That's a solid platform for now. I just don't see a lot of people getting excited about "shoring up ACA."
Adding Medicare to the marketplace is exciting. Just another way of phrasing, public option
I'm curious how he phrased that in the interview. Fixing the exchange, putting Medicare on it, and then opening up Medicare to all is my preferred way to do Medicare-for-All, but he needs to change the messaging there so Obamacare is not front-and-center and Medicare-for-All sounds more like the masterplan than an afterthought.
It's a stepped path to M4A, hell introducing a Gov option will help a lot of places with a duopoly of coverage choices
To give some ideas about the contours of the debate that will likely play out between (1) Medicare for All advocates (Bernie,
hopefully Kamala and Yang and Buttigieg as well, maybe others; Warren is so far adopting an "all of the above"-style neutrality, as opposed to impassioned advocacy for M4A), on the one hand, and (2) "Medicare for More" advocates on the other, this is Adam Gaffney of
@PNHP, in conversation with a "Medicare for More" advocate (
@amprog's Topher Spiro):
"How so? Reductions in drug prices and administration could cover cost of increased utilization from expanded coverage. Success of national health insurance doesn't hinge on reducing healthcare professional pay, whatever one's feelings on the issue."
"Physician pay accounts for 8% of NHE [National Health Expenditures], so even an overnight 10% pay cut will reduce health spending by less than 1%. Meanwhile, while doctors are well paid, some healthcare workers are very poorly paid, like home health aides."
"And admin costs are indeed a major driver of excessive spending, including on the provider side: Hospital spending accounts for about a third of healthcare spending. Of that, about 25% goes for admin in the US, double that of Canada. That's an enormous amount of money."
Notice how Gaffney is attempting to address
the lack of attention to the administrative savings
that are unique to Medicare for All proposals: a frequent pattern you'll observe is that "Medicare for More" advocates often (1) ignore/obscure the
huge benefits that come from eliminating the private insurance role (profiteering and administrative inefficiency) in basic comprehensive coverage in the U.S., and they often (2) exaggerate the
political risks of doing so.
Medicare for All advocates believe that a persuasive and successful political campaign can be pursued, based on (1)
the expanded benefits (dental/hearing/vision for everyone and no more cost-sharing at point of service, which alone meets or exceeds even the best employer-sponsored insurance plans, and is music to the ears of seniors experiencing the limitations of current Medicare) and (2)
the dramatic premium/spending cuts that are unique to M4A; these are two very appealing attributes that are only made possible by (3) the elimination of private-insurer-induced profiteering and administrative inefficiency (i.e., this is
a property that is unique to the M4A proposals).
The political benefits of M4A over competing proposals are described in more detail
here in this thread, and also
here and
here; the exaggeration of political risks of pursing M4A are discussed
here and
here. The subject of the transition process from our current system to M4A is discussed
here. See also:
https://pnhp.org/news/bluecross-blueshield-proposal-to-reduce-premiums-and-expand-access/
Don McCanne, M.D. (Senior Health Policy Fellow, PNHP)
...Now it is widely recognized that not even the Affordable Care Act is meeting the needs. People well informed on health policy understand that the single payer model has become the obvious solution that would ensure affordable health care for all, but some are ideologically opposed, willing to sacrifice the suffering of others in order to reduce the role of government, and others are opposed because of the impact on the vested interests, especially the private insurers and the profiteers such as the pharmaceutical firms...
https://thehill.com/blogs/congress-blog/healthcare/433444-why-medicare-for-some-is-the-wrong-idea
...Let's get real: Commercial insurance is the biggest threat to health care choices and our freedom to receive the health care we need. Employers choose our insurers, and the insurers restrict the providers we can use, the treatments we can receive, and the prescription drugs we can take. Every year, we can be forced to change provider networks, benefits, out-of-pocket costs and, often, insurers. If we change jobs, every aspect of our health insurance changes. And, we are left to fend for ourselves if we leave the job market.
No one loves Aetna, Anthem or any other insurance company. What we love – and what we need – is the freedom to get care from the doctors we want to see at a price we can afford. Medicare for all guarantees all Americans access to health care, with freedom to see the doctors we want, throughout our lives, wherever we live, wherever we work and whenever we are out of work. That's about as pragmatic as it gets.
Maybe the "pragmatists" are concerned that we lack the votes in Congress to pass Medicare for all or that the commercial interests with a stake in maintaining the status quo are too powerful to overcome. That might be right. The health care industry is flush with cash, and insurers use campaign contributions to wield
substantial influence in Congress. As we learned in 2009 and 2010, the health insurance industry will fight hard to retain its place in the health care system.
But fixing our broken commercial health insurance system is too important to leave to the politicians or to the insurance industry. The American people deserve a frank conversation about how we can guarantee access to health care as a right in this country. That conversation does not begin with Medicare for some. It begins – and ends – with Medicare for all...
https://twitter.com/wendellpotter/status/1105529272402350081
When I was working for the health insurance industry, we considered these right-wing think tanks our business partners. They got plenty of funding, and we got plenty of research that worked out in our favor. More on that here: Link. The good news is, even making some pretty absurd assumptions about cost, Mercatus still found that #medicareforall would save $2 trillion over 10 years compared to current healthcare spending: Link.
EDIT: For political cover, it looks like
Pete is saying we can keep Medicare Advantage.
"If the framework we're using is Medicare, a lot of people who have Medicare also have Medicare supplements, Medicare Advantage, something like that..." It's certainly an understandable position for him to take from a political perspective, but it's not clear that it's necessarily the best one (even from a political perspective of selling Medicare for All); and there are obvious problems with the substance of that position, as mentioned
here. He's certainly right to emphasize that supplemental policies could exist under M4A, but that would be quite a different role for private insurers from the one they currently have under the current Medicare Advantage program.
