What Democrats’ Medicare for All plans would mean for Michigan

hospital

What would Medicare for All mean for people in a state like Michigan that has a relatively low uninsured rate, a mix of urban and rural communities, growing Medicaid rolls, sluggish personal income growth and a still-dominant automotive industry that offers decent benefits? (Shutterstock image)

When Lee Green hurt his back and lost the ability to move his left leg, doctors had him up for an MRI within four hours and in surgery within six hours. 

His total bill for costly care that cured his temporary paralysis and has him back on his mountain bike: zero dollars. 

Eight years ago, Green moved from his native Michigan to Canada, where the country’s government-run insurance system guarantees health care for all residents without premiums, deductibles or co-payments. It’s not without its faults, including long wait times for some specialist visits, but “I would say between Canadian problems and American problems I will definitely take Canadian problems,” Green told Bridge Magazine. 

He has a unique perspective. The 61-year-old has not only been a patient in both systems, he’s a physician who chairs the Department of Family Medicine at the University of Alberta, which he joined after a 26-year career at the University of Michigan. 

“It’s much simpler in Canada: You go in, and you get health care. You don’t get the bill,” he said. “Nobody up here pretends that it’s free. We are all quite well aware that we pay for it in taxes, but the view of it in Canada is that’s just a fairer and more sensible way to do it.”

Lee Green

“It’s much simpler in Canada: You go in, and you get health care. You don’t get the bill,” said Lee Green, a physician who chairs the Department of Family Medicine at the University of Alberta, which he joined after a 26-year career at the University of Michigan.

As the Michigan presidential primary nears on March 10, single-payer health care systems like Canada’s are the subject of renewed focus as Democratic presidential hopefuls Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts push plans for government insurance programs they’ve dubbed Medicare for All. Sanders traveled from Detroit to Windsor with diabetes patients last year to highlight high prescription drug prices in the United States.

Other Democratic presidential candidates including former Vice President Joe Biden, former South Bend Mayor Pete Buttigieg, Sen. Amy Klobuchar of Minnesota and former New York Mayor Mike Bloomberg prefer to build upon the 2010 Affordable Care Act by creating a “public option” plan to compete with private insurers and inch toward universal coverage.

But with per capita health care spending in the U.S. ranking tops among developed nations and performance ranking last among peers, Democrats on the progressive left are proposing a wholesale overhaul of a private system Sanders called “insane” during this month’s presidential debate.

What would Medicare for All mean for people in a state like Michigan that has a relatively low uninsured rate, a mix of urban and rural communities, growing Medicaid rolls, sluggish personal income growth and a still-dominant automotive industry that offers decent benefits?

Yes, you’d pay higher taxes

What Sanders and Warren are proposing is “not really Medicare — it’s entirely free health care,” said Dr. Eric Larson, a practicing  anesthesiologist and clinical assistant professor at Michigan State University. 

“Traditional Medicare just covers things like hospital charges, and so if you want to get doctor visits and other things covered, you actually have to pay out of pocket.”

Eric Larson

What Sanders and Warren are proposing is “not really Medicare — it’s entirely free health care,” said Dr. Eric Larson, a practicing  anesthesiologist and clinical assistant professor at Michigan State University.

That’s why many residents older than 65 who now qualify for Medicare, more than 1.5 million residents in Michigan, purchase supplemental insurance coverage to combine with their public plan. In 2016, seniors nationwide spent an average of $3,785 on Medigap, premiums for privage supplementary insurance.

Sanders and Warren promise a more robust version of Medicare that everyone of any age would qualify without any co-pays, premiums or deductibles. Private insurers could still offer supplemental policies, but not for services covered by the government-run plan that would include comprehensive medical, dental and vision.

Creating that kind of a system would be expensive. While estimates vary, economists have generally predicted a price of more than $30 trillion over 10 years to implement and operate a single-payer health care system in the U.S. 

In comparison, the federal government spent about $750 billion on traditional Medicare in 2018, and about $597 billion on Medicaid.

The Warren campaign says her plan would require $20.5 trillion in new spending over a decade, and a trio of economists who helped her develop it, including University of Michigan public policy and economics professor Betsey Stevenson, say she could pay for it without directly raising taxes on the middle class. 

Her proposed “wealth tax” on the top 1 percent of earners would generate about $3 trillion over that span if enacted, they estimated. The largest chunk — an estimated $8.8 trillion — would come from a proposed employer contribution, while large corporations ($2.9 trillion) and financial firms ($900 million) would see additional new taxes. 

Businesses that now sponsor health insurance for their employees would be required to pay an equivalent or slightly lower amount to the government for Medicare for All. Their total tax would depend on their number of employees.

Sanders has been less specific about funding but has laid out several options to pay for Medicare for All, including a 7.5 percent employer-side payroll tax, a 4 percent “premium” on household incomes, a wealth tax and a more progressive income tax that would push higher rates on bigger earners.

Total costs may fall

That’s a lot of new taxes, but Medicare for All supporters say it would ultimately reduce total expenses for most businesses and families because of efficiencies created by a single-payer system.

Biden, who opposes Medicare for All, argues it would be impossible to implement without middle-class tax increases.  One payment option floated by Sanders would impose a 4 percent “income-based premium” on households making more than $29,000 a year. That would raise taxes on the middle class, but Sanders contends they’d ultimately save by paying less in premiums, co-pays and deductibles. Experts say the total impact on families will depend on the final tax structure.

Experts at the Political Economy Research Institute at the University of Massachusetts-Amherst estimated a middle-income family with two adults, one child and $60,000 in salaries would save $1,570 a year on health care compared to employer-sponsored insurance, or $8,385 compared to individual coverage. 

But taxes would increase for more affluent families who now have private insurance, according to PERI. A family making $221,000 could effectively pay an additional $8,520 a year, and a family making $401,000 could pay an additional $22,340 for health care.

Academic analyses of single-payer health plans for the United States or individual states tend to project that health spending would fall in the first year and suggest the potential for long-term savings, according to a review published this month in the Public Library of Science medical journal.

That’s largely because of predicted efficiencies. The government would centralize insurance administration and have widespread bargaining power to negotiate prices with pharmaceutical companies and medical providers. That’s why it’s called a single-payer system. 

Under the Affordable Care Act, private insurers are allowed to spend up to 20 percent of customer premiums on administration.  By contrast, administrative costs account for roughly 4 percent of traditional Medicare spending, according to researchers from the Mercatur Center at George Mason University who predict 6 percent administrative costs under Medicare for All.

Single-payer health care would cut “overhead” on the provider side because doctors and hospitals would no longer need an “army of billers” to collect payments, said Abdul El-Sayed, a doctor who ran for Michigan governor in 2018 and is now a senior adviser to the Medicare for All NOW advocacy group.

And it would cut overhead on the insurance side by eliminating marketing budgets and CEO salaries, he said, noting the state’s largest insurer, Blue Cross Blue Shield of Michigan, paid CEO Daniel Loepp $19.2 million in total compensation in 2018. 

“Those two things are so critical in terms of bringing down the cost of health care immediately and also reducing the accelerating costs of health care that has frozen so many people out of the system,” said El-Sayed, who proposed a state-based version of Medicare for All in 2018.

Despite administrative savings, a smaller number of researchers predict total health care spending could still increase under Medicare for All because of increased demand for services by newly-insured residents. And skeptics fear the bloat of federal management. 

“Traditionally when it comes to any sort of government program in general, you don’t see any sort of efficiencies gained by centralizing anything,” said Larson, the Grand Rapids anesthesiologist who hosts a popular podcast called Paradocs. “And probably it would be worse.” 

More people would be covered

Michigan residents who still lack health insurance –  an estimated 535,000 as of 2018 –  would be among the most immediate beneficiaries of Medicare for All. 

According to U.S. Census data, Michigan was one of only eight states that saw its uninsured rate rise that year, the most recent for which data are available. 

But the state’s uninsured rate of 5.4 percent was still well below the national average of 8.9 percent. That’s largely because Michigan expanded Medicaid eligibility under the Affordable Care Act. More than 2 million state residents are now enrolled in Medicaid, including more than 650,000 who obtained coverage through the Healthy Michigan program.

Roughly 51 percent of Michigan residents get health insurance through their employer, according to a Kaiser Family Foundation analysis. An additional 22 percent have insurance through Medicaid, 15 percent Medicare and 5 percent have non-group plans, including less than 300,000 people who enrolled in plans through the federal Obamacare exchange.

But even residents with insurance can have “inadequate” coverage, said Michigan State University bioethicist Leonard Fleck. Their “bare-bones” plans may require deductibles as high as $5,000 for an individual or limit treatment to a small set of providers. 

Medicare for All would be a “net benefit in the sense that essentially everybody is covered with a relatively comprehensive package of health care benefits,” Fleck said. “That’s in contrast to what we have right now.”

Transitioning to a single-payer health care system would require ethically, politically and economically “painful” decisions, he said, noting policy makers would have to decide the scope of the benefit package and effective cost controls. 

For instance, traditional Medicare now covers expensive cancer treatments that can prolong lives but not save them. Should the government pay for that kind of care? Or limit access but give patients more ability to purchase separate supplemental policies for extra benefits?

“If Medicare for All is going to be affordable, then the package of benefits that we would offer to everybody is going to have to be limited in some way,” Fleck said. 

Even if you like your private plan, you’d lose it

Nearly 5 million Michigan residents now get health insurance through their employer, and “to just take that all away one day and say, ‘We’ve got this thing we think is going to work’” would be a mistake, said Jeff Romback, deputy director of policy and planning for the Michigan Association of Health Plans, which represents insurers. 

Medicare for All is “sounds great until you get to the nitty-gritty details,” he said.

Unionized auto workers in Michigan have bargained for particularly generous employer-sponsored plans, and if the government decides it can’t spend as much on everyone under Medicare for All, those autoworkers could end up with inferior coverage, Fleck said, the MSU bioethicist. 

“It might not be a huge decline in terms of the range of benefits, but it would be a decline,” he said. “And workers could justifiably object that that was a price they would have to pay in order to help other people who had no insurance or were underinsured.” 

Prior to the latest round of contract negotiations, UAW workers paid about 3 percent of their own health care costs, compared to 28 percent for the average U.S. worker. Ford said full-time hourly workers represented by the UAW did not pay any premiums or deductibles.

El-Sayed

"It shouldn’t have to be that you bargain for your simple right to see a doctor,” said Abdul El-Sayed, a doctor who ran for Michigan governor in 2018.  He noted that General Motors temporarily froze health benefits for auto workers who went on strike last year.

“I’m proud of that too, but it shouldn’t have to be that you bargain for your simple right to see a doctor,” said El-Sayed, a local UAW writers union member who noted that General Motors temporarily froze health benefits for auto workers who went on strike last year.  “If it’s that easy to take way, then it’s not as guaranteed as you might think,” he said. 

Public surveys suggest the popularity of Medicare for All nosedives when respondents are told they would lose their ability to purchase private insurance. Michigan polling commissioned last year by the Detroit Regional Chamber, showed 52 percent of likely Michigan general election voters opposed eliminating private insurance in favor of a Medicare for All system.

In a follow-up poll, whose results were released Monday, Glengariff Group Inc. presented 600 likely Michigan voters with a suite of health care reform ideas. 

Roughly 20 percent of all voters and 23 percent of Democrats surveyed chose Medicare for All, but a majority prefered “more moderate options,” including a public option or other changes to the Affordable Care Act, said pollster Richard Czuba. “This is a policy limb that Medicare for All supporters are out on.”

Warren has sought to calm voter fears by proposing a multiyear transition. Like more moderate Democrats, she would first try to expand the Affordable Care Act, create a public option and allow anyone over 50 years old to enroll in a more robust Medicare program.

Under Medicare for All, Michigan businesses would no longer have any need to provide or pay for employee health insurance. Instead, they’d pay new taxes to finance a single-payer system that would cover everyone.

That just shifts the cost and leaves taxpayers who can’t afford the new bill subject to federal penalties, said Brian Calley, the state’s Republican former lieutenant governor who now serves as president of the Small Business Association of Michigan.

Calley

Brian Calley, the state’s Republican former lieutenant governor, said Michigan business owners are wary of a federal health care takeover because “the last time the government tried to help with the ACA, it increased the cost and reduced the quality of coverage” for small businesses and their employees.

Sanders and Warren both include small business exemptions to the new taxes they are proposing, but Calley said Michigan owners are wary of a federal health care takeover because “the last time the government tried to help with the ACA, it increased the cost and reduced the quality of coverage” for small businesses and their employees.

“History would show that it increases costs, and there's literally nothing anybody can do to affect that cost. You just have to pay what the government tells you you have to pay,” Calley said. 

Work for a health insurer? You’d need to find a new job

Private health insurance firms will face “virtual elimination” under Medicare for All, according to an analysis by the Political Economy Research Institute that highlighted other “formidable challenges” including reduced income potential for physicians and increased demand for services.

That could mean thousands of job losses in Michigan. Blue Cross Blue Shield of Michigan has more than 8,100 employees. The Michigan Association of Health plans represents other insurers like Aetna, Health Alliance, Meridian and Priority Health that have more than 7,600 employees combined. 

“And we pay our fair share in taxes,” said Romback, whose association estimates that its members paid their Michigan employees a combined $753 million in 2017 and contributed $4.2 billion to the state economy. 

In this month’s debate, Sanders said he would spend “many billions of dollars” on a worker transition program providing up to five years of income and job training opportunities for private insurance employees who lose their jobs. Warren supports a similar effort. 

Supporters argue a government-run insurance program would stimulate the economy and create jobs in other areas, including the provider side of the health care industry, which would see increased demand from newly insured patients. 

“Jobs will be there, they’ll just look different,” El-Sayed said. “I think it’s best that the money we spend in health care goes to actually providing care rather than denying people the health care they already paid for.”

Laura Appel

“We can’t have everybody pay 90 cents of every dollar of cost and keep our system afloat,” said Laura Appel, senior vice president at the Michigan Health & Hospital Association. “There would be a number of organizations who would find it difficult to stay open. I’m not talking about hospitals, particularly — there’s all kinds of providers that are beyond hospitals.”

Care could change

Michigan hospitals are wary of the proposed transition to a single-payer health care system because they do not know what rates the federal government would pay. 

Traditional Medicare generally pays “below the cost of delivering services,” said Laura Appel, senior vice president at the Michigan Health & Hospital Association.

Medical providers rely on a “delicate balance” of commercial payers, Medicaid payments, nonprofit contributions and other revenue sources to pay their bills, Appel said, predicting hospitals, clinics and other providers could close if the federal government implemented a single-payer system that forced them to subsist on only traditional Medicare rates. 

“We can’t have everybody pay 90 cents of every dollar of cost and keep our system afloat,” Appel said. “There would be a number of organizations who would find it difficult to stay open. I’m not talking about hospitals, particularly — there’s all kinds of providers that are beyond hospitals.” 

Sanders’ proposed legislation does not specify reimbursements rates, but experts project the federal government would need to significantly increase traditional Medicare payments to avoid driving medical providers out of business.

Assuming rates are made sustainable, Medicare for All could be a “complete revolution” for hospitals and clinics in northern Michigan that are struggling to keep their doors open because of dwindling populations, said Green, the University of Alberta professor who has researched rural care in both the U.S. and Canada. 

“They’d be able to afford their doctors and staff. That makes it a great deal easier to keep your clinic open and buy supplies. By simply making every patient a paying patient, if you will, that would eliminate most of the problem.”

In rural Canada, it’s “a matter of policy” that health care be available to all residents, Green said. Hospitals are not paid by the number of cases they admit. Instead, they receive a “global budget” to ensure operation regardless of patient volume, he said. That means medical providers don’t have to worry whether they can afford to practice in remote areas. 

Doctors in remote parts of Canada still face challenges, including a lack of creature comforts and difficulty finding suitable jobs for spouses, Green said. “But you can at least concentrate on those issues and try to come up with solutions if you’re not down to the bare survival level of just trying to keep the doors open.”

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Comments

Kevin Grand
Mon, 01/27/2020 - 7:43am

Mr. Kurth wrote on another piece this morning, "Truth may be subjective, but facts aren’t. "

We were told about a decade ago that another government-ran health care plan would result in savings up to $2,500/American. That if we liked our doctor, we could keep them. If we liked our plan, we could keep it.

How well did THAT "promise" work out?

Did rates decrease? Did deductibles fall? How many people actually were able to keep their plan?

And if you want to compare government-ran health care plans, why not do a piece on the NHS over in England?

I'm certain that people would love to hear about waiting in the backs of ambulances or stacked along the hospital walls like cord wood waiting for treatment?

What about the waiting to see if the government will actually treat you, or if their actuaries determine that your treatment ISN'T worth the cost to the state?

Does Baby Gard ring a bell?

Be honest
Mon, 01/27/2020 - 9:05am

Those were not lies. The Republicans sabotaged and continue to sabotage the wildly popular ACA. If you don't like the ACA, the problems were and continue to be caused by greedy Republicans who prefer to pay insurance companies, hospitals, big pharma and all their CEOs. Stop spreading lies yourself.

Avenged
Mon, 01/27/2020 - 11:40am

some were lies from the start- not sabotaged like the you can keep your doctor or your plan. My last employer stopped offering insurance due to us being able to get it on the market and our doctor did not accept the plans :(

Disagree
Wed, 01/29/2020 - 8:06am

So your employer lied. Makes no sense to have health insurance based on what your employer deems to give you. Your problems don't happen with Medicare.

Jeff
Mon, 01/27/2020 - 1:52pm

I got to witness the failure of the ACA first hand, before the Republicans had done anything. My employees signed up for a plan they chose. The third month's premiums doubled from the advertised premiums when they signed up. Yet everything else stayed the same. It was cheaper for them to pay the penalty every year as the $900 was only 2 to 3 months of premiums. One employee switched plans 5 times and it was the same result every time. There was never to be any savings. Additionally, if a business chose to keep its plan for their employees, they had to pay an "special insurance fee" of $150 per employee, all due on the first of every year to help cover costs of the plan. It was never wildly popular, it was widely depressing by the end of the second year as costs went up substantially, instead of saving anyone any money.

Rocky
Wed, 01/29/2020 - 8:15am

It was a slow start and insurance companies tried as they always do to exploit the system before changes could take place. My auto insurance rates just went up again, even though they will supposedly go down next year when the new law takes effect. Now the ACA is wildly popular despite the Republican and Trump promises to give us something better. Watch the video of Trump with his campaign promises and his actions regarding affordable healthcare, not to mention entitlements:
https://www.cnn.com/2020/01/23/politics/donald-trump-medicare-entitlemen...
HE is the biggest liar. NO president in the history of the US has ever come close to his habit of lying. He is literally incapable of telling the truth about anything. Since elected he has made over 16,000 false or misleading claims!
https://www.washingtonpost.com/politics/2020/01/20/president-trump-made-...
I know "fake media" LOL Was that his first lie?

Bones
Mon, 01/27/2020 - 9:40am

>We were told about a decade ago that another government-ran health care plan would result in savings up to $2,500/American. That if we liked our doctor, we could keep them. If we liked our plan, we could keep it.

And socialists like me were warning you all that a market-based solution like the ACA would have these exact problems because healthcare is inelastic.

>How well did THAT "promise" work out?
>Did rates decrease? Did deductibles
fall? How many people actually were able to keep their plan?

It went poorly, not because the government was involved, but because the profit-motive was not excised. Certainly the GOP kicking all the legs out from underneath the program didn't help either, but why would you be intellectually honest when discussing the failure of the ACA?

>And if you want to compare government-ran health care plans, why not do a piece on the NHS over in England?

Because M4A isn't like the NHS? Because the NHS has been gutted by the Tories and New Labour for years? Yeah, let's fear-monger over a system that's been devastated to bring it more in line with the US' profit-based model.

>I'm certain that people would love to hear about waiting in the backs of ambulances or stacked along the hospital walls like cord wood waiting for treatment?

As opposed to the hundreds thousands who aren't waiting in ambulances and waiting rooms because the prospet of a lifetime of medical debt prevents them from even seeking treatment?

>What about the waiting to see if the government will actually treat you, or if their actuaries determine that your treatment ISN'T worth the cost to the state?

As opposed to waiting to see if an unaccountable bureaucrat denies your treatment because it's in the shareholders' best interest?

Why should the prescriptions we take be dependant upon on the insurance company? Why should the surgeries our doctors perform be dependant on the insurance company? Why do we annually pump exorbitant amounts of money into the health insurance industry, a middleman that provides absolutely nothing productive to the healthcare process? Why is a lifetime of unpayable debt an acceptable outcome in the richest country on earth?

interested
Mon, 01/27/2020 - 10:47am

Those are very astute observations.

Kevin Grand
Mon, 01/27/2020 - 3:08pm

"And socialists like me were warning you all that a market-based solution like the ACA would have these exact problems because healthcare is inelastic.
...
It went poorly, not because the government was involved, but because the profit-motive was not excised. Certainly the GOP kicking all the legs out from underneath the program didn't help either, but why would you be intellectually honest when discussing the failure of the ACA?
...
Because M4A isn't like the NHS? Because the NHS has been gutted by the Tories and New Labour for years? Yeah, let's fear-monger over a system that's been devastated to bring it more in line with the US' profit-based model."

Glad to see you chime in with a cogent argument for a change, Bones.

This plan was all done by the democrats, you cannot place any blame on the republicans here for the end result. It was also contingent upon "The stupidity of the American Voter". Those aren't my words, they're the words of Jonathan Gruber himself.

https://www.forbes.com/sites/theapothecary/2014/11/10/aca-architect-the-...

Were any of the obvious problems addressed before its implementation?

Nope.

The democrats jammed it through via reconciliation and the rest is history.

"As opposed to the hundreds thousands who aren't waiting in ambulances and waiting rooms because the prospet (sic) of a lifetime of medical debt prevents them from even seeking treatment?"

And to see who is to blame for that, look again at what happened to insurance costs and deductibles. Again, they rose due to an ill-conceived proposal jammed through via the democrats.

"As opposed to waiting to see if an unaccountable bureaucrat denies your treatment because it's in the shareholders' best interest?"

So, when the US Government is the ONLY insurance provider, how is this any better again?

"Why should the prescriptions we take be dependant (sic) upon on the insurance company? Why should the surgeries our doctors perform be dependant (sic) on the insurance company? Why do we annually pump exorbitant amounts of money into the health insurance industry, a middleman that provides absolutely nothing productive to the healthcare process? Why is a lifetime of unpayable debt an acceptable outcome in the richest country on earth?"

This is going to come as a shock to you, but I actually agree with most of what you posted.

Considering how much money the US Taxpayer has shelled out to prop up big pharma's R&D for years now, Americans should have the lowest cost drugs on the planet hands down. I also don't agree with how hospitals bill patients. Medications, treatments and surgeries should all cost the same across the board for all patients. They shouldn't be dependent upon how well an insurance company negotiates it rates. You don't see this at a restaurant or retail store, so why should a hospital be any different?

Matt
Mon, 01/27/2020 - 7:25pm

Once again Bones our existing medical system has nothing to do with the "Market". In only a very few areas is this anything near true - cosmetic surgery for one. (which incedentaly have not experienced the price inflation the rest of the sector has.)This requires interested parties on both side negotiating what they'll provide and what they'll pay. This does not exist nor has it for 50? years.

JK
Mon, 01/27/2020 - 1:47pm

I know you're going to find this incredibly hard to believe, but my family's health insurance costs did go down, after the markets stabilized. For the past couple of years, we were paying about what we paid before the ACA, which isn't terrible given that there should have been some inflation at a minimum. The reductions we saw year-to-year were especially surprising given that, for years, we'd seen nothing but increases, both pre-&post-ACA. But now, thanks to the buffoon in the oval office telling healthy young people they don't have to get coverage any more, and court cases ruling the ACA unconstitutional, there is so much instability in the market again that our premiums increased for 2020 by $155 per month. The days of blaming Obama and the ACA for high costs are over. The GOP has had 3 years to fix what they claim is a broken system, but all they've done is increase my costs by undermining the system and adding uncertainty back into the market. Trump's rambled on and on about how he'll provide the best insurance at the lowest costs, but all he's done is increase my costs. I'll take someone will to work toward an unrealistic ideal over empty promises any day of the week.

Thanks
Tue, 01/28/2020 - 10:34am

Your experience and analysis are exactly the same as mine and everyone I know.

Thanks
Mon, 01/27/2020 - 9:00am

Great article, very in depth. I must say that wait times for specialists in the US are usually many months, sometimes less, if you are already a patient with that physician. It's not necessary worse in other countries. In most European countries, you are entitled to social medical care, but you can pay to go to a private doctor out of the system if you choose. Most people don't and are very happy with the care they receive. As you can imagine, even paying out of pocket for care there is not nearly as expensive as here. NO ONE there loses his or her home because they can't pay for healthcare. It's ridiculous to maintain our current system to protect the jobs of people working in the insurance industry. Those people should retrain and work in the healthcare industry, no one cries for the demise of the blacksmith industry.

Of all the Democrats running, Biden is the worst. Naturally, Biden is being pushed on the American public by Republicans, Democratic Corporatists DINOs, and of course the corporate mainstream media. If Biden gets the nomination, it will be four more years of Trump. The match will be 2016 all over again, the choice between two evils, with Biden winning the popular vote and Trump the rigged electoral college.

All weekend the media has been saying how Democrats most likely to vote, old people, prefer Biden. These old people are the same people who fear their private insurance will be taken away. These are the retired or almost retired union workers who are happy with their hard fought for insurance benefits. The vast majority of Americans do not have those benefits.

Younger Americans, under age 40, will not vote if there is no reason. Biden is not Obama. Biden is old, tired, and CORRUPT, corrupted by corporate America and tied to a HUGE scandal where his son got special favors.

The only way to beat Trump is to have a candidate that excites ALL Democrats and perhaps some independents. Otherwise people will stay home. Sadly the result will not just be four more horrific years with Trump, but 50 years of fascist rule under all the judges that Trump has appointed and will continue to appoint.

This is the most crucial election of our times and ANY Democrat will be better than Biden. Please, Democratic establishment, don't do this to us again!

Medicare for all OR Medicare for all who want it are both fine for now. Just don't make us have to choose between Trump and Biden. Either way we all lose, especially if voter turnout is too low to flip Senate seats!

Michael Houseman
Mon, 01/27/2020 - 9:26am

This push for socialism is horrific. Obama with his "if you like your plan, you can keep it," hasn't worked out very well. The continual assertion that it will be better if everyone is included is a fabrication. No country that has adopted socialized medicine is better off for it. Socialism has failed in every country, and either the country has moved away from it or suffered for increasing it. Every socialist program that has been tried in the United States has caused problems, such as social security, because socialism is a Ponzi scheme meant to entice ignorant people. If Obamacare hasn't worked out why would a single payer Ponzi scheme work any better.

Oy vey
Mon, 01/27/2020 - 10:44am

See Be Honest's reply! People say we should feel bad if the insurance industry is hurt. That's about as sad as the lobbyist industry disappearing. Of course these problems are much bigger than Trump, all republicans and their lobbyists are complicit in wanting Americans to die prematurely, painfully, and penniless, leaving their families in total despair and hopeless.

Rork
Mon, 01/27/2020 - 10:52am

It works in many European countries for around half the cost. If we want to spend a bit more than they do we could make it slightly better. How can some people ignore the fact of these examples of how it works?

Paul Jordan
Mon, 01/27/2020 - 12:17pm

This is nothing but right wing propaganda.
The reality is that the people of every European social democracy are better off than the people of the United States. This is due in no small measure to their government run universal health care systems.
Check out the differences in health care outcomes, life expectancy, and cost per person.

Bones
Mon, 01/27/2020 - 12:55pm

Everything about this comment is so remarkably uninformed that I'm not even sure how to go about addressing it. The ACA was not socialist; neither is M4A. Pretty much every country with socialized medicine reports lower costs and better satisfaction. As far as Ponzi schemes go, I have some bad news for you about how capitalism works, vis a vis accumulation. If you can look at a major corporation where the CEO is paid hundreds of times what their low level employees make, and not see a Ponzi scheme, then I don't know what to tell you

Mark
Mon, 01/27/2020 - 9:51am

I laughed out loud at the statement "That’s a lot of new taxes, but Medicare for All supporters say it would ultimately reduce total expenses for most businesses and families because of efficiencies created by a single-payer system."
There is nothing efficient about Government run anything and you are kidding yourself if you think this will actually happen. And depending on who is saying it, is really more of an outright lie.

study history
Tue, 01/28/2020 - 10:46am

We are still benefiting from New Deal work projects thanks to the government. We the People do great work when Republicans take their greedy hands and step aside, stop breaking things.

Steven Martin
Mon, 01/27/2020 - 9:56am

Job losses for private insurance company workers whose job it is to handle paperwork and deny claims is worth dramatic increase in those covered and delivery of good care to everyone. There are ways to move workers who lose their jobs into new ones or provide retraining opportunities. The “moral injury” affecting treatment under the current system and the picking off for coverage the healthier among us must stop or the whole system could eventually collapse. Medicare for all would put us on the path to improving care for everyone, just like most other wealthy and developed countries in the world.
Regarding tax hike. The rich will pay more and the deductibles and co pays which are hidden taxes the insured pay now will be dedicated to the new system. Anyone who pushes the tax increase argument is pushing the insurance companies talking points. They care only about profit

Gretchen
Mon, 01/27/2020 - 10:05am

I continue to see, every time there's a mention of "Medicare for All" and reference to the Canadian health care system, about the "long waits" when seeing a specialist. This last year here in the US, I've been sent to , local and in and out of network "specialists" by my doctor. I don't know what the "wait time" in Canada may be, but in my own experience with the same scheduling experience here in southwest Michigan, between the time of diagnosis and my GP or myself calling to schedule an appointment with a specialist, I have yet to have an appointment that hasn't been "out" less than 4 weeks and up to 8 weeks. My appointments have not been for an "emergency", just a visit for consultation, exam, and them possible tests and scans. Am I happy I usually have to wait that long? No, I'm not, but I have also had some experience with the Canadian system and have had lesser "wait times", but never more than 4 to 5 weeks. Healthcare is never free, but when I look at the bills, even after the "discounts" my insurance takes off, the costs are mind-boggling and we should be able to do better by our people. There is no such thing as a "non-profit" healthcare system anywhere in this country. We pay some of the highest prices in the world, and many are bankrupted in trying to pay for surgery, prescriptions, etc. and that's not right. Single-payer will have a cost, but not the cost our current system puts on those with and without health insurance. We need to try something else. Is the ACA perfect - no, but it was a starting point for many who had no healthcare opportunities. Will you have it or nothing if you support single-payer? NO - there (may be) continuation of employer insurance for those who want to continue/subscribe (if your employer continues it). I believe those with more income will have access to other options, but no one will be "forced" into an all-or-nothing" situation. Quite the scare tactics! Remember the scare tactics that continue today about the ACA?? It's better than what we had or didn't have, especially for those with no workplace insurance options, and it worked better than no healthcare at all for millions!

middle of the mit
Wed, 01/29/2020 - 8:12pm

I agree with you wholeheartedly.

And for the conservatives out there poo pooing the ACA, the only thing that differs from the Heritage Foundation Plan that Newt Gingrich put out in the 90's and the one that Mitt Romney passed in Massachusetts is that insurers have to spend 80% of premiums on actual healthcare.

https://www.forbes.com/sites/theapothecary/2011/10/20/how-a-conservative...

https://www.youtube.com/watch?v=TTByvLtYIYA

Here is Mitt telling you how he feels about the individual mandate and how far he would go to make people comply.

https://www.youtube.com/watch?v=fCZ8vK2oByU

And here is a rep from the Heritage Foundation telling us about health insurance portability. And how they will forge new foundations across the nation.

Here is my personal story.

I had to have surgery only a few times in my life. The latest was in the early 2000's, I didn't have a primary doctor at the time so it took almost 2 months to get an appointment to get a doctor. Then it took another 6-8 weeks to get an appointment with a specialist. Then another 4 weeks to get to the surgery I needed. It wasn't life threatening surgery but it sure did cut down on my ability to do my job.

I have had life threatening reasons to go to the ER since. All within the last few years. And even though I live in N MI, I didn't have to wait at all. It is a most serious case goes first system. Always has been and SHOULD ALWAYS BE.

The thing that gets me about this article are two things.

1)What Sanders and Warren are proposing is “not really Medicare — it’s entirely free health care,” said Dr. Eric Larson, a practicing anesthesiologist and clinical assistant professor at Michigan State University.

“Traditional Medicare just covers things like hospital charges, and so if you want to get doctor visits and other things covered, you actually have to pay out of pocket.”

Medicare does cover healthcare for your doctor. It is called Medicare part B. So this doctor either doesn't understand what he is talking about or he is pulling your strings. Which wouldn't surprise me at all. The next time you to the doctor, ask them how much the procedures or medicine they are prescribing or proscribing cost. My experience? They don't know and they don't care. You will told to ask billing. Though to my new doctors benefit, he will at least try to look it up and find out.

The reason most seniors choose Medicare advantage and pay MORE out of pocket is because it covers dental and vision. Put that into Medicare and you see most of them leave.

2)Experts at the Political Economy Research Institute at the University of Massachusetts-Amherst estimated a middle-income family with two adults, one child and $60,000 in salaries would save $1,570 a year on health care compared to employer-sponsored insurance, or $8,385 compared to individual coverage.

I thought conservatives told us we would get better plans and better prices if we individually negotiated for prices with our insurance companies. Yet from these numbers, while I understand that the employer is paying more than the individual, I think conservatives have forgotten the free market principle of bulk purchasing. The more you buy, the better deal you get. And if people are allowed to group together they will get a better deal. That is how business gets a better deal than individuals.

If that doesn't make any sense to you, then start purchasing the smallest amount of what you need at the amount you need it. It doesn't matter what it is. Buy the small package of hamburger but buy five of them instead of one 5lb package.

It's time for you conservatives to put your money where your talking points are.

In Global, elitist, quasi monopolistic international corporations.

3)When Oblameocare was first introduced, some Obama supporters turned Republicans in my friends circle were furious. Government forcing us to buy health care. But they were always complaining because they needed to see a doctor but didn't have or couldn't afford insurance.

My question to them?
"Would you pay a 2-3% sales tax if it allowed you to see a doctor with a small deductible or co-pay?"

The answer?

"Hell ya I would"

How would you interpret that?

Jean
Mon, 01/27/2020 - 10:14am

Michael Houseman
You would do well to look up all that Socialism actually provides in Michigan. I'll wager you've NOT a clue.

Bob Shishka
Mon, 01/27/2020 - 10:19am

Anyone currently benefitting from the disastrous FOR PROFIT health care system in this country ( see Danny Loep, CEO of BCBS of Michigan) OF COURSE will scare monger the living hell out of the peasants. The system, as it is, works just fine for THEM. This article was LOADED with “ be afraid.... be very afraid” comments designed to plant seeds of doubt. These individuals are prepared to fight for the status quo & right now Bernie Sanders has them ALL very worried.... to which I say, “ Good”! By the way... Wasn’t Governor Gretchen Whitmers’ father the CEO of BCBS of Michigan at one point in time? And didn’t the current CEO ( friend of the Whitmer family) reach out to her and advise her to run? Yeah.... no conflict of interest there right? A responsible citizen in this country simply cannot believe ANYTHING in print nowadays. It’s all spin designed to confuse, obfuscate & misdirect so that in the end.... you will vote against your own interests. Damn shame. It’s a big club....,and working class folks....AIN’T IN IT!!! Bob

Gary Guerriero
Mon, 01/27/2020 - 12:42pm

For those concerned about job losses in the private insurance industry: spend a few (many) hours on the phone with so-called customer service of one of the larger health insurance companies. You may come to the same conclusion I have; most deserve to lose their jobs. And include the employees who spend their time figuring out ways to deny services or charge more for necessary prescriptions. Not even forgetting the fat cat execs and their outrageous compensation packages that allow them to buy politicians.

Bug
Mon, 01/27/2020 - 11:27am

I have been self insured for 35 plus years. Coverage for myself exceeds $8,000 a year plus a $6500 out of pocket max. With an emergency surgery my total costs for the year was in excess of $15,000. My income was just over $60,000. This does not include the vision and dental that I do not have coverage for either. I would happily pay more in taxes to know that I have coverage and access to health care without worrying if my insurance will decline payment. This only makes sense! There are too many go fund me sites due to lack of coverage. Where else do you still pay for inadequate service.

jan d
Mon, 01/27/2020 - 11:37am

As a Medicare recipient with supplemental Blue Cross coverage (spouse is a retired state employee) I avoid seeking medical treatment and following up on further ordered medical treatment. Medicare covers some or none, Blue Cross covers nothing and I get to pay the rest. If it isn't deductible it's co-pay. Just recently the doctor told me I would have to complete six weeks of therapy before he could do the procedure that will fix the problem, because...insurance won't cover the procedure until I do the therapy. A complete waste of money and time. I am afraid of government sponsored healthcare because already with Medicare I am told that because of my age I don't qualify for certain treatments. I see this as a certain road to health decline and death. I believe the doctor in Canada got his prompt treatment because of who he is. Another patient would be told to wear a brace or something for a period of time before they could get their problem fixed or they would have to wait an extended period of time because of a backlog. Government seems to get everything gummed up. The Congress who approved Obamacare were so convinced of its success that they exempted themselves and their staff from having to participate. If Blue Cross is non-profit, why is the guy at the top paid such high compensation? I sure do not have answers for healthcare but based on what I have gone through since going on Medicare makes me wary of government control.

Too Much
Tue, 01/28/2020 - 11:11am

Too many lies in your post to address. My parents, both almost 100yo have Medicare and love it. No comparison between the little they pay and what I pay for health insurance. Yet they have so many more healthcare needs. One has to wonder why they are still as healthy and independent as they are if Medicare is so horrible according to your post and what we hear from Republicans all the time. Remember the "Death Panels" that the ACA was supposed to bring according to the perennial Republican scare tactics? Republicans have been trying to get rid of Medicare from it's inception and sabotage the ACA from it's beginning, even though the ACA is an insurance-based Mitt Romney Republican American Heritage Foundation model!!

Read the latest from a few days ago: Trump now says he's open to entitlement cuts, including Medicare
https://www.cnn.com/2020/01/23/politics/donald-trump-medicare-entitlemen...

Hey seniors, vote for Trump because "What have you got to lose?" Seniors, see if you can get a better healthcare deal in a Republican utopia of an unregulated free market!! How would you prefer that, jan d, finding better health care coverage as a senior without a Medicare option????? Or are you really just an insurance industry lobbyist?

Bbm
Sun, 02/02/2020 - 5:05pm

Just for your information, Congress did not exempt themselved from ACA, they and their staff were required to give up their government heslth insurance and get ACA insurande. So tired of disinformation from everyone. And my cousin in Caada says there is very little wait for apppintments. You ststed that you THPUGHT there was prefrrential treatment. Opinion should have at least a rudimentary asdociation with fact.

Southeast Michigan
Mon, 01/27/2020 - 2:02pm

Looks like the majority of comments here see through the scare tactics and lies promoted by the insurance industry and their lobbyists. Now we just have to spread the truth and encourage our friends to vote. The current system isn't working for so many of us, but some people like it that way. Yet everyone on Medicare loves it. As a working person, it's so scary to be dealing with cancer while trying to stay employed, and rather than focusing on getting better having to worry about losing my house or my children getting ill, wondering how to pay the bills and doctor recommended procedures my insurance won't cover. So many people I know are dealing with the same issues and are very lonely. I can't wait until I'm eligible for Medicare, especially when it's not clear if the government will allow insurance companies to deny service for a preexisting condition. I pray things will get better for all of us.

M4A Proponent
Mon, 01/27/2020 - 2:04pm

"M4A for those who wants it"/public option may be a death knell for universal single payer. It will attract the most high risk and be therefore high cost or massively subsidized, giving its detractors ammunition to point to its failure. What is so hard to understand about (cost +profit) > cost alone? And why is it that this view is never referenced by the media but instead there is consistent claims of increased taxes? We are already paying massive tax - in the form of premiums, and while these are currently shared between employers and individual, there is massive saving to be had from a true single payer system. To be successful and affordable insurance requires a wide risk pool. There are huge added benefits with M4A aside from cost as well: A) companies no longer need to expend time and effort managing this aspect of the benefits offered (I actually do believe in the private rider option for faster attention in non-urgent situations as is provided in much of Europe) B) life expectancy is increased C) health outcomes are better D) medical bankruptcies are erased E) worker mobility is improved creating higher wages as employers compete to keep good workers F) there is no wait period G) coverage is nationwide and therefore no out of area increase in costs H) the negotiating power is enormous and can be exercised effectively in controlling drug prices I) your doctors stay the same because your employer is not constantly changing the insurance plan trying to find cheaper options J) every single person is covered K) out of pocket expenses are minimal if not erased. The ACA did not go far enough to be a successful example of universal healthcare and was undermined at every opportunity by Republican lawmakers, in direct opposition of what would be best for their constituency, assuming that constituency is the voters rather than the healthcare industry.

Jeff
Mon, 01/27/2020 - 2:05pm

Why does no one ever reference the research in to the costs done by California and the CBO. Both of their multi year studies found, in today's money, the actual costs come to approximately $1200 per year, per person (legal resident), and after all possible savings. That's why the California legislature's most liberal politicians shelved the whole idea under Jerry Brown. They couldn't justify doubling the state budget, and knew increasing taxes that much was impossible. In those studies, the pharmaceutical companies commented nearly all R&D in to new drugs, medical equipment, etc. would stop. The U.S. does 99% of all the R&D for the world in the medical field. I had a relative just pass away in Canada, told them he thought he was having a heart attack, fell over dead after an hour in a waiting room.

Canuck
Tue, 01/28/2020 - 11:44am

"I had a relative just pass away in Canada, told them he thought he was having a heart attack, fell over dead after an hour in a waiting room." No one believes that.

Matt G
Sun, 02/02/2020 - 1:58pm

Nict try, health insurance CEO.

Judy
Mon, 01/27/2020 - 2:13pm

Most of the "Medicare for All" plans allow supplemental insurance, covering what the universal insurance would not. The constant refrain that "private insurance would be eliminated" is not true. Anyone who has bargained for health care benefits (as unions have) could effectively keep whatever benefits exceed the universal plan. This most fundamental of misunderstandings is ruining the chance for rational discussion.

J Hendricks
Tue, 01/28/2020 - 5:45pm

The health care horse has been flogged to death and yet we still have no real solution. We need to isolate the really BIG costs (think cancer, heart, long-term care, pre-existing conditions) that crash an otherwise workable private health care system. A catastrophic fund that would kick in after a certain cost cap is hit will give private insurers the confidence they need to provide the needed coverage at a reasonable cost -and still stay in business. Meanwhile we should all participate in the funding of catastrophic find through a tax. We can then spend our time fighting over whether the funding is sufficient for the fund. But the rest of the system would just roll along fine and we can all move onto some other problem.

Disagree
Wed, 01/29/2020 - 8:22am

We have great solutions already, Medicare for all who want it.

middle of the mit
Wed, 01/29/2020 - 8:23pm

In other words, the elderly are already isolated with medicare and medicaid from the private insurance industry and those that choose medicare advantage are subsidized by medicare, right?

Now you want to have a catastrophic fund, much like we just got rid of in our auto insurance rates that conservatives said is what was driving up costs?

I am seriously curious as to how you think we can take the most vulnerable out of the equation and lower costs without leaving them with no insurance, something they may been paying into most of their working lives?

Imagine you have been into homeowners insurance for twenty years or more and then when you have a fire or a claim, your insurance company tells you they are not going to cover it. The home they have been covering and accepting payments for is too old or out of date, or has pre-existing conditions?

That is what you are asking for.

Contracts! What are they good for? CEO's that destroy companies and not much else!

Elephant
Wed, 01/29/2020 - 8:31pm

GOP thinks you don't deserve healthcare if you can't afford it! We're all doomed when the coronavirus becomes a pandemic because unlike other developed western countries, we don't have universal healthcare, as if the climate disasters weren't enough. Now we have to deal with plagues too!

YouMustBeHorace
Thu, 01/30/2020 - 1:36pm

This assessment is only true if the federal government budget stays as it is. It would not. Nor would the federal tax structure. Tax the rich with a progressive and heavy tax for income over 10 million. Re-allocate money from the general fund and back off on funding a Pentagon that has lost track of several trillion dollars. We can't afford to reward that kind of irresponsible spending. And the assumption that business would pay more may be misinformation. What they pay for employee health insurance now would simply become a tax instead of an expense. And yes, private health insurance companies need to go. Their SMT's are rewarding themselves far too handsomely for denying health care to the sick and dying. But those workers experienced in insurance processing will be needed in the gvt. health administration. Transfer over. Not nearly as many will lose a working opportunity as you presume.
And FURTHER...the biggest mistake ever made in this country vis-a-vis healthcare was when Nixon let his crony talk him into allowing healthcare to become for-profit. Healthcare costs have been sky-rocketing ever since and this is why we pay 10 to 1000 times more for healthcare and drugs. It's a disgraceful situation that needs to end.

Common sense
Sun, 02/09/2020 - 11:26am

This whole article is comparing apples to non existent oranges. Bernie's and Warren's plans do not mirror the Canadian plan at all. Canadian Healthcare only covers a fraction of what Sanders proposes. His would cost exponentially more than Canada's.

John S.
Sun, 02/09/2020 - 8:37pm

Thanks for the article. It is plain that health care in the U.S. is a rat's nest of both market and government failures. On the demand side, it is both physicians, other practitioners, and patients who drive demand, typically without much understanding or concern with prices. It is the insurance companies who negotiate prices. Under single payer, it will be the government, and its leverage to negotiate lower prices will be greater than what exists today. How much health care today is unnecessary? When consumers don't see prices, I'd guess it is a lot. Think of all the money spent on prolonging the lives of those in the last month or two of their already full life. Another market failure is information asymmetry. Many areas of health care are post-experience goods--neither physicians nor patients in many cases can know whether or not a particular drug or procedure will be effective or not. Patients are seldom given clear information on the relative effectiveness of procedures and drugs in comparison to other options. Incentives are out of whack. The more procedures ordered, the more the charges, and the more the profits. Keep that MRI machine clanging--it is a big money maker. Ever wonder why hospitals like areas of managed care that are big profit makers? Of course, administrative costs add to the health care cost bloat. Want more government? It is unlikely that Americans are as honest as Canadians and there will be need, as there is today, for more government in order to control fraud. What percentage of Medicare spending is fraud? 10%. Health care money of over $3 trillion a year is a pot of gold--like a dead carcass on the African savanna, it will attract all kinds of human vultures. Financing? Anybody can do back of the envelope calculations and find a way to pay for Medicare for All. Still, it is always don't tax me, tax that guy behind the tree. Suggestions? Raise the top marginal income tax rate--basically, the wealthiest Americans pay a flat tax. Increase the Medicare tax. Add a financial transactions tax--that would have a side benefit of greatly reducing algorithmic trading. Reducing the financial burden on U.S. business would be good both for employers (more competitive globally) and for workers (they'd begin to see real pay increases ). In the end, if we want to reduce health care costs in this country, there's need to recognize that as necessary as medicine is, in the end there are sharp limits to what it can do, as opposed to individuals taking personal responsibility to live healthier lives. Most health care costs today are for diseases of civilization.

kate
Mon, 03/09/2020 - 5:51pm

Premiums and other improvements that would have been made to ACA during the last 3 years have obviously been thwarted, but here's the deal...the medical/health care and billing systems need to change, and most doctors will tell you that. 25%+ of their time is on paperwork, doctors get paid to prescribe (oftentimes) unnecessary tests, and the list goes on. Health care providers still are not able to communicate with each other re. patient history and care in this age of internet. Why not??
Next, our government can easily put a limit on executive pay of insurance companies, drug companies, drug middlemen (these guys are a total leech on our economy and have been a big part of the opioid problem as well). Health Insurance companies should ALL be required to restructure as non-profits. There is clearly a conflict-of-interest to keep costs down for the insured when you are trying to boost your bottom line for shareholders.
Big Pharma has to be better regulated. Big Pharma is also motivated to maximize their bottom line for (many foreign) shareholders. Maybe this is something we take on at the government level...prescription drug manufacture. Let our top universities expand their research departments and the government takes over the manufacture of drugs to keep costs down...

Judkast
Tue, 03/10/2020 - 12:48pm

Everyone should sacrifice for adequate care but the very rich should sacrifice more. There is no such thing as total equity for all and if you want better coverage especially for medical costs you need to pay for it. Consequently, most cannot afford adequate care so if the time comes if/when one can't afford, options for "decent, humane death" should be available.