Drew Altman,
Kaiser Family Foundation January 9, 2019
Adapted
from a Peterson-Kaiser Health System Tracker chart. Spending is in purchasing power parity
equivalents. Chart: Axios Visuals
Now that the
Democrats have taken control of the House, their "Medicare for All"
proposals are going to get hearings and scrutiny. One feature of Bernie
Sanders' version that hasn't gotten a lot of attention yet, but it will: the
plan has no deductibles or other forms of patient cost-sharing.
Why it
matters: In a country where so many Americans are bedeviled by medical bills,
especially people who are sick and use a lot of medical care, this would be a
big deal. It would actually make our system more generous than any of the other
developed nations that Democrats like to cite as models for our own.
Details: It may be
surprising, but no other developed nation has zero out of pocket costs — even
those that treat health care as a basic human right, as Medicare for All
supporters want to do. That’s because their national health plans have cost-sharing,
or allow people to purchase health care outside the plan, or both.
- Even in the United
Kingdom’s very comprehensive National Health Service, there are copays for
some drugs and consumers pay a substantial amount for long term care.
- As the chart shows, consumers in other
high-income countries spent an average of $857 per person out-of-pocket on
health care in 2016, ranging from $467 in France to $2,326 in Switzerland.
Two proposed
national health plans — Sanders’ plan and a similar plan in the House now
sponsored by Rep. Pramila Jayapal of Washington state — have no
cost-sharing for covered services. (Details regarding exactly which benefits
these plans would cover are still evolving, so patients could end up with some
out-of-pocket costs for non-covered services.)
- Other congressional proposals that would
expand access to Medicare or Medicaid have various cost sharing arrangements based
on the Affordable Care Act, Medicare, or cost sharing levels set by
states.
The big
picture: Deductibles and other forms of cost sharing have been rising steadily in private coverage, far
outpacing wage growth. The Sanders cost sharing strategy could make the proposal
more popular to the more than 150 million Americans who would have to switch
from their private coverage to join a national plan.
- It will certainly appeal to the one third of people in
fair or poor health, with insurance, who had trouble paying for health
care in 2017.
The
catch: A zero cost sharing approach is also sure to make any Medicare
for All plan more expensive — because if the patients aren't paying for any of
the costs, the government has to pick up the entire bill.
- It will also subject any
plan to the inevitable criticism that it will lead to overuse of medical
care and drive up health spending, since there wouldn't be any incentive
for patients to worry about costs.
- All of this will draw new attention to the
price tag of the plan. (Sanders says it would still be less
expensive than our current system because it would get rid of bureaucracy
and administrative costs.)
What to
watch: House Speaker Nancy Pelosi has said that hearings may begin soon
in the House on Medicare for All, but we are far from the stage where legislative
sponsors have had to make significant compromises in order to get a bill
passed.
If and when the
debate gets to that point, it seems likely that there would end up being a
modest level of cost sharing to deter unnecessary use of medical care and keep
the overall costs of the plan down.
No doubt
cost-sharing would be kept lower than it generally is today, both as a selling
point and to eliminate the barriers to care and economic burdens high
cost-sharing has become today for many families. It is also possible that
enrollees would be allowed to buy additional care outside of the plan, as they
can in some other countries.
The bottom
line: There will be plenty of other arguments, for and against a
Medicare for All-style plan. But the burden of rising out-of-pocket costs is
one reason the plan could have appeal for many Americans — even if
it's not possible to get rid of them completely.
https://www.axios.com/medicare-for-all-out-of-pocket-costs-7aa80feb-ea06-4f35-a43a-9cfc719ab897.html
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