| Today's Managing Health Care Costs Number is 30 million |
Two competing health plans have been in the news today. Bernie Sanders has rolled out his "Medicare for All" plan, and the Lindsey Graham Bill Cassidy proposal has gained new "moderate" support and will be yet another Republican attempt to repeal Obamacare.
First, the Republican plan. David Leonhart titled his post on this "New TrumpCare Deserves a Quick Death." He points out that although the sponsors claim that this bill would allow states freedom to innovate - it would rapidly decrease the available funds. Even states committed to universal health care access might be hacking away at the number of those with subsidized insurance very quickly. The Congressional Budget Office hasn't weighed in yet -but this bill is close enough to past TrumpCare bills that he estimates it would lead to 15 million additional uninsured in 2018, and 30 million losing insurance over the next decade.
It's hard to say that Graham-Cassidy absolutely won'tpass, and it would be a deeply disruptive bill that would make health care in the US much worse than it currently is. The more time Congress spends on that bill, the less effort it will put into the market fixes we so desperately need for the Affordable Care Act.
With great fanfare, Bernie Sanders has introduced his Medicare for All plan today. He has 17 cosponsors in the Senate (he had none when he introduced his last universal health care bill), and about 60% of House Democrats have endorsed a different universal health care bill. The Sanders approach is aspirational - In an interview with Vox, he says:
I mean, this is a big issue, and we are introducing comprehensive legislation at a time when we have Donald Trump as president, who wanted to throw 32 million people off the health insurance. You know, Mitch McConnell, Paul Ryan, running the Senate and the House. We're not going to get this thing done with these guys in power.
Sarah Kliff has a summary of the details of the Sander's plan. The initial plan was explicit about benefits and cost sharing (rich benefits for all, no substantial cost sharing for patients) and mum on costs; this afternoon he released additional details including a 7.5% employer payroll tax exempting small businesses (that's much less than most employers spend on health coverage), and a 4% income tax on individuals exempting low income people. For many, this would be a good deal.
And that's the problem. If Sanders is able to provide insurance for all with close to no cost sharing (which means there will be more discretionary utilization), it's either going to cost more (much more, as California discovered) or providers will be paid much less. The Sanders plan would create a national fee schedule (Medicare), but would increase payment to providers caring for Medicaid beneficiaries. The decline in provider reimbursement would have to be huge to provide enough savings to make this work.
We need meaningful reform of the health care system - and we need lower unit prices. There will be plenty of time to evaluate whether the Sanders plan is the best way to get to universal access - and I'm in favor of modest cost sharing as opposed to no cost sharing at all. Today lets us all see the vision of each party -- one is satisfied to leave 30 million additional Americans uninsured; the other wants to insure everyone, but there is a danger that this is the "unicorn" plan in that it is rooted in fiction in that it might not be affordable.
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