to grow significantly, and become more robust as an arena for health plan participation and competition.

This, of course, would partially reverse the disastrous decline in health plan choice and competition that has marked the last six years.

Creating a Fairer Tax Code

The greatest impact of the Trump administration’s change to the existing health reimbursement account regulations is the liberalization of the federal tax treatment of health insurance.

Under current law, employers and employees enjoy unlimited tax relief for the provision and purchase of health insurance—but if, and only if, that insurance is provided under the conventional umbrella of employer-sponsored group coverage.

For the many small businesses that cannot afford to offer such coverage, many workers and their families, deprived of any individual tax relief to offset their health insurance costs, face the dilemma of either buying inordinately expensive individual coverage on or off the Obamacare exchanges or going without any coverage at all.

By extending the federal tax advantages of traditional group health insurance coverage to health reimbursement accounts for the purchase of individual insurance, the Trump administration rule would give employers who do not, or cannot, offer job-based coverage the chance to help their workers and their families with their premium costs.

There is no cap on the employers’ tax-free contributions; they can give as much as they wish to help their workers.

The rule, in effect, allows for an employer-based defined contribution for health insurance, precisely the kind of financing mechanism that could spur a resurgence in consumer choice, personal ownership of portable health plans, increased plan participation, and robust competition in the nation’s health insurance markets.

However, administrative changes, no matter how beneficial, are no substitute for legislative solutions.

The Trump administration can make a rule change, and the next administration can just as easily unmake a rule change. Good, sound, and stable public policy can only be assured through congressional action. Transient regulation is no substitution for permanent law.

President Donald Trump is practicing addition, not subtraction by offering more options, not fewer.

The president has done what he can within the law to improve the market environment for personal health plan choice and competition. His actions will doubtless contribute to an increase in health insurance coverage.

Now, Congress needs to step up. First, Congress should codify the president’s rules in statute. Second, Congress should fix the nation’s badly broken health insurance markets.

The roadmap for that reform is the Health Care Choices Proposal, widely supported by a broad coalition of health policy analysts.

It would return most regulatory power over health insurance markets back to the states, guarantee financial help to the poor and the sick, and allow any person in a government health program to redirect their public funding to payment for a private or employer plan of their choice.

Americans need relief. They want lower costs and more choice. Trump’s team has taken a good step in that direction and Congress should follow suit.

By gulfsouthb32553561, May 28 2019 07:17PM

With the debate over health care heating up again, Medicare for All once more is a hot topic. Sen. Bernie Sanders, I-Vt., has sponsored a new version of his Senate bill that promises to free Americans from health care concerns.

But at the core of the Sanders bill is still the vast and fundamentally illiberal restriction on choice for both patients and providers.

One key provision of the bill would outlaw health care plans that duplicate coverage. Section 107 states bluntly that “it shall be unlawful for—(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.”

In other words, it will be expressly illegal for any private company or employer to provide health benefits that compete with the government.

The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more >>

The Sanders bill, however, is gracious enough to allow insurers or employers to provide any benefit not covered in the legislation.

This provision to outlaw private plans that duplicate government coverage, allowing only the sale of supplemental plans, is similar to Canadian Medicare, which covers all Canadian citizens.

In Canada, approximately 30% of health care spending is private spending, with 12.4% coming from private insurers. The Canadian system, however, does not include dental, vision, and prescription drug coverage that is part of the Medicare for All package. The Sanders bill would leave almost no room for the private sector at all.

Where Canadian health care leaves significant room for private health care plans, Medicare for All would preclude a substantial amount of private coverage in America, leaving essentially cosmetic surgery and experimental drugs excluded by the secretary of the Department of Health and Human Services, per Section 203(b) of the bill.

Under this regime, the government would take near complete control over the 18% of gross domestic product that is health spending. Private spending, which amounts to about 45% of national health expenditures, would collapse.

If Medicare for All passes, you will not keep your health care plan. And you will not be able to find one if you so choose.

Proponents of Medicare for All would argue the loss in choice is a worthy trade-off, but they will have to countenance the government’s having the final say in health care choices between patient and provider.

Title II of Medicare for All gives the HHS secretary explicit authority to determine what items or services are “medically necessary or appropriate for maintenance of health.”

We already have seen the result of this in the United Kingdom’s National Health Service, which decided to cut or limit coverage for certain procedures in an effort to control costs. Although the NHS has deemed those procedures “unnecessary,” the decision to perform, for instance, a tonsillectomy should be decided in the clinic rather than by HHS.

It is theoretically possible to avoid that kind of government intrusion into an individual’s health choices. Enrollment as a patient in Medicare for All would not be necessary, although it would be automatic. Likewise, participation as a provider technically would be voluntary.

The problem is that the bill makes it virtually impossible to practice medicine without participating in the program.

Under Title III, nonparticipating providers could not bill the government for services offered under Medicare for All. And if the provider does furnish such a service, he or she would have to submit an affidavit affirming the service and could not participate in Medicare for All or treat anyone covered by it for a period of one year.

Thus, if a patient wants to avoid waiting for an appointment with a physician and contract with one privately, that physician either would have to renounce his participation in Medicare for All, which would cover practically everyone in the United States, or he already must have been practicing outside the program.

There likely would be a market for direct primary care physicians, otherwise known as concierge medicine doctors, but it is unrealistic to expect these services to be widely available to the average American.

In essence, we would see a two-tiered medical system: one for most Americans, and one for wealthy Americans. This is a common complaint in Canada, and one of the ways the Canadian Medical Association has suggested to address it is by contracting more with, interestingly, private providers.

Medicare for All would make it nearly impossible to practice medicine outside of participation in the program. Patients would have little other option than to accept the medical decisions of the HHS secretary.

Today, about half of the $3.5 trillion a year in American health care spending is direct government spending; the rest is private health spending, mostly directed by employers.

Medicare for All would cede that spending entirely to the government.

By gulfsouthb32553561, Apr 12 2019 07:10PM

Independent Vermont Sen. Bernie Sanders, a self-described “socialist,” is doubling down on his efforts to give federal officials total control over Americans’ health care.

The senator has just unveiled the Medicare for All Act of 2019 with 13 leading Senate Democrats, including fellow contenders for the 2020 Democratic presidential nomination: Sens. Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California, and Elizabeth Warren of Massachusetts.

Americans should find this bill chilling. If passed, it would essentially abolish all private health coverage in America, regardless of whether Americans like their current plans.

Here are the specifics.

Outlawing Current Coverage

This bill, title by title and section by section, is almost identical in substance to the Medicare for All Act of 2017 (S.1804) introduced last Congress.

Under Title I, the bill would create a new national health insurance plan to provide universal coverage to all U.S. residents, regardless of their legal status. This new program would be phased in over a four-year period.

Under Section 107, the bill would outlaw private health coverage, including employer-sponsored coverage, that “duplicates” the coverage provided under the government health plan. Approximately 181 million Americans would lose their existing private coverage.

Like the earlier version, the new Senate bill would also abolish other federal health programs, including Medicare, Medicaid, the Children’s Health Insurance Program, Tricare, and the popular and successful Federal Employees Health Benefits Program. The tens of millions of Americans currently covered by these programs would also be involuntarily absorbed into the new government health program.

Under Title II, the bill would provide 13 categories of health benefits, including a new long-term care benefit. This is a richer benefit package than that contained in the earlier Sanders bill, which listed 10 categories of benefits. Also like the earlier bill, taxpayers would be compelled to fund abortion, and the bill would override current law that ensures conscience protections for medical professionals.

The new bill would also eliminate virtually all cost sharing, except for a limited out-of-pocket obligation for prescription drugs. This provision, of course, would induce increased demand for medical services and thus increase the overall costs of the program.

Under Title II, the bill would set forth detailed terms and conditions for the participation of doctors and other medical professionals in the government system, including the limiting conditions governing private contracts.

Under Section 303 of the new Senate bill, private contracts between doctors and patients would be discouraged. Doctors who choose to take private payment from patients outside the system would face a stiff penalty.

Under Section 303, the physician would have to sign an affidavit that he engaged in such a contract, submit it to the secretary of health and human services, and then forego all reimbursement from all other patients enrolled in the new federal entitlement for a period of one year. Few doctors, of course, would be able to do such a thing.

This is essentially the same policy embodied in the previous version of the Sanders legislation, and an even more restrictive version is embodied in the House bill (H.R. 1384).

This, along with the abolition of all insurance alternatives, would come as a striking restriction on patients’ personal liberty. Interactions with physicians are sometimes focused on highly sensitive matters, and patients might desire confidentiality and prefer not to submit a claim either to a government agency or even a private insurance company.

Then, of course, there is also the problem of getting access to specialized services. If the government plan, operating as a monopoly, does not or cannot offer you what you want or need, you would have no viable alternative under this legislation.

The Likely Consequences

If the Senate bill—or some version of it, such as the House Democratic bill—were to become law, ordinary Americans could surely expect three major consequences.

1. Slower care.

With a single government health program designed as an entitlement for 327 million Americans—providing services “free” at the point of service—utilization would explode. Americans would face long waiting lists, delays, and even denials of medical care. It would be unavoidable.

The experience of “single payer” countries, like Britain and Canada, shows that waiting lists for medical treatment are common, especially for hospitalization and specialized medical services.

2. Even fewer doctors available.

Today’s doctor shortage, fueled by accelerated retirements and physician burnout, would surely worsen. Beyond imposing Medicare’s huge regulatory regime and its paperwork burden on the entire nation, the Senate bill would impose Medicare payment rates (rates lower than private insurance) as the means to reduce reimbursement for all doctors, hospitals, and medical professionals. Former Medicare Trustee Charles Blahous estimates that this would translate into a stunning 40% decline in medical reimbursement.

While leftist ideologues might vigorously applaud such a radical reduction in physician payment as a major source of health care “savings,” the negative impact on patient access and quality of care would be incalculable.

3. Massive new taxation.

Curiously, the new Senate bill, like its predecessor, has no financing provisions. Instead, as with the last version, Sanders has offered a list of financing options that could be used to pay for this massive enterprise, including a 4% income-based premium, a 7.5% payroll tax, the elimination of all tax breaks for existing health insurance, and a series of taxes on wealthy citizens.

Independent analysts have concluded that such “options” would fall far short of covering the true costs of such a program, meaning that individuals and families would pay much higher taxes than the senator’s revenue proposals anticipate. Both the liberal Urban Institute and the conservative Mercatus Center projected that the earlier version of the Sanders’ plan would cost approximately $32 trillion over 10 years.

Those earlier projections are obsolete, because the senator has now added a costly long-term care program to the bill’s mandatory benefits package.

This is not a realistic way forward. Socialism is the wrong prescription for Americans who want quality, affordable health care.

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