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Javier E

How Insurers Exploited Medicare Advantage for Billions - The New York Times - 0 views

www.nytimes.com/...vantage-fraud-allegations.html

medicare insurance industry fraud cheating overbilling

shared by Javier E on 09 Oct 22 - No Cached
  • The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
  • Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
  • Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed.
  • ...41 more annotations...
  • But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
  • Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.
  • by next year, more than half of Medicare recipients will be in a private plan.
  • a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
  • The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
  • As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
  • Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.
  • The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.
  • Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.
  • The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers
  • Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.
  • At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.
  • they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.
  • Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.
  • In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,
  • Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.
  • The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.
  • “You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”
  • Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.
  • But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.
  • In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.
  • But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.
  • Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete
  • Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.
  • “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”
  • The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.
  • Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist
  • Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.
  • Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.
  • The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.
  • Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.
  • Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.
  • At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.
  • few analysts expect major legislative or regulatory changes to the program.
  • Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.
  • Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.
  • Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.
  • The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.
  • Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”
  • Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.
  • “Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”
Javier E

When Hospitals Buy Doctors' Offices, and Patient Fees Soar - NYTimes.com - 0 views

www.nytimes.com/...ould-even-out-doctors-pay.html

medical medicare fee hospital policy funding

shared by Javier E on 08 Feb 15 - No Cached
  • Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.
  • This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.
  • The heart doctors are a great example. In 2009, the federal government cut back on what it paid to cardiologists in private practice who offered certain tests to their patients. Medicare determined that the tests, which made up about 30 percent of a typical cardiologist’s revenue, cost more than was justified, and there was evidence that some doctors were overusing them. Suddenly, Medicare paid about a third less than it had before.But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.
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  • Cardiologists are not the only doctors who have been migrating toward hospital practice. In the last few years, there have been increases in the number of doctors working for hospitals across the specialties. And spreads between fees for office services exist in an array of medical services, down to the basic office visit. The president's proposal would apply to all doctors working in off-campus, hospital-owned practices.
  • Like Medicare, most private insurers pay higher prices to hospitals than to independent doctors.Private insurers tend to copy many of Medicare’s payment policies. And, in general, large hospital groups tend to have more negotiating clout with insurers, meaning they can bargain for higher prices than smaller practices.
  • Hospitals don’t like the idea. Nearly all the money would come out of their pockets, and they argue that running a medical practice really does cost more for hospitals than it does for independent physician practices. Hospitals have to stay open at all hours, run emergency rooms and comply with an array of regulatory requirements that physician-owned practices don't need to worry about.
  • The Medicare Payment Advisory Committee, a group of experts that advises Congress, thinks that the pay differences should be narrowed, but only for a select set of medical services in which it’s really clear that there’s no difference between the care offered by a hospital and a physician office.
  • The pay differences, of course, are not the only reason that more doctors are going to work for hospitals. There are generational trends: Younger doctors are less interested in entrepreneurship and more interested in predictable hours and salary. And another Medicare program is trying to create financial incentives for health systems to manage patients’ entire health care experience, which many hospitals find easier to do if they employ the doctors.
  • in contrast to a lot of things in the president’s budget, it’s hard to dismiss this proposal as mere wishful thinking. Congress is often looking for places to save money in the Medicare budget, in part because it must find money every year to keep all doctors’ pay from declining precipitously — the result of a misguided payment formula passed in the 1990s.
Javier E

Jimmy Dore and the Left's Naïve Cynics Have Turned on AOC - 0 views

nymag.com/...medicare-for-all-strategy.html

health care medicare Democratic party platform progressive politics crisis policy

shared by Javier E on 23 Dec 20 - No Cached
  • The fact that this decision has earned AOC the enmity of some influential progressive commentators reflects a pathological tendency within a small subset of the U.S. left — namely, a habit of mining anti-political cynicism out of its own naïveté.
  • A political tactic is only as moral as it is effective.
  • To see what I mean by this, it’s worth examining the most thoughtful case for Dore’s strategy in some detail.
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  • Her argument can be summarized as follows:
  • • The pandemic has made Medicare for All more substantively necessary — and politically possible — than ever before.
  • • Although AOC argues that the “opportunity cost” is “too high to waste on a floor vote for a bill that wouldn’t ultimately pass,” the extraordinary circumstances of the COVID pandemic make this the best chance that progressives are going to get to win Medicare for All for the foreseeable future
  • • Even if the vote fails, forcing the debate “could spark a referendum on our failing health-care system at a moment when no other issue takes credible priority,” heightening the salience of the left’s signature policy demand — and the contradictions between a corrupt Democratic leadership and its base,
  • • Ultimately, “the moral case for action requires no strategic justification.
  • If one posits that the strategic wisdom of a political tactic has no bearing on the morality of pursuing it, then whether Dore’s proposal would achieve what he says it would is immaterial. But that’s a strange thing to stipulate!
  • Like most ardent Sanders supporters, they draw their moral fervor from a consequentialist analysis of public policy. Time and again, Berniecrats have accused opponents of universal health care of complicity in preventable deaths, as such loss of life is a predictable consequence of failing to extend health coverage to all Americans
  • But if Gray and Kulinski are indeed consequentialists, then they should recognize that “strategic justification” is the only measure of a political tactic’s moral worth. If politics is a tool for minimizing needless suffering — rather than a theater for performing one’s personal convictions — then a tactic is only as morally sound as it is likely to succeed.
  • whether it is in AOC’s power to effect the outcome Kulinski demands is precisely the object of contention! And that question can only be answered by a debate over strategy.
  • The core premise of Gray’s column is that single-payer health care enjoys overwhelming popular support
  • Lamentably, support for single-payer simply is neither as widespread nor intense as Gray suggests. Medicare for All does poll well — but it polls best when respondents are given few details about what the policy actually entails.
  • Even when pollsters spell out the meaning of single-payer in explicit terms, voters still have a tendency to interpret the proposal as a strong public option
  • This point is made plain by a KFF survey from September 2019, which found a majority of Democrats voicing approval for single-payer — but also favoring “building on the Affordable Care Act” over “replacing the Affordable Care Act with Medicare for All.”
  • Big money can corrupt Democratic politicians. But it can also buy off public opinion.
  • Democratic voters were treated to a nationally televised debate over Medicare for All about a dozen times during the 2020 primary — and they proceeded to vote for the candidate with the least progressive health-care policy in the field
  • Progressives may argue that the primary debates over Medicare for All were distorted by the biases of corporate media (I would argue this). But where do we think most voters are going to get their information about a House vote on Medicare for All if not from corporate-media entities?
  • This gets at a conspicuous tension in progressive electoral analysis. Some left-wing pundits posit that (1) big money exerts a profound influence on American politics, (2) corporate media influences how voters see the world, (3) big money and corporate media are profoundly hostile to left-wing policies, and yet (4) Democrats have no electoral incentive to spurn left-wing policies, and only do so because they are personally reactionary or corrupt.
  • he left’s critique of corporate media implies that it is not necessarily irrational for Democrats to believe that antagonizing powerful interest groups might cost them elections
  • they can also influence voter behavior through propaganda campaigns. And on Medicare for All specifically, the health-care industry has demonstrated success in turning voters against the policy.
  • In Colorado four years ago, progressives and health-care lobbies did battle over a ballot referendum that would have brought a single-payer health-care system to the Rocky Mountain State. The referendum went down by a margin of 79 to 21 percent.
  • the collapse of Vermont’s attempt to establish single-payer through legislative action – and the subsequent election of a Republican to its governorship –lends further credence to this notion.
  • The reality that big money can thwart progressive aims — even when Democratic officials are supportive — was made plain by some of this year’s ballot measures. In Illinois, Democratic governor J.B. Pritzker backed a referendum that would have lifted the state’s constitutional prohibition on progressive taxation. Specifically, the measure would have enabled the state to raise taxes on residents who earn over $250,000 so as to limit budget cuts in the midst of a fiscal crisis. Opponents spent over $100 million propagandizing against the policy. Supporters spent roughly as much, but the combination of well-funded propaganda and the public’s aversion to higher taxes led to 53 percent of the deep-blue state’s voters opting to make it impossible for their representatives to tax the rich at a higher rate than the poor.
Javier E

Opinion | 'Medicare for All' Could Kill Two Million Jobs, and That's O.K. - The New Yor... - 0 views

www.nytimes.com/...medicare-for-all-jobs.html

medicare jobs reform health-care economics policy

shared by Javier E on 16 May 19 - No Cached
  • Any significant reform would require major realignment of the health care sector, which is now the biggest employer in at least a dozen states. Most hospitals and specialists would probably lose money. Some, like the middlemen who negotiate drug prices, could be eliminated. That would mean job losses in the millions.
  • the point is to streamline for patients a Kafka-esque health care system that makes money for industry through irrational practices. After all, shouldn’t the primary goal of a health care system be delivering efficient care at a reasonable price
  • In 2012, the Harvard economists Katherine Baicker and Amitabh Chandra warned against “treating the health care system like a (wildly inefficient) jobs program.” They were rightly worried that the health care system was the primary engine of recovery from the Great Recession
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  • Change could come in many guises: for example, some form of Medicare expansion, government negotiations on drug prices or enhancing the power of the Affordable Care Act. The more fundamental the reform, the more severe the economic effect.
  • The first casualties of a Medicare for all plan, said Kevin Schulman, a physician-economist at Stanford, would be the “intermediaries that add to cost, not quality.” For example, the armies of administrators, coders, billers and claims negotiators who make good middle-class salaries and have often spent years in school learning these skills.
  • Stanford researchers estimate that 5,000 community hospitals would lose more than $151 billion under a Medicare for all plan; that would translate into the loss of 860,000 to 1.5 million jobs. A Navigant study found that a typical midsize, nonprofit hospital system would have a net revenue loss of 22 percent.
  • Medicare for all would result in job losses (mostly among administrators) “somewhere in the range of two million” — about half on the insurers’ side and half employed in hospitals and doctors’ offices to argue with the former.
  • “What we can’t quantify is the effect that high health care costs have had on non-health care industries.”
  • The expense of paying for employees’ health care has depressed wages and entrepreneurship, he said. He described a textile manufacturer that moved more than 1,000 jobs out of the country because it couldn’t afford to pay for insurance for its workers. Such decisions have become common in recent years.
Javier E

The Young Left Is a Third Party - The Atlantic - 0 views

www.theatlantic.com/...603232

politics culture progressive young leftist age generation Generation Z

shared by Javier E on 10 Dec 19 - No Cached
  • Americans 55 and up account for less than one-third of the population, but they own two-thirds of the nation’s wealth, according to the Federal Reserve. That’s the highest level of elderly wealth concentration on record. The reason is simple: To an unprecedented degree, older Americans own the most valuable real estate and investment portfolios. They’ve captured more than 80 percent of stock-market growth since the end of the Great Recession.
  • under the age of 40, for their part, are historically well educated, historically peaceful, and historically law-abiding
  • “In the U.S, as in the U.K. and in much of Europe, 2008 was the end of the end of history,” says Keir Milburn, the author of Generation Left, a book on young left-wing movements. “The last decade in the U.K. has been the worst decade for wage growth for 220 years. In the U.S., this generation is the first in a century that expects to have lower lifetime earnings than their parents. It has created an epochal shift.”
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  • Young Americans demanding more power, control, and justice have veered sharply to the left. This lurch was first evident in the two elections of Barack Obama, when he won the youth vote by huge margins
  • Obama won about 60 percent of voters younger than 30 in the 2008 primary. Bernie Sanders won more than 70 percent of under-30 voters in the 2016 primary, which pushed Hillary Clinton to the left and dragged issues like Medicare for All and free college from the fringe to the mainstream of political debate.
  • Joe Biden polled at 2 percent among voters under 30, within the margin of error of zero. Nationally, he is in single digits among Millennials, the generation born between 1981 and 1996. Yet Biden is the Democratic front-runner for the 2020 presidential nomination, thanks to his huge advantage among old voters and black voters, who are considerably more moderate than younger Democrats.
  • Bernie Sanders, by contrast, leads all candidates among voters under 30 and polls just 5 percent among voters over 65
  • age divides young leftists from both Republicans and Democrats. Democrats under 30 have almost no measurable interest in the party’s front-runner. Democrats over 65 have almost no measurable interest in the favored candidate of the younger generation.
  • age—perhaps even more than class or race—is now the most important fault line within the Democratic Party. 2c 2c 2c 2c 2c 2c 2c 2c 2c
  • It might be most useful to think about 2cyoung progressives as a third party trapped in a two-party system.
  • they are a powerful movement politically domiciled within a larger coalition of moderate older minorities and educated suburbanites, who don’t always know what to do with their rambunctious bunkmates.
  • this progressive third party’s platform look like?
  • justice: Social justice, sought through a reappraisal of power relationships in social and corporate life, and economic justice, sought through the redistribution of income from the rich to the less fortunate.
  • This group’s support for Medicare for All, free college, and student-debt relief is sometimes likened to a “give me free stuff” movement.
  • every movement wants free stuff, if by free stuff one means “stuff given preferential treatment in the tax code.” By this definition, Medicare is free stuff, and investment income is free stuff, and suburban home values propped up by the mortgage-interest deduction are free stuff. The free stuff in the tax code today benefits Americans with income and wealth—a population that is disproportionately old.
  • Medicare for All might be politically infeasible, but it is, taken literally, a request that the federal government extend to the entire population the insurance benefits now exclusively reserved for the elderly. That’s not hatred or resentment; it sounds more like justice.
  • across ethnicities, many Americans have a deep aversion to anything that can be characterized as “political correctness” or “socialism.”
  • this might be the biggest challenge for the young progressive agenda
  • While Medicare for All often polls well, its public support is exquisitely sensitive to framing. According to the Kaiser Family Foundation, the net favorability of eliminating private insurance or requiring most Americans to pay more in taxes—both part of the Sanders plan—is negative-23 points.
  • The young left’s deep skepticism toward capitalism simply isn’t shared by previous generations.
  • Gen X is firmly pro-capitalist and Baby Boomers, who came of age during the Cold War, prefer capitalism over socialism by a two-to-one margin.
  • Social Security and Medicare are, essentially, socialism for the old, but that’s not the same as converting them into Berniecrats.)
  • “This is only the halfway point of an epochal change in Western politics following the Great Recession,” Keir Milburn says. The far right has responded with calls for xenophobic nationalism to preserve national identity, while the left has responded with calls for social democracy to restore socioeconomic justice
  • the far right is ascendant, but they have no answer to the future because they’ve given up on the future. The young left has identified that the future of adulthood no longer feels viable to many people, and it’s putting together a different vision.”
Javier E

Many Hospitals Charge More Than Twice What Medicare Pays for the Same Care - The New Yo... - 0 views

www.nytimes.com/...-hospitals-medicare-rates.html

medicare public health health health-care policy politics

shared by Javier E on 21 Sep 20 - No Cached
  • Hospitals across the country are charging private insurance companies 2.5 times what they get from Medicare for the same care, according to a new RAND Corporation study
  • “The prices are so high, the prices are so unaffordable — it’s just a runaway train,” said Gloria Sachdev, the chief executive of the Employers’ Forum of Indian
  • While the pandemic caused losses for many hospitals, many of these big systems are sitting on large profit reserves, while also receiving some of the $175 billion in aid Congress allocated to make up for their costs and lost revenue.
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  • Employers provide health insurance coverage for more than 153 million Americans. The companies and insurers in the study paid nearly $20 billion more than Medicare would have for the same care
  • Proponents of a so-called public option seize on such price-gouging news to argue that creating a government health plan that could use its clout to demand lower prices would help bring down the cost of care.
  • A public option, distinct from the more controversial “Medicare for all” proposals that would do away with private insurance, has been embraced by Joseph R. Biden Jr., the Democratic presidential nominee. Democrats and even some Republicans seem open to the idea, according to a recent poll from the Kaiser Family Foundation.
Javier E

It Takes a Party - NYTimes.com - 0 views

www.nytimes.com/...it-takes-a-party.html

election 2016 parties position policies partisan polarization GOP Democratic party

shared by Javier E on 14 Apr 15 - No Cached
  • there has never been a time in American history when the alleged personal traits of candidates mattered less. As we head into 2016, each party is quite unified on major policy issues — and these unified positions are very far from each other. The huge, substantive gulf between the parties will be reflected in the policy positions of whomever they nominate, and will almost surely be reflected in the actual policies adopted by whoever wins.
  • any Democrat would, if elected, seek to maintain the basic U.S. social insurance programs — Social Security, Medicare, and Medicaid — in essentially their current form, while also preserving and extending the Affordable Care Act. Any Republican would seek to destroy Obamacare, make deep cuts in Medicaid, and probably try to convert Medicare into a voucher system.
  • Any Democrat would retain the tax hikes on high-income Americans that went into effect in 2013, and possibly seek more. Any Republican would try to cut taxes on the wealthy — House Republicans plan to vote next week to repeal the estate tax — while slashing programs that aid low-income families.
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  • Any Democrat would try to preserve the 2010 financial reform, which has recently been looking much more effective than critics suggested. Any Republican would seek to roll it back, eliminating both consumer protection and the extra regulation applied to large, “systemically important” financial institutions.
  • And any Democrat would try to move forward on climate policy, through executive action if necessary, while any Republican — whether or not he is an outright climate-science denialist — would block efforts to limit greenhouse gas emissions.
  • How did the parties get this far apart? Political scientists suggest that it has a lot to do with income inequality. As the wealthy grow richer compared with everyone else, their policy preferences have moved to the right — and they have pulled the Republican Party ever further in their direction. Meanwhile, the influence of big money on Democrats has at least eroded a bit, now that Wall Street, furious over regulations and modest tax hikes, has deserted the party en masse. The result is a level of political polarization not seen since the Civil War.
ethanshilling

House Votes to Avert Deep Medicare Cuts to Pay for $1.9 Trillion Stimulus Plan - The Ne... - 0 views

www.nytimes.com/...care-stimulus-coronavirus.html

us Politics pandemic

shared by ethanshilling on 21 Mar 21 - No Cached
  • The House voted on Friday to avert an estimated $36 billion in cuts to Medicare next year and tens of billions more from farm subsidies and other social safety net programs, moving to stave off deep spending reductions that would otherwise be made to pay for the $1.9 trillion stimulus bill enacted last week.
  • In passing the virus aid plan, Democrats used a fast-track budget process to push past Republican opposition, arguing that urgent needs brought on by the pandemic outweighed concerns about running up the national debt.
  • Democrats remained confident that, even though they opposed the stimulus package, Republican senators would eventually support legislation to avoid cutting Medicare, farm subsidies and social services block grants to pay for it.
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  • In remarks on the House floor, Representative John Yarmuth of Kentucky, the chairman of the Budget Committee, described the bill as “a loose end we have to tie up before our work is finished.”
  • The politically unpopular specter of drastic Medicare cuts during a pandemic is likely to prod lawmakers to a deal before the year is out.
  • The debate over paying for the stimulus stems from a 2010 law called the Statutory Pay-as-You-Go Act that requires certain deficit spending to be automatically offset by cuts to federal programs.
  • Many mandatory spending programs could be completely defunded, including social services block grants, a Justice Department program that provides aid to crime victims, and the Black Lung Disability Trust Fund.
  • “We need to be working together, as we did for you when you were giving tax cuts to the wealthiest Americans,” Representative Jan Schakowsky, Democrat of Illinois, said in a comment directed at Republicans.
  • Conservatives see the confrontation as an opportunity to criticize overspending by the Democrats.
maddieireland334

Medicare Is Leaving Elderly Women Behind - 0 views

www.theatlantic.com/...472155

medicare elderly policy culture health women

shared by maddieireland334 on 05 Mar 16 - No Cached
  • maddieireland334 on 05 Mar 16
     
    They have longer life spans and less money, but U.S. health policy is failing the nation's oldest female patients-and no presidential candidate seems to have an answer. Please consider disabling it for our site, or supporting our work in one of these ways Subscribe Now > Medicare is America's gold health standard, right?
Javier E

The 'insurgent left' and path dependency - The Washington Post - 0 views

www.washingtonpost.com/...rgent-left-and-path-dependency

Democratic party strategy reform path dependency Politics

shared by Javier E on 24 Jul 18 - No Cached
  • the insertion of the insurgents into the Democratic Party is allegedly creating anxiety among mainstream Democrats who worry that it provides the hard right with just the angle they need right now to hold onto power.
  • their goals are ambitious. But are they extreme and dangerous? Not at all, and in fact, the insurgents’ goals are directionally shared by moderates. The questions are how far to go and how best to get from here to there
  • Ocasio-Cortez ran on, among other things: Medicare for all, free public college and trade school, a job guarantee, ending private prisons and abolishing ICE (Immigration and Customs Enforcement). Consider the motivation for these ideas:
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  • is the angst of mainstream Democrats well-founded? I’m not sure it’s even real.
  • Look at the policy agenda of moderate Pennsylvania Democrat Conor Lamb, who won a congressional district that went for Trump by almost 20 points. He’s for jobs through infrastructure investment, increasing health coverage through building on the Affordable Care Act, raising wages through strengthening unions and reducing student debt through refinancing at lower rates and partial debt forgiveness in exchange for public service.
  • It’s also an agenda that points in the same broad direction as that of the so-called insurgents. The difference between moderate and socialist Democrats is less about policy goals and more about path dependency.
  • Path dependency is the concept that where you end up is a function of where you start out. In this context, it means you can only get from the current policy regime to a more progressive one through incremental change. Medicare for More must proceed Medicare for All. Smaller, more customized job creation programs must proceed the guarantee of a good job for everyone who wants one
  • In practice, that means you can’t assume away the power of the health insurance industry in blocking single payer. You can’t assume the federal government can handily employ tens of millions of people in what are now private-sector functions. Instead, you build a public option into the health-care exchanges and you extend Medicare eligibility to slightly younger people. You subsidize private employers to hire targeted workers.
  • At least, that’s where you start. It’s not where you end. Under path dependency, the efficiency of the public option, if it is properly supported, will start to claw back excess profits from the current health-care system.
  • The logic of social justice and the policy agenda it implies is deep and persuasive, especially in a society as diverse as our own
  • The problem is that the intersection of wealth concentration and pay-to-play politics is undermining representative democracy, thereby blocking the electorate from a chance to see real, progressive change in action.
  • The solution is for path-dependent moderates to coexist and work closely with those who would leapfrog the path to more quickly achieve their goals.
  • Neither I nor anyone else can tell you who’s right, i.e., how binding the path is. That is an empirical question to be answered by a very different politics than we have today. To find that answer, we need to get to that new politics, and fast.
anonymous

Covid-19 Relief Bill Fulfills Biden's Promise to Expand Obamacare, for Two Years - The ... - 0 views

www.nytimes.com/...obamacare-biden.html

shared by anonymous on 09 Mar 21 - No Cached
  • President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.
  • The changes will last only for two years. But for some, they will be considerable: The Congressional Budget Office estimated that a 64-year-old earning $58,000 would see monthly payments decline from $1,075 under current law to $412 because the federal government would take up much of the cost.
  • “For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition. The bill, he said, would “make a big dent in the number of the uninsured.”
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  • “Obviously it’s an improvement, but I think that it is inadequate given the health care crisis that we’re in,” said Representative Ro Khanna, a progressive Democrat from California who favors the single-payer, government-run system called Medicare for All that has been embraced by Senator Bernie Sanders, independent of Vermont, and the Democratic left.
  • “We’re in a national health care crisis,” Mr. Khanna said. “Fifteen million people just lost private health insurance. This would be the time for the government to say, at the very least, for those 15 million that we ought to put them on Medicare.”
  • The stimulus bill would make upper-middle-income Americans newly eligible for financial help to buy plans on the federal marketplaces, and the premiums for those plans would cost no more than 8.5 percent of an individual’s modified adjusted gross income. It would also increase subsidies for lower-income enrollees.
  • Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.
  • The Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.
  • Mr. Biden made clear when he was running for the White House that he did not favor Medicare for All, but instead wanted to strengthen and expand the Affordable Care Act. The bill that is expected to reach his desk in time for a prime-time Oval Office address on Thursday night would do that. The changes to the health law would cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.
  • Even so, some 30 million Americans were uninsured between January and June 2020, according to the latest figures available from the National Health Interview Survey. The problem has only grown worse during the coronavirus pandemic, when thousands if not millions of Americans lost insurance because they lost their jobs.
  • Republicans have always said that their plan was to repeal and replace the health law, but after 10 years they have yet to come up with a replacement. Mr. Ayres said his firm is working on “coming up with some alternative health care message” that does not involve “simply throwing everybody into a government-run health care problem.”
  • Yet polls show that the idea of a government-run program is gaining traction with voters. In September, the Pew Research Center reported that over the previous year, there had been an increase, especially among Democrats, in the share of Americans who say health insurance should be provided by a single national program run by the government.
  • “I would argue there is more momentum for Medicare expansion given the pandemic and the experience people are having,” said Mr. Khanna, the California congressman. “They bought time, but I think at some point there will be a debate on a permanent fix.”
  • But because those provisions last only two years, the relief bill almost guarantees that health care will be front and center in the 2022 midterm elections, when Republicans will attack the measure as a wasteful expansion of a health law they have long hated. Meantime, some liberal Democrats may complain that the changes only prove that a patchwork approach to health care coverage will never work.
  • Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.
  • “For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition.
  • WASHINGTON — President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.
  • The Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.
  • The poll found that 36 percent of Americans, and 54 percent of Democrats, favored a single national program. When asked if the government had a responsibility to provide health insurance, either through a single national program or a mix of public and private programs, 63 percent of Americans and 88 percent of Democrats said yes.
  • Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.
  • Republicans have always said that their plan was to repeal and replace the health law, but after 10 years they have yet to come up with a replacement. Mr. Ayres said his firm is working on “coming up with some alternative health care message” that does not involve “simply throwing everybody into a government-run health care problem.”
  • In January, he ordered the Affordable Care Act’s health insurance marketplaces reopened to give people throttled by the pandemic economy a new chance to obtain coverage.
  • Yet polls show that the idea of a government-run program is gaining traction with voters. In September, the Pew Research Center reported that over the previous year, there had been an increase, especially among Democrats, in the share of Americans who say health insurance should be provided by a single national program run by the government.
  • With its expanded subsidies for health plans under the Affordable Care Act, the coronavirus relief bill makes insurance more affordable, and puts health care on the ballot in 2022.
  • cludes rich new incentives to entice the few holdout states — including Texas, Georgia and Florida — to finally expand Medicaid to those with too much money to qualify for the federal health program for the poor, but too little to afford private covera
  • “Biden promised voters a public option, and it is a promise he has to keep,” said Waleed Shahid, a spokesman for Justice Democrats, the liberal group that helped elect Representative Alexandria Ocasio-Cortez and other progressive Democrats. Of the stimulus bill, he said, “I don’t think anyone thinks this is Biden’s health care plan.”
  • “I think that argument has been fought and lost,” said Whit Ayres, a Republican pollster, conceding that the repeal efforts are over, at least for now, with Democrats in charge of the White House and both houses of Congress.
anonymous

Chiquita Brooks-LaSure, CMS Head, Vows To Improve Access To Health Care : Shots - Healt... - 0 views

www.npr.org/...-new-head-of-medicare-medicaid

shared by anonymous on 04 Jun 21 - No Cached
  • The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity.
  • "We've seen through the pandemic what happens when people don't have health insurance and how important it is," said Chiquita Brooks-LaSure, who was confirmed by the Senate to lead the Centers for Medicare & Medicaid Services on May 25 and sworn in on May 27.
  • That approach is an abrupt switch from the Trump administration, which pushed the agency to do what it could to help repeal the Affordable Care Act and scale back the Medicaid program, the federal-state program for people with low incomes.
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  • she is not surprised at the robust increase in the number of people enrolling in ACA insurance since President Biden reopened enrollment in January. As of last month, the administration says, more than 1 million people had signed up.
  • "Over the last couple of years, I've worked with a lot of the state-based marketplaces and we could see the difference in enrollment when the states were actively pushing coverage," Brooks-LaSure said. A former congressional and Obama administration health staffer, she most recently worked as managing director at the consulting firm Manatt Health.
  • Brooks-LaSure also suggested that the Biden administration would support efforts in Congress to ensure coverage for the millions of Americans who fall into what's come to be called the Medicaid gap. Those are people in the dozen states that have not expanded Medicaid under the Affordable Care Act who earn too little to qualify for ACA marketplace coverage.
  • Brooks-LaSure said she would prefer that states use the additional incentive funding provided in the recent American Rescue Plan toward expanding their Medicaid programs "because, ideally, states are able to craft policies in their own states; they're closest to the ground."
  • Last year's economic downturn — and the resulting drop in tax revenue from employees' paycheck withholdings — is likely to accelerate the date when Medicare's hospital insurance program will not be able to cover all of its bills.
  • Democrats in Congress are looking at both lowering Medicare's eligibility age and adding benefits the program now lacks, including dental, hearing and vision coverage.
  • "I hope that we, when we are looking at solvency, really focus on making sure we keep the Medicare program robust," said Brooks-LaSure. "And that may mean some changes that strengthen the program."
Javier E

Poverty as a Childhood Disease - NYTimes.com - 0 views

well.blogs.nytimes.com/...poverty-as-a-childhood-disease

poverty government policy childhood public health

shared by Javier E on 15 May 13 - No Cached
  • At the annual meeting of the Pediatric Academic Societies last week, there was a new call for pediatricians to address childhood poverty as a national problem, rather than wrestling with its consequences case by case in the exam room.
  • Poverty damages children’s dispositions and blunts their brains. We’ve seen articles about the language deficit in poorer homes and the gaps in school achievement. These remind us that — more so than in my mother’s generation — poverty in this country is now likely to define many children’s life trajectories in the harshest terms: poor academic achievement, high dropout rates, and health problems from obesity and diabetes to heart disease, substance abuse and mental illness.
  • “After the first three, four, five years of life, if you have neglected that child’s brain development, you can’t go back,” he said. In the middle of the 20th century, our society made a decision to take care of the elderly, once the poorest demographic group in the United States. Now, with Medicare and Social Security, only 9 percent of older people live in poverty. Children are now our poorest group, with almost 25 percent of children under 5 living below the federal poverty level.
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  • At the meeting, my colleague Dr. Benard P. Dreyer, professor of pediatrics at New York University and a past president of the Academic Pediatric Association, called on pediatricians to take on poverty as a serious underlying threat to children’s health. He was prompted, he told me later, by the widening disparities between rich and poor, and the gathering weight of evidence about the importance of early childhood, and the ways that deprivation and stress in the early years of life can reduce the chances of educational and life success.
  • When Tony Blair became prime minister of Britain, amid growing socioeconomic disparities, he made it a national goal to cut child poverty in half in 10 years. It took a coalition of political support and a combination of measures that increased income, especially in families with young children (minimum wage, paid maternity and paternity leaves, tax credits), and better services — especially universal preschool programs. By 2010, reducing child poverty had become a goal across the British political spectrum, and child poverty had fallen to 10.6 percent of children below the absolute poverty line (similar to the measure used in the United States), down from 26.1 percent in 1999.
  • Dr. Dreyer said: “Income matters. You get people above the poverty level, and they actually are better parents. It’s critical to get people out of poverty, but in addition our focus has to be on also giving families supports for other aspects of their lives — parenting, interventions in primary care, universal preschool.”
  • Robert H. Dugger, managing partner of Hanover Investment Group, who made the economic case for investing in young children. “History shows that productivity increases when people are able to access their rights to life, liberty and the pursuit of happiness,” Mr. Dugger told me. “There is no economic recovery strategy stronger than committing to early childhood and K-through-12 investment.”
Javier E

Beware of Romneycare : The New Yorker - 0 views

www.newyorker.com/...121029ta_talk_surowiecki

health care

shared by Javier E on 24 Oct 12 - No Cached
  • In most areas of the economy, free-market principles insure that products and services keep improving, and that consumers get better and better deals. But the free market, though it may be the best way of allocating new TVs and cars, falters when it comes to paying for bypass surgery or chemotherapy. The reasons for this were established nearly fifty years ago, by the economist Kenneth Arrow, in a classic article entitled “Uncertainty and the Welfare Economics of Medical Care.” Arrow showed that health care is distinctive in ways that limit the power of the market. Because people don’t have the expertise to evaluate doctors, hospitals, or treatments, it’s hard for them to comparison-shop. Because they can’t pay for major care out of pocket, they must rely on insurance, thereby often losing the final say in what to buy or how much to spend. More fundamentally, markets work only when consumers have the power to say no if the price isn’t right. Yet it’s very hard for people to say no in the case of things like end-of-life care or brain surgery.
  • the truth is that, despite the rhetoric, Romney’s main concern isn’t to bring down over-all health-care costs. In fact, he has regularly attacked one of the Affordable Care Act’s most aggressive cost-cutting measures—the independent board that can make binding recommendations on how to cut Medicare spending. What he wants is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney Administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding would lag behind the rise in health-care costs. And, if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country.
  • The real issue, come November 6th, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea of what government should do. ♦
izzerios

Trump Tells Congress to Repeal Health Care Law 'Very Quickly' - The New York Times - 0 views

www.nytimes.com/...ble-care-act-donald-trump.html

trump health care

shared by izzerios on 10 Jan 17 - No Cached
  • “In an ideal situation, we would repeal and replace Obamacare simultaneously, but we need to make sure that we have at least a detailed framework that tells the American people what direction we’re headed,”
  • vote gives Senate and House committees until Jan. 27 to write legislation that would repeal major provisions of the health care law.
  • convinced Mr. Trump to leap into the fray. Not only did he try to steel Republican spines, but he threatened Democrats who might stand in his way, saying he would campaign against them,
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  • “It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, he said,
  • He described the health law as a catastrophe. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare,”
  • After meeting with House Republicans on Tuesday, Mr. Ryan took a similar tone, calling the campaign to repeal the health law “a rescue mission to save families who are getting caught up in the death spiral that has become Obamacare.”
  • That legislation would take Democratic cooperation to be passed, because Senate Republicans are eight votes short of a filibuster-proof majority.
  • Far from a “death spiral,” Mr. Obama and congressional Democrats call the Affordable Care Act the best health law since the creation of Medicare and Medicaid in 1965.
  • Obama administration reported on Tuesday that more than 11.5 million people nationwide had signed up for health insurance or been automatically re-enrolled under the Affordable Care Act as of Dec. 24, 2016.
Javier E

On the Eve of Disruption: Final Thoughts on the 2016 Election - 0 views

talkingpointsmemo.com/...--100887

politics Democratic party

shared by Javier E on 19 Dec 16 - No Cached
  • I don’t mean to suggest that the Democrats’ situation is hopeless. The numbers of supporters are still roughly equal in presidential years. The Republicans have benefitted over the last eight years from a halting recovery to the great recession (which they were partly to blame for) and by the unpopularity of the Affordable Care Act, Barack Obama’s signature program, as well as by the rise of ISIS, and continuation of terrorist attacks in the United States. That allowed them to run as the candidates promising change without specifying exactly what those changes would consist of
  • now, with Republicans in charge, the shoe is on the other foot. Trump could prove very vulnerable politically. Trump promised in his campaign that he would protect Medicare and Social Security, but if he and his nominee for Health and Human Services, Tom Price, accede to Congressional Republican plans to privatize Medicare, cut Social Security, and repeal without significantly replacing the ACA, he could lose the support of the “Trump Democrats.”
  • In August 1995, Bill Clinton did in House Speaker Newt Gingrich by showing that Gingrich planned to finance tax cuts for the wealthy by cuts in Medicare. In 2005, Senate Minority leader Harry Reid took the winds out of George W. Bush’s re-election by blocking his plan to privatize Social Security.
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  • Trump also won office by promising to keep American troops out of “wars of choice,” but he could be drawn back into conflicts –whether in the Middle East or South China Sea – by his own choleric temperament and by his intemperate National Security Advisor Michael Flynn
  • Finally, Trump and the Republicans could be damaged by another economic downturn although that’s less likely to happen over the next four years if Trump goes through with his tax cuts and infrastructure spending
  • as far as regaining Congress and the White House is concerned, the best offense in this case is a good defense. Much of the Democrats’ success will inevitably depend on Trump and the Republicans advancing unpopular proposals, and the Democrats making them pay for them at the ballot box.
Javier E

The Medicare Miracle - NYTimes.com - 0 views

www.nytimes.com/...gman-the-medicare-miracle.html

obamacare results

shared by Javier E on 01 Sep 14 - No Cached
  • What’s the moral here? For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all.
jayhandwerk

Why 'Medicare for All' Will Sink the Democrats - The New York Times - 0 views

www.nytimes.com/...edicare-for-all-democrats.html

medicare politics US democrats

shared by jayhandwerk on 25 Oct 17 - No Cached
  • Repeal-and-replace may be done for now, but for Senator Bernie Sanders, the war is just beginning — and it has already become a fracas that is dividing the Democratic Party, to its detriment.
  • As a centrist Democrat, I’m scared to see my party pulled into positions that are both bad politics and dubious policy. And I’m disappointed that few of our party’s moderates are willing to resist the freight train coming at us from the left.
  • when factors like whether taxes would be raised or the Affordable Care Act would be repealed are introduced, the consensus swings to opposition.
Javier E

Opinion | A Better Path to Universal Health Care - The New York Times - 0 views

www.nytimes.com/...health-care-germany.html

universal health-care germany

shared by Javier E on 22 Feb 19 - No Cached
  • Germany offers a health insurance model that, like Canada’s, results in far less spending than in the United States, while achieving universal, comprehensive coverage
  • this model, pioneered by Chancellor Otto von Bismarck in 1883, was the first social health insurance system in the world. It has since been copied across Europe and Asia, becoming far more common than the Canadian single-payer model.
  • Germans are required to have health insurance, but they can choose between more than 100 private nonprofit insurers called “sickness funds.” Workers and employers share the cost of insurance through payroll taxes, while the government finances coverage for children and the unemployed.
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  • Insurance plans are not tied to employers. Services are funded through progressive taxation, so access is based on need, not ability to pay, and financial contributions are based on wealth, not health.
  • Contributions to sickness funds are centrally pooled and then allocated to individual insurers using a per-beneficiary formula that factors in differences in health risks.
  • Editors’ PicksYou Know the Lorena Bobbitt
  • The United States has the foundation for this kind of system. Its Social Security and Medicare systems use taxation to pay for social insurance policies, and the health care exchanges created by the Affordable Care Act provide marketplaces for insurance policies.
  • In Germany, for example, insurers can charge only small out-of-pocket fees limited to 2 percent or less of household income annually
  • Compared with the mostly fee-for-service, single-payer arrangements in Canada or the Medicare system, enrolling Americans in managed care plans paid on a per-patient basis would offer greater incentives to increase efficiency, improve quality of care and promote coordination of care.
  • Under a German-style plan, states could still be given flexibility in regulating nonprofit insurers to reflect regional priorities, similar to the flexibility offered to states in managing Medicaid and the A.C.A. exchanges.
  • Germany, Austria, the Netherlands and other countries with similar systems vastly underspend the United States.
  • Americans may be concerned that lower spending reflects rationing of care, but research has consistently found that not to be the case
  • Administrative and governance costs in multipayer systems are higher than in single-payer systems — 5 percent of health spending in Germany compared with 3 percent in Canada.
  • While recent polls indicate that a majority of Americans support so-called Medicare for all, approval diminishes when the plan is explained or clarified.
  • Americans have long valued choice and competition in their health care. The German model offers both: Patients choose private insurers that compete for enrollees, in the process driving innovation and improving quality.
  • Advocates and policymakers should pick carefully among these paths, choosing one that strikes a balance between what is possible and what is ideal for the United States health system
  • While the single-payer model serves Canada well, transitioning the United States to a multipayer model like Germany’s would require a far smaller leap. And that might encourage Americans to finally make the jump
Javier E

Opinion | The Fleecing of Millennials - The New York Times - 0 views

www.nytimes.com/...uttigieg-2020-millennials.html

millennials economics income wealth American dream

shared by Javier E on 28 Jan 19 - No Cached
  • the economy has now been growing for almost a decade. But the truth is that younger Americans have not benefited much.
  • Look at incomes, for starters. People between the ages of 25 and 34 were earning slightly less in 2017 than people in that same age group had been in 2000:
  • The wealth trends look even worse. Since the century’s start, median net worth has plummeted for every age group under 55
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  • Why is this happening? The main reason is a lack of economic dynamism. Not as many new companies have been forming since 2000 — for reasons that experts don’t totally understand — and existing companies have been expanding at a slower rate.
  • Rather than starting new projects, companies are sitting on big piles of cash or distributing it to their shareholders.
  • Because the layoff rate has declined since 2000, most older workers have been able to hold on to their jobs. For those who are retired, their income — through a combination of Social Security and 401(k)’s — still outpaces inflation on average.
  • But many younger workers are struggling to launch themselves into good-paying careers. They then lack the money to buy a first home or begin investing in the stock marke
  • Given these trends, you’d think the government would be trying to help the young. But it’s not. If anything, federal and state policy is going in the other direction. Medicare and Social Security have been spared from cuts. Programs that benefit younger workers and families have not.
  • The biggest example is higher education. Over the past decade, states have cut college funding by an average of 16 percent per student.
  • First, the national debt, while manageable now, is on pace to soar. The primary cause is the cost of health care: Most Americans receive far more in Medicare benefits than they paid in Medicare taxes. The Trump tax cut also plays a role. It is increasing the debt — and it mostly benefits older, affluent households.
  • Second, the warming planet is likely to cause terrible damage and bring huge costs.
  • Young Americans favor aggressive action, now, to slow climate change. But the Republican Party — which wins elections with strong support from older voters — has vetoed any such action.
  • Today’s young Americans will be left to suffer the consequences and bear the costs.
  • Last week, one of those young Americans — somebody who qualifies as an older millennial — announced that he was running for president: the 37-year-old mayor of South Bend, Ind., Pete Buttigieg. A Navy veteran and Rhodes scholar who’s been praised by Barack Obama, Buttigieg (“BOOT-edge-edge”) is a rising star in Democratic politics
  • I think his candidacy is important, because it has the potential to influence the entire campaign. Buttigieg kicked off his run by talking about “intergenerational justice” and made clear that he would focus sharply on the future.
  • the country’s biggest economic problems aren’t about hordes of greedy old people profiting off the young. They’re about an economy that showers much of its bounty on the already affluent, at the expense of most Americans — and of our future. The young pay the biggest price for these inequities.
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