Economists and analysts have discussed how much Democrat health care plans like Medicare for All — endorsed by 2020 candidates Bernie Sanders and Elizabeth Warren — would cost the federal government, as opposed to the expansions of Obamacare touted by Joe Biden and Amy Klobuchar? And which one will cost you more?
Well, it’s complicated.
At the third Democratic primary debate in Houston, Texas, Klobuchar slammed Sanders’ Medicare for All plan for eliminating all private health insurance.
“While Bernie wrote the bill, I read the bill,” she said at the debate. “On page eight of the bill, it says we will no longer have private health insurance as we know it. I don’t think that’s a bold idea. It’s a bad idea.”
But Klobuchar’s — and Biden’s — general plan is to expand the Affordable Care Act, a system which already isn’t working for millions of Americans. Klobuchar’s plan, in particular, is light on specifics.
Klobuchar’s primary goal is to reduce health care costs, which have risen steadily over the last 50 years and are on track to rise even higher, according to the Peter G. Peterson Foundation. In 2017, the U.S. spent $3.5 trillion on health care, which was 18 percent of the GDP. In 1960, health care costs amounted to only 5 percent of GDP.
According to GoFundMe, a quarter-million medical fundraisers are set up each year due to Americans’ inability to pay medical bills.
Two-thirds of bankruptcies are due to unpaid medical bills, despite increased coverage under the ACA, according to the American Public Health Association.
The PPF attributes the rise in health care costs to an increase in prices. To combat rising costs, Klobuchar wants to restore the ACA’s phased-out subsidies for premiums (which means higher taxes) and provide a nonprofit, public health care option that allows Americans to choose coverage through Medicare and Medicaid.
Given that 19 Republican states did not expand Medicaid coverage under the ACA, it’s unlikely they would opt-in to Klobuchar’s public option program, so the top criticism with Klobuchar’s plan is that it would just be more of the same, and not create any meaningful change.
Klobuchar has not yet announced how much her plan would cost or how she would pay for it. Biden’s plan, which is very similar to Klobuchar’s in that it includes an expansion of Medicaid and a public health care option, would cap premium prices for individuals at 8.5 percent of their income.
His campaign estimates individuals will save $750/month, and that the plan would cost $750 billion over a decade. Biden plans to help pay for it by closing loopholes in the capital gains tax, but his campaign notes that will only generate about $127 billion, and doesn’t specify how Biden will find the other $623 billion.
That’s a smaller price tag than Sanders’ signature Medicare for All plan, which clocks in at around $30 trillion over ten years, according to several economic analyses.
Under both Biden’s and Klobuchar’s plans, Americans will see higher taxes on top of paying monthly premiums and deductibles. The difference with Medicare for All is that Americans won’t have to pay premiums or deductibles or copays anymore.
Sanders says the answer to paying for Medicare for All is that we already are.
“The largest share of national health expenditures already comes from the government, amounting to $26 trillion out of the $47 trillion, or 55 percent, of what our country will spend on health care from 2018 to 2027,” he said in a document explaining how he plans to pay for Medicare for All. “If the status quo stays in place, between 2022 and 2031 the federal government will spend $59.65 trillion. According to estimates from the conservative Mercatus Center, under the Senate’s Medicare for All legislation, those expenditures will drop by approximately $2 trillion.”
In an interview with Rolling Stone, Sanders said that if a family four currently pays $16,000 a year on premiums, copays and deductibles, they will only pay $9,000 a year in taxes under Medicare for All, without any premiums, copays and deductibles.
But some Democrats and conservative thinkers worry that even if Medicare for All theoretically reduces how much Americans pay for health care, the plan would devastate the health care ecosystem, leading to skyrocketing prices in the long run. Concern centers around hospitals in particular.
At the first Democratic primary debate, Rep. John Delaney (D-Md.) said, “If you go to every hospital in this country and you ask them one question, which is, ‘How would it have been for you last year if every one of your bills were paid at the Medicare rate?’ Every single hospital administrator said they would close.”
In April, The New York Times ran a story claiming hospitals would lose “billions” under Medicare for All.
But a 2016 Health Affairs study and the conservative Foundation for Research on Equal Opportunity (FREOPP) say hospital consolidation is one of the primary reasons for rising health care costs.
“On average, procedures cost 44 percent more in hospital markets with an above-average degree of consolidation,” FREOPP founder Avik Roy said in blog post on the topic. Roy served as a health care policy advisor for Mitt Romney’s 2012 campaign and an advisor for Rick Perry’s 2016 campaign and Marco Rubio’s 2016 campaign.
This leads to exploitive pricing and other anti-competitive practices, including forcing insurers to sign contracts that barred them from recommending patients to less expensive hospitals.
Roy advocates for a mixed private/public health care system in his work, and said “capping reimbursement rates for private and individual payors at Medicare rates in extremely concentrated hospital markets” would help stop and prevent hospitals’ anti-competitive practices.
Roy thinks Medicare’s discount program, Medicare Advantage, should be used as the template for health care in America.
Medicare Advantage provides health care to seniors via private insurers, provides lower costs to seniors and is less debt-ridden than the traditional Medicare program.
Traditional Medicare also disproportionately benefits wealthy seniors, Roy said, because American taxpayers pay for subsidies for their health coverage. Besides being hardly “fair” that low-income Americans pay for the health care of the “ultra-rich,” Roy said it’s also fiscally irresponsible.
Eliminating those subsidies for individuals with lifetime earnings of over $10 million would knock more than $50 billion off Medicare spending over a decade.
‘The best way to reform Medicare — and to provide affordable health care to every American — is to go in the opposite direction: to enact reforms that will further improve the quality and affordability of Medicare Advantage plans, and to learn from Medicare Advantage to improve the coverage that younger Americans can obtain,” Roy said.
An ABC News/Washington Post poll found that 40 percent of Americans are most likely to “oppose” Trump in 2020 based on how he has handled health care, and “voters in the 2018 midterms selected health care as the top issue in their vote by a wide margin over three others offered – and those who picked it favored Democrats for Congress by 75-23 percent.”
In July, Sanders pushed back on plans like Roy’s, Biden’s and Klobuchar’s, arguing that health care is a human right, and as long as corporations are major players and decision-makers in health care, they will engage in unfair and anticompetitive practices and prices will continue to rise.
“I will not be deterred from ending the corporate greed that creates dysfunction in our health care system,” he said on Twitter. “We must pass Medicare for All.”