This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at https://www.nytimes.com/2020/03/09/opinion/medicare-for-all-cost.html
The article has changed 5 times. There is an RSS feed of changes available.
| Version 3 | Version 4 |
|---|---|
| The Dangers of Medicare for All | The Dangers of Medicare for All |
| (about 7 hours later) | |
| It may seem counterintuitive, but single-payer health care proposals like Medicare for All could very well destroy Medicare as we know it and jeopardize medical care for seniors. | It may seem counterintuitive, but single-payer health care proposals like Medicare for All could very well destroy Medicare as we know it and jeopardize medical care for seniors. |
| It’s not just because single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatments, even for the most serious life-threatening diseases like cancer, brain tumors and heart disease. And it’s not just because single-payer systems restrict access to the newest drugs for cancer and other serious diseases, sometimes for years, compared with the United States system. | |
| Or that single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes. Or that tens of thousands of citizens in single-payer countries have died because of wait times for nonemergency treatment. | |
| And it’s not just because Bernie Sanders’s Medicare for All bill could cost an estimated $32 trillion in its first decade, more than double all currently projected federal individual and corporate income tax collections. | |
| Beyond that, Medicare for All will radically change health care for retirees because the services they get from hospitals and doctors are in effect subsidized by higher payments from privately insured patients. According to a report by the Centers for Medicare and Medicaid Services, while private insurance often pays over 140 percent of the cost of care, Medicare and Medicaid pay an estimated 60 percent of what private insurance pays for inpatient services, and an estimated 60 percent to 80 percent for physician services. Most hospitals, skilled nursing facilities and in-home health care providers already lose money per Medicare patient. By 2040, under today’s system, approximately half of hospitals, roughly two-thirds of skilled nursing facilities and over 80 percent of home health agencies would lose money overall. | |
| The estimated $32 trillion cost of Medicare for All includes the immediate cuts of about 40 percent to hospitals and about 30 percent to doctors now treating patients under private insurance, with these cuts likely growing more severe over time. Will these cuts occur without hurting timeliness or quality of care for patients? | The estimated $32 trillion cost of Medicare for All includes the immediate cuts of about 40 percent to hospitals and about 30 percent to doctors now treating patients under private insurance, with these cuts likely growing more severe over time. Will these cuts occur without hurting timeliness or quality of care for patients? |
| Here’s another truth — abolishing private insurance would harm today’s retirees on Medicare, because more than 70 percent of them use private insurance in addition to or instead of traditional Medicare. About 29 percent of those enrolled in traditional Medicare (A and B) buy “Medigap” plans, state-based private insurance that supplements non-drug Medicare benefits. | Here’s another truth — abolishing private insurance would harm today’s retirees on Medicare, because more than 70 percent of them use private insurance in addition to or instead of traditional Medicare. About 29 percent of those enrolled in traditional Medicare (A and B) buy “Medigap” plans, state-based private insurance that supplements non-drug Medicare benefits. |
| Twenty-two million other beneficiaries, 34 percent, enroll in alternative private Medicare Advantage health plans to replace traditional Medicare, a number doubling in the past decade. And millions of Medicare beneficiaries buy private prescription drug coverage in Part D. | Twenty-two million other beneficiaries, 34 percent, enroll in alternative private Medicare Advantage health plans to replace traditional Medicare, a number doubling in the past decade. And millions of Medicare beneficiaries buy private prescription drug coverage in Part D. |
| We also must not ignore the fact that Medicare is already facing serious financial challenges. A projection in the 2019 Medicare trustees’ report states that the Hospital Insurance Trust Fund, one of two Medicare funds, will be depleted in 2026. On top of that is the issue of funding the program. Just as the population of older people is greatly expanding, the taxpayer base financing the program is greatly shrinking. | We also must not ignore the fact that Medicare is already facing serious financial challenges. A projection in the 2019 Medicare trustees’ report states that the Hospital Insurance Trust Fund, one of two Medicare funds, will be depleted in 2026. On top of that is the issue of funding the program. Just as the population of older people is greatly expanding, the taxpayer base financing the program is greatly shrinking. |
| Medicare now spends over $740 billion for more than 60 million enrollees, but taxpaying workers per beneficiary — will decline by half in 2030 from when Medicare began. Nearly four million Americans now reach age 65 every year. In 2050, the 65-and-over population is projected to have almost doubled from 2012. America’s aging population means more heart disease, cancer, stroke and dementia — diseases that depend most on specialists, complex technology and innovative drugs for diagnosis and treatment. The current trajectory of the system is unsustainable. | Medicare now spends over $740 billion for more than 60 million enrollees, but taxpaying workers per beneficiary — will decline by half in 2030 from when Medicare began. Nearly four million Americans now reach age 65 every year. In 2050, the 65-and-over population is projected to have almost doubled from 2012. America’s aging population means more heart disease, cancer, stroke and dementia — diseases that depend most on specialists, complex technology and innovative drugs for diagnosis and treatment. The current trajectory of the system is unsustainable. |
| But there is another paradigm. The Trump administration has begun breaking down barriers to competition in the health care market by improving transparency essential to value-seeking patients. It has also reduced the government’s harmful overregulation of health care and insurance: barring “gag clauses” that prohibit pharmacists from revealing that a prescription drug may cost less than the insurance co-payment if bought with cash; and executive orders that require hospitals and doctors to post prices for procedures under Medicare and that facilitate tools to show patients their out-of-pocket costs have been introduced. | But there is another paradigm. The Trump administration has begun breaking down barriers to competition in the health care market by improving transparency essential to value-seeking patients. It has also reduced the government’s harmful overregulation of health care and insurance: barring “gag clauses” that prohibit pharmacists from revealing that a prescription drug may cost less than the insurance co-payment if bought with cash; and executive orders that require hospitals and doctors to post prices for procedures under Medicare and that facilitate tools to show patients their out-of-pocket costs have been introduced. |
| These moves, intended to remove the cloak of mystery around health care prices, are long overdue. The Trump administration has also increased private plan choices under Medicare, through Medicare Advantage, over the past few years. Nationwide, 3,148 private insurance plans now participate in Medicare Advantage, an increase of 15 percent over 2019 and the largest number of plans in the history of the program. | These moves, intended to remove the cloak of mystery around health care prices, are long overdue. The Trump administration has also increased private plan choices under Medicare, through Medicare Advantage, over the past few years. Nationwide, 3,148 private insurance plans now participate in Medicare Advantage, an increase of 15 percent over 2019 and the largest number of plans in the history of the program. |
| The average Medicare beneficiary can choose from 28 plans offered by seven firms in 2020. The continual increase in choices of coverage under Medicare Advantage to 28 in 2020 from 19 in 2016 reversed the trend of reduced choices under the Obama administration, when 33 plans offered in 2010 declined to 18 in 2015. | The average Medicare beneficiary can choose from 28 plans offered by seven firms in 2020. The continual increase in choices of coverage under Medicare Advantage to 28 in 2020 from 19 in 2016 reversed the trend of reduced choices under the Obama administration, when 33 plans offered in 2010 declined to 18 in 2015. |
| And while these private plans provide extra benefits not covered by traditional Medicare, according to the Centers for Medicare and Medicaid Services, average premiums for Advantage plans dropped this year by 23 percent compared with 2018 — down to the lowest monthly premiums since 2007 — likely a result of competition among insurers, reversing the average premium costs seen from 2012 through 2015 under the Obama administration. | And while these private plans provide extra benefits not covered by traditional Medicare, according to the Centers for Medicare and Medicaid Services, average premiums for Advantage plans dropped this year by 23 percent compared with 2018 — down to the lowest monthly premiums since 2007 — likely a result of competition among insurers, reversing the average premium costs seen from 2012 through 2015 under the Obama administration. |
| Voters must realize this. It is pure fantasy to believe that the access and quality Americans enjoy today would be maintained if private insurance — used by more than 217 million Americans — were abolished and everyone used Medicare for All. | Voters must realize this. It is pure fantasy to believe that the access and quality Americans enjoy today would be maintained if private insurance — used by more than 217 million Americans — were abolished and everyone used Medicare for All. |
| Abolishing private insurance, whether by law or via the slower pathway via introducing a public option, will eliminate the health care access and quality that today’s retirees enjoy. Instead, empowering older people to seek value with their money with more flexible coverage and larger, liberalized health savings accounts, stimulating competition among doctors and hospitals, and increasing the supply of medical care will generate what Americans most value and expect from health care — access, choice and quality. | Abolishing private insurance, whether by law or via the slower pathway via introducing a public option, will eliminate the health care access and quality that today’s retirees enjoy. Instead, empowering older people to seek value with their money with more flexible coverage and larger, liberalized health savings accounts, stimulating competition among doctors and hospitals, and increasing the supply of medical care will generate what Americans most value and expect from health care — access, choice and quality. |
| Scott W. Atlas is a senior fellow at Stanford University’s Hoover Institution and the author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost.” | Scott W. Atlas is a senior fellow at Stanford University’s Hoover Institution and the author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform at Lower Cost.” |
| The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com. | The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com. |
| Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. | Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. |