JustCare

Tag: Medicare for all

  • Biden-Sanders Unity Task Force recommends incremental health reforms

    Biden-Sanders Unity Task Force recommends incremental health reforms

    The Biden-Sanders Unity Task Force recently released its recommendations for health care reform. Unfortunately, the three Sanders’ appointees on the health care task force were not able to move the Biden appointees to support reforms that will guarantee health care to all Americans, much less get us meaningfully closer to Medicare for all. Rather, the Task Force’s proposed reforms are small and not likely to help most Americans.

    Vice-President Joe Biden wants to “build upon our bedrock health care programs, including the Affordable Care Act, Medicare, Medicaid, and the Veterans Affairs system.” In his view, building means adding a “public option” and lowering the age of Medicare eligibility to 60. It’s unclear what exactly a public option would mean or how it would help guarantee Americans access to good affordable health care.

    Here’s what we know: Joe Biden believes that if Americans had the choice of enrolling in a “public health plan”–health insurance provided directly by the federal government–in the state health insurance exchanges, private health insurers would engage in “real competition” and have a financial incentive to deliver quality affordable care. But, the evidence suggests otherwise.

    We know that private Medicare Advantage plans do not engage in real competition with the public Medicare plan. Rather, they game the system, market to healthy people, create barriers to care for their members who need it and drive up costs. There is no reason to believe that private health plans would behave any differently for people under 65 if a public option were available.

    What’s more, the Unity Task Force has in mind the possibility of more than one public plan choice, but it does not explain why there would need to be more than one choice. It says that at least one choice would not have a deductible and would be administered by traditional Medicare, not a private health insurance company. For reasons that are not explained, the government administrator of the new public plan would engage in its own negotiations with doctors and hospitals over prices rather than piggyback off of Medicare rates.

    Anyone with employer coverage or coverage through the ACA would be free to enroll in the public plan. One special feature of this public plan is that people who are not eligible for Medicaid but whose incomes are low would automatically be enrolled in the public plan. People living in states that have not expanded Medicaid could also enroll in this public plan. They would not pay a premium for it and could opt out of it if they chose.

    In addition to creating a public plan option, the Unity Task Force recommends that, at age 60, anyone could choose to enroll in Medicare. But, it does not recommend an out-of-pocket cap on traditional Medicare or other reforms that would improve Medicare benefits and make it easy to enroll in traditional Medicare.

    Of course, with many options available, it will be easy for marketers to confuse people about what health plan is best for them. Inevitably, plenty of health plans will not meet people’s needs. For example, they might inappropriately delay and deny care, have narrow networks without high-value health care providers, or high copays. To help people distinguish among plans, the Unity Task Force supports appropriating money to let people know about their options and enroll them. But, assistance is of little help if there are no good options available. And, information that would shed helpful insight into which are better than others–such as which don’t have high denial rates–is not available.

    The Unity Task Force recommends giving states the right to come up with their own health plans. Many advocates and states want that right. Still, the likelihood of success on the part of states to guarantee residents affordable health care is slim given financial constraints and their lack of resources to take on the private health insurance industry. States have never been able to serve Americans well on the health insurance coverage front and there is no evidence that they will do so in the future.

    The Unity Task Force sees its recommendations as meeting the needs of people who are recently unemployed as a result of the pandemic along with people who have been uninsured for a long while. But, it’s unclear why. With health care costs continuing to rise and little focus on reining them in, it’s hard to imagine the public option–the Task Force’s chief way of improving health insurance–will be affordable to most people without substantial federal subsidies.

    If you can’t afford health insurance as a result of these health care reforms, you might want to get care at community health centers, sometimes known as Federally Qualified Health Centers, and rural health centers. The Task Force recommends greater and more predictable funding for these health centers.

    To address shortages of health care providers, particularly primary care nurses and dentists and mental health counselors, the Unity Task Force recommends a larger National Health Service Corps.

    Here’s more from Just Care:

  • At 55, Medicare is going strong, at least for now

    At 55, Medicare is going strong, at least for now

    On July 30, Medicare turned 55. Notwithstanding myriad attempts by conservatives to destroy it, Medicare continues to withstand the test of time. Medicare offers health and financial security to more than 60 million older adults and people with disabilities. At an online conference, union representatives, small business entrepreneurs, doctors and members of Congress spoke about our need to improve and expand Medicare to everyone.

    Think about it, if you have traditional Medicare, the tried and true government-administered health care plan, you can:

    • Get care from almost any doctor and any hospital in the United States.
    • Go directly to the doctor or hospital for care without any administrative hassles.
    • Know in advance that your care will be almost fully covered if you have supplemental insurance.
    • Budget for your care.
    • Sleep soundly at night knowing that you can get the care you need when you need it.

    Medicare needs to be improved. It should have an out-of-pocket cap so you don’t need supplemental insurance to protect yourself financially and it should have additional benefits. But, no other insurance gives you the health security that traditional Medicare offers wherever and whenever you need care.

    Congresswoman Pramila Jayapal spoke about how we can see even more clearly now with the coronavirus pandemic how expecting people to get private health insurance through their jobs jeopardizes their health and well-being. We not only have an economic crisis, we also a public health crisis.  The case for Medicare for all has been made by the 151,000 Americans who have lost their lives to COVID-19, by the tens of thousands of people who have been charged extraordinary sums for their care, by the many Americans at risk of medical bankruptcy.

    No person under 65 can go to the hospital or the doctor’s office and feel secure that their insurer will cover the full cost of their care or that their health care providers won’t bill them for services that are not covered.

    Small businesses are reeling because of the private health insurance system. Instead of being able to concentrate on their businesses, small business owners are caught up in trying to ensure their employees have health care. With Medicare for all, they would be able to give their businesses the time and attention they need.

    Unionized workers are losing their jobs and their health insurance.The co-president of UNITEHERE Local 11, Ada Briceno, explained that workers need the protection of guaranteed and universal health care. Improving and expanding Medicare to everyone would also allow unions to negotiate for benefits such as fair wages and retirement security instead of spending most of their energy on health care.

    To end the novel coronavirus pandemic and protect everyone, we need to improve and expand Medicare to everyone. Dr. Susan Rogers, the incoming president of Physicians for a National Health Program (PNHP) explained how our current profit-driven private health insurance system unfairly discriminates against people of color and people with low incomes: “People of color are more likely to suffer from chronic diseases which leaves them more vulnerable to the coronavirus and housing in high poverty neighborhoods make social distancing near impossible.”

    You can listen to the online conference here and watch it here.

    Here’s more from Just Care:

  • Hospital rates out of control with private health insurance

    Hospital rates out of control with private health insurance

    Hospital rates are out of control for people with private health insurance. Medicare, in sharp contrast to private health insurers, has the power to rein in provider rates for its recipients, even when hospitals have monopoly power. Consequently, private insurers today pay hospitals much higher rates than Medicare, and health care costs are unsustainable for working Americans. 

    On average, it costs more than $2,500 a day to stay overnight in the hospital. Prices keep going up, and more people are choosing not to get care. Congress needs to rein in hospital rates to ensure Americans under 65 access to care–and, soon. The higher these rates go, the more people will forego needed care and the harder it will be to rein in hospital rates.

    Higher hospital rates mean higher expenses–more staff, higher salaries, more investments. So, if Congress decides to step in to control these rates, reducing rates could mean layoffs and other stressors on health care providers. N.B. Congress has no plans to do so as of yet.

    To date, hospitals have gambled on generating the revenues they need for fancy equipment and high executive salaries from private health insurers. For some time they did well. Now, it looks as if many of them made a bad calculation.

    The novel coronavirus has cut into hospital revenues significantly. Even before the novel coronavirus pandemic, many hospitals–particularly rural hospitals–were closing down, and now many more hospitals are folding. If the hospitals operated on global budgets, with government guaranteed annual income, the future of hospitals would be far more secure.

    How do private insurer rates compare with Medicare rates today? Kaiser Family Foundation (KFF) looked at 19 studies.

    Because private health insurers and providers are able to claim their data as proprietary, there is no national data on private health insurer rates to analyze and compare with Medicare rates. Researchers have only been able to compare some private insurer rates to Medicare rates; but, hospitals generally prohibit them from disclosing the specific rates particular providers are charging particular insurers.

    KFF’s key findings:

    1. Overall, private insurers pay nearly 50 percent more than Medicare for physician services.
    2. Private insurers pay more than two and a half times Medicare rates for outpatient hospital services (264 percent) and nearly twice as much as Medicare (189 percent) for inpatient hospital services.
    3. Private insurers pay about twice Medicare (199 percent) for hospital services overall.

    Allowing hospitals and doctors to keep raising rates is hurting Americans, keeping them from affording health insurance and from getting needed care. If Congress stepped in and negotiated lower hospital and doctor rates for everyone, many providers likely would claim they could not manage. But, right now, they have less incentive to operate efficiently than they would if their rates came down.

    Hospital rates make no sense. Within a community and throughout the country, hospital rates vary wildly. Market power influences rates significantly. Bigger hospitals might operate more efficiently than smaller hospitals, but they also generally command higher rates from private health insurers than smaller hospitals.  They have more market power. In areas where private insurers have greater market power, they are able to negotiate lower rates.

    Hospitals with strong market power today deploy it to command high prices from private health insurers because they can, even if they are non-profit. Their goal is to maximize revenues. The rates they charge private health insurers are not high because of Medicare rates. They seek the highest possible rates regardless of what Medicare pays them.

    Kaiser Family Foundation explains that “much of the literature suggests that providers negotiate prices with private insurers irrespective of Medicare rates, and that providers with substantial market power are best positioned to command high prices, allowing them to evade financial pressure to become more efficient.”

    Hospitals that operate efficiently manage with Medicare rates. MedPAC, the independent agency that provides Congress with policy advice on Medicare, believes that hospitals that claim they lose money on Medicare could do a better job of containing costs.

    The federal government could ensure the financial viability of hospitals if it enacted Medicare for all. Hospitals would be assured annual revenues through global budgets. And, they would save a huge amount in administrative expenses, largely from not engaging in hundreds of negotiations with private health insurers. Most important, health care spending would fall and everyone in the US would be guaranteed access to the health care they need.

    Here’s more from Just Care:

  • Hospital price transparency won’t make health care affordable

    Hospital price transparency won’t make health care affordable

    In our Kafkaesque healthcare system, people are told to make an “informed choice” of health insurance when not even the prices private health insurers pay hospitals are transparent. Beginning in January 2021, hospitals might be required to disclose publicly the prices they charge private health insurers, but that won’t make health care affordable or help people make a meaningful choice of health insurance. In sharp contrast, Medicare’s rates have always been publicly available; more important, costs are predictable and you can get the care you want.

    For decades, working-age Americans have had to choose almost blindly among health insurers, not having a clue as to what their copays would be if they needed complex care. Most people have relied on premium differences and provider network differences to make their choice. But, knowing that will not tell you your out-of-pocket costs if you develop a costly condition because hospitals charge private health insurers wildly different prices for people’s care.

    Most people do not realize that the differences in prices insurers pay could mean huge differences in their out-of-pocket costs if they need hospital care. Regardless, they have had no ability to see these prices. Until, perhaps, now. While hospital price transparency would be a step forward, it is not nearly enough to protect working people against high out-of-pocket costs. Unlike traditional Medicare, private insurers do not allow people to protect themselves against unpredictable costs with supplemental coverage.

    The US Department of Health and Human Services (HHS) is requiring hospitals to disclose their negotiated prices with insurers effective January 1, 2021. The American Hospital Association is fighting back, claiming that this requirement would violate hospitals’ First Amendment rights. As of now, the AHA is losing its lawsuit to keep hospital prices secret. The Judge in the case does not buy the First Amendment argument. Rather, he believes that disclosing hospital prices would empower patients to compare hospital prices.

    It’s not clear what good it would do patients to be able to compare prices. Hospital prices should be the same for everyone, much like restaurant prices and television prices. And, they should be reasonable. They should not be based on the hospital’s negotiating leverage with insurers, as they are today, which can drive prices through the roof. And, they should be public.

    But, disclosing prices will not rationalize them. For that, we need Medicare for All, which would ensure fair prices and guarantee everyone access to care with no out-of-pocket costs. At the very least, we need all-payer rate setting, with the government using the collective leverage of all Americans to negotiate the rates.

    Disclosing hospital prices might help people avoid some exorbitant health care charges. But, it will not help nearly as much as traditional Medicare helps, or Medicare for All, which has no copays. People have no control over how many doctors see them in the hospital or how many tests and procedures they receive. So, a hospital with higher prices could have lower total costs if it performs fewer procedures. There’s no way anyone could know that in advance.

    It’s time the federal government stopped proposing small bore fixes to out-of-control health care prices. Americans do not have choice when it comes to health care. It’s unaffordable. People face huge financial barriers to care. It is untenable and unconscionable. We need Medicare for All.

    Here’s more from Just Care:

  • Medicare helps reduce racial and ethnic disparities in health care but not nearly enough

    Medicare helps reduce racial and ethnic disparities in health care but not nearly enough

    In a recent piece for Health Affairs, Renee Landers et al. write about the role Medicare has played and can continue to play in reducing racial disparities. In a separate piece for the International Journal for Health Services, Gracie Himmelstein and Kathryn Himmelstein expose the disparities in health care literally rooted in the hospitals Americans use, disparities that Medicare in its current form cannot address. In combination, these pieces reveal the value of expanding and improving Medicare and the value of Medicare for all in addressing racial inequities.

    When Medicare was enacted in 1965, it played a major role in addressing racial and ethnic disparities in health care coverage and access to care. Hospitals  were required to desegregate in order to benefit from Medicare payments. But, even though virtually everyone over 65 has health care coverage, people with Medicare still experience disparities in access to care and health outcomes.

    Black and Hispanic people under 65 are far more likely to be uninsured than White people. Expanding Medicare coverage to everyone, or to people five to 15 years younger than 65, or allowing people to buy-in to Medicare, could all affect health and racial equity to different degrees. Medicare for all would help most in reducing disparities in affordability and access to care. Other options could help, but far less.

    Even with the same insurance coverage, both people of color over 65 and people of color with disabilities on Medicare have been found to have lower quality of care and worse health outcomes than White people. Out-of-pocket costs in Medicare create financial barriers to care. Many people do not know about Medicare Savings Programs and other programs that fill gaps in coverage.

    And, Medicare does not cover dental, vision or hearing care. These benefit gaps need to be addressed to further reduce disparities. So do social determinants of health, such as housing, food and education.

    We also need better data. Federally funded health plans are required to collect data on race and ethnicity for their enrollees. Privately funded health plans are not. The data collected needs to include quality measures. Then, equity outcomes could be tracked, including inequitable treatment.

    On top of guaranteed health care for all with full coverage and improved benefits, we need to address the inequitable distribution of health care resources in the US, which the Medicare for All bills in Congress are designed to do.  Gracie Himmelstein and Kathryn Himmelstein, MD show in a recent study that US hospitals serving people of color have poorer resources, including fewer capital assets, than other hospitals. Fewer resources are likely to mean poorer quality care.

    Hospitals with poorer resources do not tend to offer capital-intensive services as frequently as other hospitals. It might be possible to correct these inequities through an equalization of resources to hospitals.

    Himmelstein and Himmelstein also found that hospital segregation continues and big differences in  quality are evident. In 2010-11, three in four Black babies were born in one-fourth of US hospitals. Hospitals serving people of color have fewer nurses relative to patients, lower patient safety and higher hospital readmission rates, along with higher mortality rates for a number of conditions.

    In addition to improving and expanding Medicare, Medicare for all is designed to ensure an equitable distribution of resources among hospitals.

    Here’s more from Just Care:

  • Coronavirus: Why aren’t we talking about Medicare for all?

    Coronavirus: Why aren’t we talking about Medicare for all?

    Helaine Olen asks in a Washington Post opinion piece how it is that we can be in a pandemic and not talking about Medicare for All? After all, pre-coronavirus, the media and the pundits could not stop talking about Medicare for All. And, now, with millions of people losing their jobs and their employer coverage and millions more people with insurance unable to afford critical care, the moral, public health, and economic case for Medicare for All is all the stronger.

    Medicare for all is, in essence, an improved version of traditional Medicare for everyone in the country. For the typical American, it would feel like a better version of the insurance they have today. They would be able to continue to see the doctors they currently see if they wanted to. But, they would have no out-of-pocket costs for their care.

    Medicare for All  would include coverage for vision, hearing, dental and long-term care. Premiums would be based on income. And, everyone would have access to virtually all doctors and other health care providers, wherever they are in the US, with no prior authorization or referral requirements.

    What’s important to understand about Medicare for all is that all but the wealthiest Americans’ health care costs would go down, as would national health spending. We would save $600 billion a year in administrative costs and profits. And, annual prescription drug savings would be about $250 billion.

    But, Vice-President Biden does not support Medicare for All. Like many Americans, he says he prefers building on our patchwork system. As a small offering to progressives, he now supports lowering the age of Medicare eligibility.

    Mr. Biden also supports giving all Americans the choice of public health insurance, a “public option.” But, he doesn’t define what it would look like or indicate how it would work. The devil is in the details. Unfortunately, the evidence suggests that a public option–particularly a state-based option–would not bring down costs or guarantee people coverage.

    The novel coronavirus pandemic has pushed health care out of the spotlight. It has taken a crushing economic toll on the country. More than 40 million people are now unemployed. But, a lot of people are not going to the doctor if they can avoid it–to save money as well as to limit their exposure to other people.

    Personal health should go hand in glove with financial health. Without a doubt, the fight for guaranteed health care for all will rage on. Health care remains a top policy priority among voters. The pandemic has only highlighted and exacerbated the problems with our health care system, jeopardizing the wellbeing of Americans and taking a large toll on many hospitals and physicians.

    Unfortunately, members of Congress are still largely in the pocket of industry. And, they are promoting legislation that does not address our health care needs–affordability, equity, reliability, access, universality–guaranteed universal health care without barriers.

    At the same time, some 25 million Americans have recently lost their jobs and their health insurance coverage; many are now on Medicaid, but most remain uninsured. Insurers are dropping providers from their networks. And, there’s reason to believe that without Congressional action, insurance premiums and prescription drug prices will continue to soar.

    We need Medicare for All more than ever.

    Here’s more from Just Care:

  • Coronavirus: Boosting support for Medicare for All

    Coronavirus: Boosting support for Medicare for All

    A Morning Consult/Politico tracking poll conducted at the end of March finds that support for Medicare for All has increased significantly since the novel coronavirus pandemic swept through the US. A solid majority of Americans (55 percent) now support a government-administered health care system. Americans are seeing first-hand that no one is invulnerable to disease, and when people get sick, our broken healthcare system does not deliver what we need. 

    Net support for Medicare for All is now at 20 points, up nine points since February. Net support takes those opposed to Medicare for All, 35 percent of Americans and deducts it from those in favor, 55 percent.  

    Three in four Democrats support a government-administered single-payer health plan that guarantees people cradle to grave health care coverage for treatment from whatever doctors they want anywhere in the US. And, Medicare for All does away with virtually all out-of-pocket health care costs, including deductibles and copays. More than half of Independents (52 percent) support the plan. And, nearly one in three Republicans (31 percent) support it.

    The biggest boost to Medicare for All came from Americans with incomes between $50,000 and $100,000, voters between the ages of 45 and 54 and black voters. About 10 percent more people in each of these demographic groups support Medicare for All.

    Policymakers who support Medicare for All might now be able to move even more people in these demographic groups to support Medicare for All. Many still do not understand how Medicare for All would work. They also do not appreciate that while their taxes would go up to pay for their health insurance, their overall health care costs would come down significantly.

    Vice-President Biden has yet to call for Medicare for All though he has just called for expanding Medicare to people 60 and older. He mistakenly believes that we don’t need universal health care to effectively contain the spread of a global pandemic. He says that it would “not solve” the coronavirus crisis. But, that’s not the point. To be sure, you need strong leadership and a solid public health infrastructure as well as guaranteed health insurance for everyone to contain a pandemic. But, Medicare for All is a necessary if not sufficient prerequisite.

    Here’s more from Just Care:

  • Coronavirus: The US needs a strong public health system

    Coronavirus: The US needs a strong public health system

    Jeneen Interlandi writes for The New York Times on why the US, the wealthiest country in the world, cannot effectively respond to the coronavirus pandemic. We need a strong public health system, which we are sorely lacking at the moment.

    The US fails in so many ways on the public health front. Medical workers do not have the personal protective equipment they need. We don’t have enough hospital beds. We can’t test people broadly or diagnose cases quickly. Government does not have the data or capacity to track the spread of the virus. And, there is no consistent message at the federal level about what Americans should be doing.

    A hundred years ago, we were on a path to a strong public health system. And over the course of the last century, we were able to control most infectious disease outbreaks relatively quickly. We passed laws to protect our food, air and water. Life expectancy rose significantly from 50 years to almost 80 years.

    By the beginning of the 21st century, people seemed to forget that epidemics can happen and that health is a social concern as much if not more than a personal issue. We stopped spending significant money on public health. Almost one in four public health workers lost their jobs in the last 12 years.

    The result: Measles and syphilis are back. More teenagers are smoking. And more bacteria and lead contaminate our food and water supplies.

    Of course, if we invested in it, we could have a public health system in which we had real-time data collected from laboratories and hospitals in a single place, enough PPE, more hospital beds, an understanding of where resources need deploying and more. We just haven’t set it up.

    Last year, a group of public health organizations asked the federal government for $1 billion to improve our nation’s public health data infrastructure. They got $50 million. Recently, they received another $500 million. But, they need another $5.4 billion to build a strong infrastructure. And, the money needs to be distributed equitably. We now know that people of color are more likely to die from COVID-19 than white Americans.

    Science, not politics, should be guiding decision-making. We need public health for all, along with Medicare for all, if we want to be able to address the next pandemic effectively. We also need to recognize that profit-driven health care will not get us low-cost ventilators or vaccines. Without these resources, the global economy could sink.

    Health can no longer be treated as an individual choice. To protect our health and wellbeing, we need to act as a nation.

    Here’s more from Just Care:

  • Medicare for all would help us combat Covid-19

    Medicare for all would help us combat Covid-19

    [Editor’s note: This post was first published in KevinMD on March 21, 2020]

    In 2009, when more than $35 billion was invested in expanding national electronic health record (EHR) uptake, one of many advantages touted was its value as a tool for managing population health. This promise has failed to materialize due to a chaotic rollout of non-communicating systems. Today, as we confront COVID-19, the coronavirus wreaking international havoc, the need for such a tool is exquisitely evident.

    How could we do better? Real-time population-based clinical data is exactly what single-payer health insurance, or Medicare for all, would give us.

    Why, after more than two decades into the EHR era, are we still light years behind other industrialized countries with respect to having standardized clinical data available to public health officials? Our health databases are a mess. None of the EHR systems communicate with one another – because they’re not designed to do so. It’s not advantageous in our market-based health care system for companies or health care providers. Even if every EHR vendor agreed to share data tomorrow, the difficulties involved with managing confidentiality and merging information would require months to years of work.

    How did we get here? The answer is simple: profit and lack of transparency. Our health care system is built on profit and creates enormous disincentives to share data across EHR systems (“ interoperability”).  Health plans are interested in retaining their patients; sharing data may risk losing them to other plans. None of the companies peddling EHRs make data sharing a priority. Even organizations using the same EHR platform cannot readily share data. Thus, we have a deeply fractured health care system that includes only part of our population, cannot readily analyze population-based data, and does not place top priority on the nation’s health.

    What is the answer? Universal single-payer health care, or Medicare for all, would resolve the issue. It would cover everyone with the same high-quality health care regardless of income, and provide exactly the kind of timely clinical data needed to monitor and improve health. This kind of database is pivotal for disease outbreak investigation and containment. Our public health infrastructure is stymied by the lack of data needed to keep emerging infections at bay.

    Taiwan is an excellent example of epidemic control when the entire population is covered by universal single-payer health care. A small but populous nation with significant routine travel to and from mainland China (2.7 million visitors from China last year), Taiwan was expected to have the second-highest number of COVID-19 cases. However, as of March 14, 2020, they reported only 50 cases and one death. How did they manage this impressive pandemic control feat? Taiwan used its population-based EHR data, along with their immigration and customs databases, to identify and manage cases. They looked for cases that could have been missed, using their national health insurance database to find patients with severe respiratory symptoms who tested negative for influenza, and then tested them for COVID-19.

    Truly universal health care is not only a moral imperative, it is key to economic success and national safety. Our public health is at great risk, especially today. Medicare for all would have provided the data we so desperately need to track and intercede with COVID-19. It would reduce the severity of coronavirus. There would be universal first-dollar insurance — so nobody would face financial barriers to getting needed diagnosis and care. And, all doctors would use the same billing system, assuring that critical diagnostic data is quickly conveyed to public health authorities in a format that is immediately useful to track the epidemic and guide control strategies. Medicare for all is a crucial step to our nation’s health.

    Here’s more from Just Care:

  • Medicare for All would lead to a better performing labor market

    Medicare for All would lead to a better performing labor market

    A new paper by Josh Bivens at the Economic Policy Institute makes the case that there is no reason that Medicare for All would reduce the number of jobs in the US. To the contrary, he finds that Medicare for All could increase people’s wages and create better jobs, helping families. An important by-product of enacting Medicare for All would be a far better performing labor market.

    How could Medicare for All increase wages? If employers gave the money they currently spend on their workers’ health insurance premiums back to their employees. Today health insurance premiums account for 8.4 percent of a typical worker’s total compensation. Economists like Emanuel Saez and Gabriel Zucman are proposing that Medicare for All require employers to return  all (or most) of the money they currently spend on their workers’ health insurance premiums to their workers in increased wages. Even if they gave all that money to their employees, employers would save money as they would not have the administrative expenses associated with providing health insurance, although they would have higher payroll contributions for Medicare and Social Security.

    Why would jobs be better? Everyone would have good affordable health care and would not have to worry about taking a job that they didn’t want because Medicare for All allows them to get the care they need when they need it. People would also experience less anxiety when they lost their jobs or were between jobs because they would still have health care coverage. Also, they would not feel locked into their jobs, if they wanted to leave, because they would always have health insurance.

    With Medicare for All, people would be more inclined to create their own jobs. Small businesses could grow and flourish, as people at these businesses would not have to worry about health care costs. Right now, the US ranks at the bottom of OECD countries in terms of people who are self-employed, at 6.3 percent. Small businesses are extremely risky because of the cost of health insurance and health care. Countries with universal health care, such as France, Spain and Germany, have between 9.9 percent and 16.0 percent self-employment.

    Why would there be more jobs? No question, Medicare for All would cause a shakeup in the job market as 1.8 million people working for insurers and in medical billing are projected to lose their jobs. But, the federal government would be paying for more health care, including dental, vision, hearing and long-term supports and services, creating more demand for health care and more jobs in the health care delivery space. 

    In addition, Medicare for All legislation should include support to help people who had been working for insurers and in medical billing to find new jobs. It’s not as big a lift as some believe. The number of people who would lose their jobs if Medicare for All were to be enacted is relatively small. It is about one-twelfth the number of people who lost jobs in 2018, 21.5 million.

    Today, about 87 million Americans are uninsured (23 million) or underinsured (64 million).  And, the cost of ensuring that people get the health care they need continues to grow. Health insurance premiums rose 20 percent in 2019. Prescription drug costs grew 9 percent. Prices keep going up far faster than in any other developed nation. For that to end, the federal government must step in to set prices for health care, as it would with Medicare for All.

    Here’s more from Just Care: