Views on the News: Proposed health care bill
According to a Sept. 13 article from CNN, Sen. Bernie Sanders (I-VT) proposed a new health care bill that would give Americans free access to doctor visits, hospital stays, reproductive care and other comprehensive health services. It would also eliminate premiums on private insurance, deductibles and copays; however, some may still have to pay up to $250 on prescription medication. The plan would cost nearly $1.4 trillion annually, resulting in a 2.2 percent tax increase on Americans. What do you think of Sanders's plan, and is it feasible?
Prof. Sarah Curi (HSSP)
We have a dysfunctional insurance patchwork: 14 percent have Medicare (a single payer plan like Canada’s Medicare), 20 percent are categorically eligible for Medicaid (a state/federal dual-payer safety-net), 7 percent by Obamacare Exchanges (akin to the Netherland’s marketplaces where the Dutch buy insurance from private insurers) or other nongroup coverage, 2 percent by the VA/TriCare (like England’s single payer NHS) and 49 percent buy insurance from private insurers selected by our employers (such “ESI” is uniquely American). All other developed countries have achieved something we have failed to do: universal coverage. Approximately 45,000 Americans per year die for want of coverage. Under Obamacare the uninsured rate dropped to a historic low of 9 percent, yet millions remain uninsured and underinsured. Access to care is not the only problem. Our costs are the highest in the world and, while we provide some of the most cutting-edge care, too much of our quality is subpar. Sanders offers a tantalizingly simple, detail-light, dead-on-arrival vision. Political pragmatism may dictate more incremental reforms, including a public option to compete with private insurers. If this, or any proposal, prompts meaningful discussion of the true challenges and pathways to cost-effectively improve access and quality, we all stand to benefit.
Prof. Sarah Curi (HSSP) is a lecturer in Health: Science, Society and Policy as well as Legal Studies.
Prof. Stuart Altman (Heller)
I support the current Medicare program and also believe every American should have financial protection against the high cost of medical care. But Medicare works well because it functions within a broader U.S. healthcare system. Few medical professionals restrict access to Medicare beneficiaries even though Medicare payments to hospitals and doctors are far less than what is paid by private insurance. This I fear would change dramatically if we substituted Medicare benefits and payments for all medical services. Yes, a Medicare for all system would be simpler and more equitable but it would lead to reductions of hundreds of billions of dollars in payments for all types of healthcare services. Government is just not going to pay the prices now paid by private insurance. Sure, health care in the U.S. today is too expensive and needs to be reduced. But such reductions should be done carefully and not at the expense of reducing quality or access to care, particularly for our most needy populations. This is what, I believe, would happen if we make the changes suggested by the plan of Senator Sanders. The economy, legal and health care systems of the United States do not function like those in Europe or Canada and forcing such a transformation could lead to many unintended negative consequences. Fixing Obamacare is a far superior approach to creating Universal coverage and more consistent with the American system.
Prof. Stuart Altman (Heller) is a Sol Chaikin Professor of Health Policy at the Heller School for Social Policy and Management.
Prof. Anny Fenton (SOC)
The first thing to understand about Senator Sander’s single-payer bill is that its primary purpose is to restart a longstanding debate (since Franklin Delano Roosevelt) regarding whether healthcare should be a right for U.S. citizens. The bill, and probably any single-payer plan, simply cannot pass while Republicans control Congress and would still struggle in a Democrat-controlled Congress due to industry pressure and the difficulty of passing increased taxes. A key issue to consider is how much the plan will cost. Estimates vary and depend upon a number of factors, particularly utilization, which is hard to predict. It’s unclear how much previously uninsured populations will use health care and thus increase costs. Health care cost estimates rarely consider the economic benefits of a healthier population, however. Healthier people are more productive and miss less work. They’re also much less likely to need expensive emergency care. In short, it’s complicated. Any single-single payer plan will likely drive up costs, but it’s unclear how much. Most importantly, however, we should ask ourselves: “How much are we willing to pay to provide some form of healthcare for every U.S. citizen?”
Prof. Anny Fenton (SOC) is a lecturer in Sociology.
Danielle Gaskin’ 18
Sen. Bernie Sanders' "Medicare for All" health care bill is an excellent piece of legislation. Much of the discourse since the Patient Protection and Affordable Care Act passed revolved around rising premiums and the uninsured population. Sen. Sanders’ plan epitomizes the argument that health care is a human right. Sanders proposes to utilize the existing framework of the Medicare program, which supports approximately 15 percent of Americans, to provide healthcare to all Americans. This plan attempts to solve two pressing problems: closing the insurance gap and lowering costs. If this bill passes, all Americans are insured and the government is forced to control burgeoning costs from insurance companies, drug manufacturers and other stakeholders. In addition, one can argue that job-based health plans have contributed to wage and job stagnation. Possibly by transitioning to a federally administered system, jobs will grow, because businesses will not be focused on health care costs.
Danielle Gaskin’ 18 is majoring in Health: Science, Society and Policy.
Abraham Cheloff ’18
Sanders’ plan speaks to many of the concerns and fears that Americans currently have regarding their access to health care. It simulates other healthcare programs already in place across Europe and other parts of the world, working to alleviate the financial stress that many of us feel due to medical expenses by distributing the cost among the entire country. That being said, this system is only economically and socially feasible when individuals, regardless of insurance status or other factors, are willing to give an extra 2.2 percent to taxes for what many will call "the greater good." While other countries have grown with this as the norm, this plan is new to the American people, and with federal, state and city taxes already growing by the year, many individuals are foregoing their own medical care to save needed dollars. The plan could put additional strain on those who are most vulnerable, and we would have to see what a system would look like where not everyone is able to pay.
Abraham Cheloff ’18 is a Biology Undergraduate Departmental Representative.