1:05
PM ET Tue, 28 Aug 2018
The
vast majority of Americans, 70 percent, now support Medicare-for-all, otherwise
known as single-payer health care, according to a new Reuters survey.
That includes 85 percent of Democrats and 52 percent of Republicans. Only 20
percent of Americans say they outright oppose the idea.
"Medicare
is a very popular program, so the idea of expanding it to everyone is popular
as well," Larry Levitt, senior vice president for health reform at
the Kaiser Family Foundation, tells CNBC Make It. "The advantage of
Medicare-for-all, which is much closer to how the rest of the world provides
health care to their residents, is that you can achieve universal coverage at a
lower cost."
The problem with health care in the US
For at
least a decade, most Americans have been dissatisfied with the country's
largely for-profit health-care system, according to Gallup.
In a poll last year, 71 percent of respondents said the system is "in a
state of crisis" or "has major problems."
Health
care in the U.S. is criticized primarily
for its inefficiency, inaccessibility and ever-rising costs. The average annual
deductible for employer-sponsored health care plans, which make up most of the
plans in the U.S., was $1,505 in 2017, compared to $303 in 2006, according to
the KFF.
Last
year workers paid on average $5,714 toward their cost of coverage by way of
monthly premiums, a 3 percent increase from the year before.
Although
the quality of care tends to be high, care doesn't reach everyone. Americans
forego treatment because of the cost more often than residents in 11 other
high-income countries, according to a report published in the Journal of the
American Medical Association.
A 2017 Bankrate
survey found that one out of four Americans said they or
someone in their family skipped necessary medical care because they couldn't
afford it. Millions wait each year
until they get a tax refund to access medical care they had
been putting off, the JPMorgan Chase Institute found.
Passing
on treatment when an issue arises is bad enough. But affordability is important
because simply going to the doctor for a physical on a regular basis can save your
life. That's according to MacArthur Foundation "genius" Atul Gawande,
who was recently selected to lead the joint health
care venture formed by Amazon, J.P. Morgan and Berkshire
Hathaway to tackle rising health-care costs.
"Incremental
care — regular, ongoing care as opposed to heroic, emergency care," he
writes in The New Yorker,
"is the greatest source of value in modern medicine."
What Medicare-for-all would change
Reuters
defines Medicare-for-all as "a publicly financed, privately delivered
system with all Americans enrolled and all medically necessary services
covered." In theory, it would solve some of the main
issues of America's current system.
Sen.
Bernie Sanders proposed his Medicare-for-all
bill in September of 2017. It aims to gradually reduce the
uninsured rate, which currently sits around 12 percent,
until it reaches 0 percent, by enrolling everyone in a nationwide public
insurance plan. Under his proposal there'd be no more deductibles or
co-payments. Although there's no opting out, people would have the option to
buy supplemental care through private insurers.
The
bill has little chance of passing with a Republican majority in Congress, as Sanders has
conceded. Right now it's just setting up Democrats for potential
legislation in the future and bringing attention to drawbacks of the current
American system, he says, such as exorbitant
spending and high drug prices.
A
single-payer system simplifies who is responsible for covering costs. That gets
rid of some of the issues that stem from the complexity of the current American
system, like balance billing.
In a
recent incident reported by NPR that's
since gone viral on social media, Drew Calver, a 44-year-old teacher and
triathlete in Austin, Texas, had a heart attack. He was rushed to an
out-of-network hospital and had stents implanted.
A
network is a list of hospitals, doctors and other medical providers who are
covered by a person's health plan. Out-of-network providers are either not
covered at all, or are covered at a much lower rate, leaving the patient
responsible for much or all of the resultant bill. Almost 18 percent of
hospital admissions end up with some out-of-network claim,
often because someone goes to an in-network hospital but ends up getting care
from an out-of-network physician. Among those who can't afford the ensuing
costs, most say they didn't realize they were receiving care outside their
insurance network.
Calver
went home after four days. Though he asked from his hospital bed and was
assured that his insurance would be accepted, his portion of the bill came to
almost $110,000. That's "nearly twice his annual pay," NPR notes.
"Under
a pure Medicare-for-all plan, those issues would go away," Levitt says.
What it might cost
Although
support for Medicare-for-all is growing, the proposal also receives plenty of
criticism. "The arguments we've found that resonate are that it would give
the government too much control over the health-care system, that people would
have to give up their current insurance plans, and that it would increase
taxes," Levitt says.
When
Sanders first introduced his bill, he argued that most Americans would find any
tax hikes offset by
savings on household health-care costs. In other words, what you
would save by not forking over premiums, co-pays when you go to the doctor or
deductibles when you visit the emergency room would outweigh any additional
amount you pay in taxes. That point is central to the debate over the viability
of universal health care.
"The
average of what people would pay when you take into account taxes, premiums and
out-of-pocket costs would go down," says Levitt. "Generally,
lower-income people would end up paying less for health care. But higher-income
people would pay a whole lot more. It depends a lot on which taxes end up
getting increased in order to pay for the new plan."
Critics
argue that the financial burden on the federal government would be staggering.
A much-discussed report released last month by the Mercatus Center
at George Mason University suggested that Sanders' proposal
would lead to a $32.6 trillion
increase in federal spending over a 10-year period. The Urban Institute came
up with a similar estimate in 2016.
However,
Canada has successfully implemented a single-payer system even though Canadians pay
about the same amount in taxes as Americans. The performance of
Canada's system ranked ninth in a 2017 study by the Commonwealth
Fund comparing 11 high-income countries, while the American
health-care system ranked last.
Proponents of
single-payer health care point out that the Mercatus report
suggests that national health expenditures could decline by about $2 trillion
over the same 10-year period. National health expenditures refers to all health
spending, including that of the federal government, private employees and state
Medicaid programs, while federal health expenditures refers only to spending
from the federal government.
"Lower
spending is driven by lower provider payment rates, drug savings, and
administrative cost savings," Yevgeniy Feyman
of the Manhattan Institute told Vox. "It's not clear to what
extent those savings are politically feasible, and socially beneficial."
At
current levels, administrative
and pharmaceutical costs are significantly higher in the U.S.
than they are in other high-income countries, and doctors earn significantly
more. The Mercatus report suggests that, under Medicare-for-all, doctors would
be paid about 10 percent less.
Sanders
has still not released a financing plan, so much of the impact of his bill on
consumers and the health care industry as whole is still unclear. Still, not
only is the system favored by the American public but, as Vox points
out, "in the Democratic wing of the Senate, every major potential
presidential candidate has endorsed it."
In
response to the Reuters survey, Sanders tweeted, "The momentum is with
us."
https://www.cnbc.com/2018/08/28/most-americans-now-support-medicare-for-all-and-free-college-tuition.html
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