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In terms of overall health care spending in the United States over the same period, however, they are actually projecting a slight reduction. There is the rub.
The federal government is going to spend a lot more money on health care, but the country is going to spend about the same. One concern is whether cuts to prescription drug spending would discourage medical innovation. When you consider a universal single-payer program would 1 cover every single American, eliminating uninsurance and 2 provide much more robust benefits, covering more services than get covered right now, then it starts to look like a good deal.
The Mercatus Center bakes in some assumptions that could vary the actual cost quite a bit. For example, its scholars assume as the Sanders bill dictates that hospitals and doctors would be paid at Medicare rates, a cut from private insurance rates but an increase from Medicaid rates. If the real payment rate were different, it could affect the price tag significantly. Still, this seems like a reasonable estimate from a group that we would expect to be pretty skeptical of single payer — and it still looks like kind of a good deal.
This is where politics enters into the mix. Conservatives are going to recite that large-sounding cost as often as they can. They were already jumping on it Monday morning. Many Americans still hold real reservations about making Big Government any bigger.
Taxes are going to rise for somebody, but many or even most Americans could end up saving money on their premiums or on out-of-pocket costs. There will be winners and losers, as there always are in health care reform. Persuasion is necessary. Sign up to get VoxCare in your inbox along with more health care stats and news.
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The direction of that change is unclear and would depending on the whether the increased cost of expanding coverage by making health insurance more generous and offering it to more people is larger or smaller than the amount saved from lower provider payments, drug payments, and administrative spending. The totals also do not represent debt impact, which would depend not only on the cost to the federal government but also on any funds the government might choose to raise through premiums, taxes, or both.
While any new revenue would in part be replacing current premiums, identifying pay-fors still remains a challenge. We at the Committee for a Responsible Federal Budget continue to mourn the loss of Alice Rivlin, a former board member of the Committee and the founding director of the Congressional Budget Office It's encouraging that many in Congress are focusing more on our unsustainable fiscal situation and want a plan to improve the nation's fiscal outlook.
When it comes to developing a budget blueprint He recently wrote an opinion piece for Inside Sources, an excerpt of which is below. Last year was nothing less than Feb 27, Health Care.
Tags Health Care. US Budget Watch Trending Jan 13, Budget Process.
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In West Virginia, healthcare providers who wish to open or expand facilities must first obtain a certificate of need CON. By Robert Graboyes Murray Feldstein. The United States spends more on healthcare than any other nation—in absolute terms, as a percentage of gross domestic product.
By Brian J. Americans face challenges in accessing affordable hospital care as increasing hospital consolidation results in lower quality. In the United States, political considerations play too large of a role in the licensing of physicians and other healthcare.
By Robert Graboyes. COVID presents a challenge of extraordinary scale and complexity. State policymakers across the country, like so many of us. By Benjamin Yeoh. Quickly developed therapeutic, prophylactic, and vaccine treatments will be essential to defeat the COVID pandemic. By Jack Goldstone. Charles Blahous, political economist and former senatorial adviser, presidential adviser, and Security and Medicare public.
Learn no-regrets finance strategies for whatever happens next. While a wide range of health proposals all claim some version of the "Medicare-for-All" moniker, competing proposals from Sen. Bernie Sanders I-Vt. Pramila Jayapal D-Wash. But neither of the proposals include projected cost estimates, and they offer sparse details on how those unknown costs would be paid.
To get some answers, the New York Times spoke to a group of economists and think tank experts for their estimates on how Medicare-for-All could affect American health care expenditures. The experts' cost estimates range widely, the Times writes, mostly because any Medicare-for-All system "would be influenced by the decisions and actions of parties concerned … in complex, hard-to-predict ways.
Currently, U. Under a Medicare-for-All system, all medical claims would be reimbursed by Medicare, which currently pays providers less than private insurers do. If Medicare were to continue paying its current rates, providers who see a large number of patients with private insurance would see significant pay cuts. This highlights one of the core challenges of a Medicare-for-All system: If the system is to save money, it has to reduce payments to the health care industry—but if its payment rates are too low, some hospitals and providers could go out of business entirely, the Times writes.
Currently, neither Sen. Sanders' nor Rep. Jayapal's plans specify how much Medicare would pay providers, so the Times ' estimators provided their best guesses. Meanwhile, Blahous based his estimates on the assumption that Medicare rates wouldn't change, although he added he believes the real rates would be higher. As the Times notes, U. In part, that's due to a system in which many payers negotiate separately for drug benefits—but it's also due America's reliance on an open market, which proponents say gives drugmakers the necessary financial incentive to develop new cutting-edge drugs.
A Medicare-for-All system would have more leverage with drugmakers, as it would be negotiating for an entire country's drug supply, the Times writes. But it might face challenging trade-offs. For instance, if it attempted to cut costs by covering fewer drugs, that effectively would mean some patients would be denied the medications they want, the Times writes.
All of the estimators believed that a Medicare-for-All system would negotiate lower drug prices, but they varied in their estimates of just how much.
If implemented, a Medicare-for-All system would provide health coverage to roughly 28 million people who currently lack it—likely leading them to use the health care system more heavily, the Times reports. This increased usage would be a factor driving up U. The plans also would provide certain benefits, such as long-term care, that aren't typically covered by health insurance, further increasing usage.
All of the estimators said health care use would increase, but varied by how much. The extraordinary complexity of America's current health insurance system leads to a lot of administrative overhead, the Times reports. Simplifying it to a single payment system would likely reduce those costs. But it's not clear just how much money would be saved, the Times reports.
The previous Sanders bill I studied did not provide new long-term care benefits whereas the latest Sanders bill, estimated by the UI team, does. My administrative cost assumption was also lower than the one employed by the UI team. Adjustment 6: Other technical factors. Their sensitivity analysis also indicates that their headline estimate does not assume a state-level Maintenance of Effort requirement, whereas my projections assume one for long-term care.
There are undoubtedly many other ways in which my assumptions differ from those of the UI team. It appears that any other differences, however, largely cancel one another.
Charles Blahous is the J. Fish and Lillian F. He recently served as a public trustee for Social Security and Medicare. Interested in real economic insights? Want to stay ahead of the competition? Each weekday morning, e21 delivers a short email that includes e21 exclusive commentaries and the latest market news and updates from Washington.
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Manhattan Institute Manhattan Institute See what we're about. Thorpe , the chairman of the health policy department at Emory University, who helped Vermont estimate the costs of a single-payer proposal there in Analysts at the Urban Institute , a Washington policy research group that frequently estimates the effects of health policy changes.
Right now, individuals and employers pay insurance premiums; people pay cash co-payments for drugs; and state governments pay a share of Medicaid costs. In a system like one introduced as a bill by Mr. Sanders or another from Representative Pramila Jayapal and the Congressional Progressive Caucus, nearly all of that would be replaced by federal spending. Other Democrats who are supporting coverage expansion through Medicare have offered more modest proposals that would preserve some out-of-pocket spending and a role for private insurance.
The economists made their calculations using different assumptions and methods, and you can read more about those methods at the bottom of this article. The biggest difference between the Mercatus estimate and the Urban one is related to how much the new system would pay doctors, hospitals and other medical providers for health services.
In our current system, doctors, hospitals and other health care providers are paid by a number of insurers, and those insurers all pay them slightly different prices. In general, private insurance pays medical providers more than Medicare does.
Under a Medicare for all system, Medicare would pick up all the bills. Paying the same prices that Medicare pays now would mean an effective pay cut for medical providers who currently see a lot of patients with private insurance. But if rates are too low, hospitals already facing financial difficulties could be put out of business. Neither Mr. So our estimators offered their best guess of what they thought such a plan might do. Thorpe said he picked a number higher than current Medicare prices for hospitals, because he thought anything lower would be unsustainable.
Blahous said he constructed his starting estimate at precisely Medicare rates, though he thought the real number would most likely be higher. He also reran his calculations with a more generous assumption: At percent of Medicare, around the average amount all health insurers pay medical providers now, the total shot up by hundreds of billions of dollars, about an additional 1.
Patients in the United States pay the highest prices in the world for prescription drugs. But it also reflects national preferences: An effective negotiator needs to be able to say no, and American patients tend to want access to the widest array of cutting-edge drugs, even if it means paying more. But politics would still be a constraint. A system willing to pay for fewer drugs could probably get bigger discounts than one that wanted to preserve the current set of choices.
That would mean, though, that some patients would be denied the medications they want. All of our economists thought a Medicare for all system could negotiate lower prices than the current ones.
But they differed in their assessments of how cutthroat a negotiator Medicare would be. Friedman thought Medicare for all could reduce drug spending by nearly a third. The Urban team said the savings would be at least 20 percent. The other researchers imagined more modest reductions. That change alone would increase the bill for the program. Other changes to Medicare for all would also tend to increase health care spending. Some proposals would eliminate nearly all co-payments and deductibles.
The proposed plans would also add medical benefits not typically covered by health insurance, such as dental care, hearing aids and optometry services, which would increase their use. The economists differ somewhat in how much they think people would increase their use of medical services. The complexity of the American system means that administrative costs can often be high.
Insurance companies spend on negotiations, claims review, marketing and sometimes shareholder returns. One key possible advantage of a Medicare for all system would be to strip away some of those overhead costs. But estimating possible savings in management and administration is not easy.
Medicare currently has a much lower administrative cost share than other forms of insurance, but it also covers sicker people, distorting such comparisons. Certain administrative functions, like fraud detection, can have a substantial return on investment. The economists all said administrative costs would be lower under Medicare for all, but they differed on how much. Those differences amount to percentage points on top of the differing estimates of medical spending.
On this question, there was rough agreement among our estimators that administrative costs would be no higher than 6 percent of medical costs, a number similar to the administrative costs that large employers spend on their health plans. Blahous said a 6 percent estimate would probably apply to populations currently covered under private insurance, but did not calculate an overall rate.
All of these estimates looked at the potential health care bill under a Sanders-style Medicare for all plan. In some estimates, the country would not pay more for health care, but there would still be a drastic shift in who is doing the paying.
Individuals and their employers now pay nearly half of the total cost of medical care, but that percentage would fall close to zero, and the percentage paid by the federal government would rise to compensate. Even under Mr. How that transfer takes place is one of the least well explained parts of the reform proposals. Taxation is the most obvious way to collect that extra revenue, but so far none of the current Medicare for all proposals have included a detailed tax plan.
Even if total medical spending stayed flat over all, some taxpayers could come out ahead and pay less; others could find themselves paying more. Raising revenue would require broad tax increases that are likely to be partly borne by the middle class , potentially impeding passage.
Advocates, including Mr. Sanders, tend to favor funding the program with payroll taxes. For some people, any increase in federal taxes might be more than offset by reductions in their spending on premiums, co-payments, deductibles and state taxes. There is evidence to suggest that premium savings by employers would also be returned to workers in the form of higher salaries.
But, depending on the details, other groups could end up paying more in tax increases than they save in those reductions. After Mr.
WebSee what Mercatus scholars have to say about Medicare for All and other health care policy proposals. How the Urban Institute’s Estimates of ‘Medicare for All’ Costs Stack Up . WebApr 10, · 0%. 5%. 7%. 9%. In our current system, doctors, hospitals and other health care providers are paid by a number of insurers, and those insurers all pay them slightly . WebMar 30, · Projections of additional federal spending over 10 years for Medicare for all Center for Health and Economy analysis of Sen. Bernie Sanders’s legislation (): .