Study: Bernie's health plan is actually a train wreck for the poor, especially minorities

[Cali_Democrat]

By Max Ehrenfreund
February 25

Millions of families among the working poor and lower-middle class would be substantially worse off under the health-care plan proposed by Bernie Sanders, according to an analysis by a public health researcher at Atlanta's Emory University.

<...>

Sanders estimates a middle-class family of four would pay an annual premium of $466 under his plan, with no deductible or co-pays. Less affluent households would pay less than that, or nothing at all.

But for at least 72 percent of households enrolled in Medicaid -- in which someone is working -- the costs of Sanders's plan would exceed the benefits, according to an analysis by Kenneth Thorpe, a public-health expert at Emory University.

That figure includes 5.7 million households, or 14.5 million people -- among them, 4.2 million Hispanic recipients and 2.5 million black recipients. The requirements for eligibility for Medicaid vary widely by state, so that group includes some households living in poverty as well as some that are modestly better off.

"The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren't going to receive really any financial benefits," said Thorpe, a former Clinton administration health official.

Read more:

https://www.washingtonpost.com/news/wonk/wp/2016/02/25/bernie-sanderss-health-plan-is-actually-kind-of-a-train-wreck-for-the-poor/

[HERVEPA]

1. And the part that gives it away, from the post

"The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren't going to receive really any financial benefits,"
said Thorpe, a former Clinton administration health official."

[Cali_Democrat]

3. Do you disagree with the numbers put forward? nt

[Bread and Circus]

9. Ignoring the fact that Medicaid is single payer "free" care makes your post....

And the article disingenuous.

You aren't really facing the problem as a cohesive whole which means it is hard to take you seriously.

Your post amounts to demagoguery.

[Baobab]

24. The Clinton campaign need to disclose the BOMBSHELL that they have been HIDING about SP

Basically, the WTO services trade deal we signed in 1995 BLOCKS SINGLE PAYER and the three deals pending now, would basically make it far worse, legitimizing the extremely controversial GATS and blocking SP and Bernie's entire platform, (It would block the whole New Deal too, and disconnect government spending from stimulating the domestic economy because many of those jobs would go to foreigners- whoever was the lowest bidder) but neither of them have brought this up, which makes Sanders either a saint, and a model of extreme restraint, or he's assuming he wont win, because the news would blow the minds of the entire country its so big of an omission.

My theory - which seems likely to be true, its kind of obvious to me after the last few years of drama- , is that all this was a manufactured crisis to create a phony healthcare crisis and education crisis, which would result in the implementation of the whole GATS program, which had repeatedly stalled over Mode Four, among other issues.. Developed countries made the promises at the beginning and their estimates of the rate of automation were probably greatly overestimating the time it would take for automation in developed countries to percolate into the developing countries so the estimates of growth in the developing countries were likely too big and their early guesses were that it would last longer than what now they probably realize it will.. Automation will result in a global concentration of wealth faster, and our future will be one with few jobs and lots and lots of free time for everybody, and nobody has any idea what the world will do.

One would think that they would abandon their attack in the future provision of safety nets, but no, they are doubling their efforts..

their plan is still to try to bring about whats called "Progressive Liberalisation" on a global scale and the biggest losers will be the US workforce who likely will see millions of jobs what formerly were "their" jobs become tradeable commodities to be won by the lowest bidders in computerized e-tendering systems like those in the EU and now also under DR-Cafta.

Services liberalisation is a creature of a push by the US and EU globally via GATS, especially.

its history is long.. I recommend reading up on GATS Article I:3 (b) and (c) if you are interested in the clash between it and public health care and education. We have been lied to, a lot!

We need to eb aware of the other side of the plan, an attack on skilled workers who make wages above global norms in some countries like the US- who are not protected by strong unions-

They likely will use WTO as the bad guys and claim we didnt realize our actions would bring about WTO rulemaking-

Something as basic as raising a minimum wage now, while negotiations are pending, could give WTO an excuse to force us to abandon the minimum wage - seriously, like they forced us to dump Glas-Steagall..

In the 90s they forced El Salvador to forgo a raise in their minimum wage to 60 cents by labeling it a trade barrier erected in anticipation of a pending trade agreement.

So its definitely possible that skilled wages can and likely will be hammered down by bringing in the WTO or RGFS to play the heavy that forces our markets open (and wages down to global average levels)

[HERVEPA]

15. Neither you nor I have a way to evaluate the numbers.

I'm sure our friend with the numbers will be back with the administration if she wins.

[libtodeath]

30. Medicaid is now funded in part by local property taxes so Bernies plan would eliminate that need

benefiting home owners and renters.

[yawnmaster]

11. Logical fallacy. eom

[LexVegas]

2. Don't trust him. nt

[immoderate]

4. Can't everybody realize that Americans are too stupid for single payer?

We thrive on waste, fraud and abuse!

--imm

[UglyGreed]

10. Many suffer and just wait it out it seems

http://www.thefiscaltimes.com/2015/03/12/Americans-Have-Insurance-Can-t-Afford-Use-It

[libtodeath]

5. What utter nonsense.

[Jefferson23]

6. On Kenneth Thorpe's Analysis of Senator Sanders' Single-Payer Reform Plan

David Himmelstein
Professor of Public Health at CUNY and Lecturer in Medicine at Harvard Medical School; Co-founder, Physicians for a National Health Program

Steffie Woolhandler
Professor in the CUNY School of Public Health at Hunter College; Lecturer in Medicine, Harvard Medical School; Co-founder, Physicians for a National Health Program

Professor Kenneth Thorpe recently issued an analysis of Senator Bernie Sanders' single-payer national health insurance proposal. Thorpe, an Emory University professor who served in the Clinton administration, claims the single-payer plan would break the bank.

Thorpe's analysis rests on several incorrect, and occasionally outlandish, assumptions. Moreover, it is at odds with analyses of the costs of single-payer programs that he produced in the past, which projected large savings from such reform (see this study, for example, or this one).

We outline below the incorrect assumptions behind Thorpe's current analysis:

1. He incorrectly assumes administrative savings of only 4.7 percent of expenditures, based on projections of administrative savings under Vermont's proposed reform.

However, the Vermont reform did not contemplate a fully single-payer system. It would have allowed large employers to continue offering private coverage, and the continuation of the FEHBP and Medicare programs. Hence, hospitals, physicians' offices, and nursing homes would still have had to contend with multiple payers, forcing them to maintain the complex cost-tracking and billing apparatus that drives up providers' administrative costs. Vermont's plan proposed continuing to pay hospitals and other institutional providers on a per-patient basis, rather than through global budgets, perpetuating the expensive hospital billing apparatus that siphons funds from care.

The correct way to estimate administrative savings is to use actual data from real world experience with single-payer systems such as that in Canada or Scotland, rather than using projections of costs in Vermont's non-single-payer plan. In our study published in the New England Journal of Medicine we found that the administrative costs of insurers and providers accounted for 16.7 percent of total health care expenditures in Canada, versus. 31.0 percent in the U.S. - a difference of 14.3 percent. In subsequent studies, we have found that U.S. hospital administrative costs have continued to rise, while Canada's have not. Moreover, hospital administrative costs in Scotland's single-payer system were virtually identical those in Canada.

In sum, Thorpe's assumptions understate the administrative savings of single-payer by 9.6 percent of total health spending. Hence he overestimates the program's cost by 9.6 percent of health spending -- $327 billion in 2016, and $3.742 trillion between 2016 and 2024. Notably, Thorpe's earlier analyses projected much larger administrative savings from single-payer reform -- closely in line with our estimates.

2. Thorpe assumes huge increases in the utilization of care, increases far beyond those that were seen when national health insurance was implemented in Canada, and much larger than is possible given the supply of doctors and hospital beds.

When Canada implemented universal coverage and abolished copayments and deductibles there was no change in the total number of doctor visits; doctors worked the same number of hours after the reform as before, and saw the same number of patients. However, they saw their healthy and wealthier patients slightly less often, and sicker and poorer patients somewhat more frequently. Moreover, the limited supply of hospital beds precluded the kind of big surge in hospitalizations that Thorpe predicts. In health policy parlance, "capacity constraints" precluded a big increase in system-wide utilization.

Thorpe bases his estimates on what has happened when a small percentage of people in a community have had copayments eliminated or added. But in those cases there are no capacity constraints, so it tells us little about what would happen under a system-wide reform like single-payer.

Thorpe does not give actual figures for how many additional doctor visits and hospital stays he predicts. However, his estimates that persons with private insurance would increase their utilization of care by 10 percent and that those with Medicare-only coverage would increase utilization by 10 to 25 percent suggest that he projects about 100 million additional doctor visits and several million more hospitalizations each year - something that's impossible given real-world capacity constraints. There just aren't enough doctors and hospital beds to deliver that much care.

Instead of a huge surge in utilization, more realistic projections would assume that doctors and hospitals would reduce the amount of unnecessary care they're now delivering in order to deliver needed care to those who are currently not getting what they need. That's what happened in Canada.

3. Thorpe assumes that the program would be a huge bonanza for state governments, projecting that the federal government would relieve them of 10 percent of their current spending for Medicaid and CHIP -- equivalent to about $20 billion annually.

No one has suggested that a single-payer reform would or should do this.

4. Thorpe's analysis also ignores the large savings that would accrue to state and local governments -- and hence taxpayers -- because they would be relieved of the costs of private coverage for public employees.

State and local government spent $177 billion last year on employee health benefits - about $120 billion more than state and local government would pay under the 6.2 percent payroll tax that Senator Sanders has proposed. The federal government could simply allow state and local governments to keep this windfall, but it seems far more likely that it would reduce other funding streams to compensate.

5. Thorpe's analysis also apparently ignores the huge tax subsidies that currently support private insurance, which are listed as "Tax Expenditures" in the federal government's official budget documents.

These subsidies totaled $326.2 billion last year, and are expected to increase to $538.9 billion in 2024. Shifting these current tax expenditures from subsidizing private coverage to funding for a single-payer program would greatly lessen the amount of new revenues that would be required. Thorpe's analysis makes no mention of these current subsidies.

6. Thorpe assumes zero cost savings under single-payer on prescription drugs and devices.

Nations with single-payer systems have in every case used their clout as a huge purchaser to lower drug prices by about 50 percent. In fact, the U.S. Defense Department and VA system have also been able to realize such savings.

In summary, professor Thorpe grossly underestimates the administrative savings under single-payer; posits increases in the number of doctor visits and hospitalizations that exceed the capacity of doctors and hospitals to provide this added care; assumes that the federal government would provide state and local governments with huge windfalls rather than requiring full maintenance of effort; makes no mention of the vast current tax subsidies for private coverage whose elimination would provide hundreds of billions annually to fund a single-payer program; and ignores savings on drugs and medical equipment that every other single-payer program has reaped.

In the past, Thorpe estimated that single-payer reform would lower health spending while covering all of the uninsured and upgrading coverage for the tens of millions who are currently underinsured. The facts on which those conclusions were based have not changed.

Drs. David Himmelstein and Steffie Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed here do not necessarily reflect the views of those institutions.

http://www.huffingtonpost.com/david-himmelstein/kenneth-thorpe-bernie-sanders-single-payer_b_9113192.html

[Wellstone ruled]

13. Got to love all this anti single payer spin.

[Jefferson23]

14. Yes and the OP changed the title and added the buzz word. n/t

[Wellstone ruled]

18. We learned Single Payer Insurance

in Econ 101 was the only real cost effective way to go. It is Bang for the Buck.

[Jefferson23]

19. Yep, the spin here and the blatant lies are what they are, and has nothing to do with

helping Americans.

[Wellstone ruled]

23. Here yah!

The Third Way Caucus of our Party is so beholding to the big pharma-banksters it is damn near criminal. But what the hey,most Americans do not have a clue,to dams busy playing video games or their I phones and thinking Reality T.V. is for real. That and a attention span of a Knat.

[Bread and Circus]

7. So Hillary supporters are now for single payer free care (Medicaid)?

[Fast Walker 52]

8. "kind of" a train-wreck?

Oooh, scary.

They may pay a bit more, but the overall health system would be much better, and they would be from out of the yoke of Medicaid, which a lot of doctors don't like.

[Gregorian]

12. Keep posting the lie, and we'll just keep revealing the truth.

Unfortunately, Kenneth Thorpe does not provide enough documentation to make an explicit comparison between his estimates and those provided in detail by the Sanders campaign. He lists his projected Federal spending per year, he fails to explain how he calculated these numbers. While this failure makes it impossible to consider his claims on a point by point basis, it is possible to extract enough from his statement to conclude that his analysis is so deeply flawed that it implies some clearly unrealistic assumptions.

Just the first link I found.

http://dollarsandsense.org/blog/2016/02/friedman-responds-to-thorpe.html

[phleshdef]

16. Our healthcare system has been a train wreck for almost everyone for decades.

The ACA is a good stop gap, but thats all it is. Its an attempt to put a leash on this wild system. Its not something that going to outright tame it.

[angrychair]

17. Good source? Bad source? Which is it?

HRC supporters were hammering people yesterday about the Washington Post being a rightwing rag and today it's authoritative on a subject as a valid reference.

Ok, let's see here:
positive for Clinton=

Negative fo Clinton=

Got it!

[beam me up scottie]

20. Why did you edit the title of the article?

This is the actual title per the link:

Study: Bernie's health plan is actually a train wreck for the poor

[Arazi]

21. I know some POC in this site who'd object to his saying poor people are predominantly POC

"The vast majority of low-income Medicaid workers, who are probably predominantly minority

Of course this piece is written by a HRC supporter so he couldn't possibly be tone deaf

[valerief]

22. Per Kenneth Thorpe, appointed as Deputy Assistant Secretary in President Bill Clinton's cabinet.

[mwooldri]

25. I know this cartoon is about Shkreli but...

So any healthcare reform that Wall St. doesn't like is going to have a hard time getting through... and I'm not convinced a Clinton administration will fight hard for real reform.

[Matariki]

26. Unsurprisingly, dishonest

A person on Medicaid would be in the income bracket where their taxes wouldn't be affected by the 2.2% increase Sanders is proposing to pay for this.

FACTS MATTER.

https://berniesanders.com/issues/medicare-for-all/

THE PLAN WOULD BE FULLY PAID FOR BY:
A 6.2 percent income-based health care premium paid by employers.
Revenue raised: $630 billion per year.

A 2.2 percent income-based premium paid by households.
Revenue raised: $210 billion per year. This year, a family of four taking the standard deduction can have income up to $28,800 and not pay this tax under this plan.

A family of four making $50,000 a year taking the standard deduction would only pay $466 this year.

[djean111]

27. Refuted here -

http://www.democraticunderground.com/12511337061

Professor Kenneth Thorpe recently issued an analysis of Senator Bernie Sanders' single-payer national health insurance proposal. Thorpe, an Emory University professor who served in the Clinton administration claims the single-payer plan would break the bank.

Thorpe's analysis rests on several incorrect, and occasionally outlandish, assumptions. Moreover, it is at odds with analyses of the costs of single-payer programs that he produced in the past, which projected large savings from such reform (see this study, for example, or this one).

We outline below the incorrect assumptions behind Thorpe's current analysis:

Damn, Thorpe is willing to contradict his own earlier studies, just to be a good lap dog and take a hatchet to Bernie.....

[Baobab]

28. Now pending plan for services liberalisation will be the worst thing ever for US minorities

and the US semi-professionals and entry level skilled workers who will see millions of jobs become global trade-able commodities..

The deals being spun in geneva extend the controversial GATS which never caught on because countries had to specify the service sectors subject to progressive liberalisation and many held back on the skilled professions to preserve local employment, however the TiSA basically includes everything by default unless its carved out now. So priorities will shift from combating other forms of discrimination to combating discrimination against foreign service providing corporations.

TiSA is a huge gift to professional staffing firms in developing countries many of whom are gearing up for a lot of business, many are clearly expecting a lot of work will come their way due to the changes in government procurement down to the local level and their low competive wages.. which will give them a legal right to do the work.. (Domestic regulations must be adjsted so they dont stand in the way, preempting national laws at a higher level) (Note: its not even clear if national minimum wages apply at all, if they do, the higher of the two countries minimum wages will probably apply - so we likely will find that no doctors or nurses or teachers or computer programmers will be working for nothing. Minimum wages likely will apply if the US proposal wins.)

On the other hand, those regulations may be impossible to enforce because of the impossibility of auditing firms on the other side of the world on what they pay their employees here, especially if their pay goes into their home bank accounts.

So TiSA will hugely benefit thousands of service providing firms throughout the developing world which are gearing up to bid on the millions of newly privatized "Mode Four" jobs in developed countries. They use L1 visas so they are not immigration. (No individual will remain in a country for more than a few years. It is basically an intra-company temporary transfer)

It will come unexpectedly because of a long standing US media blackout on GATS and everythng connected to it which might let the cat out of the bag, like single payer. its been very well planned out over the last 20 years. the TiSA negotiations in Geneva have been going on since 2006.(Not 2012 or 2013 as claimed- proof here )

The following is excerpted from report #17 (2014) on the WTO-and-TiSA state of play prepared by Tanvi Sinha, on behalf of CUTS International, Geneva



"
As part of the TiSA mandate, each participant
must match or exceed the highest level of
services commitments that it has made in any
services trade and investment agreement that it
has signed. This “best FTA” approach is meant to
ensure that the starting point of TiSA
negotiations (each government’s initial offer)
reflect the furthest extent of concessions in any

previous agreement. But such commitments are
only the floor. In this regard, US advocates for
"highest common denominator” approach,
suggesting that commitments for all TiSA parties
should be brought up to the highest degree of
commitment of any other party.9

0 Basic Structure

It has been widely argued that to establish
legitimacy of the agreement, efforts have been
made to tailor its principles and composition in a
way that is complies with the WTO conditions
and hence can acquire a "multilateral"
framework. The Agreement is hence being
crafted to be compatible with GATS so that a
critical mass of participants will be able to
pressure remaining WTO members to sign on in
the future.10

Hence it is reported that some core GATS articles
(including on definitions, scope, market access
and national treatment, general and security
exemptions) are being incorporated into TiSA.
However, it should be emphasized that foreign
services providers and their products will receive
"National Treatment” except for those services
specified in an exemption list (a serious deviation
from the GATS structure). In this respect, it was
agreed that commitments on national treatment
would in principle be applied on a horizontal
basis to all services sectors and modes of supply.
Exemptions to this horizontal application would
have to be listed in the countries' national
schedule of commitments. Participants in the
negotiations might also agree that commitments
would in principle reflect actual practice (the
"standstill clause&quot and that future elimination of
discriminatory measures would be automatically
locked in (the so—called "ratchet clause&quot unless
an exemption were listed.11 There are also
discussions around enforceability and Dispute
Settlement Mechanism to be adopted.

0 Overview of Negotiating Sessions

A total of seven negotiating sessions have been
held so far with the eighth session planned from
21 — 15 September 2014 in Geneva that will be
chaired bythe EU. Table 1 provides a summary of
the relevant information for the sessions
including the issues addressed.

8 Criticism of TiSA

The leaked financial services draft annex shows
the US and EU, who pushed financial services
liberalisation in the WTO, as the most active in
the financial services negotiations in TiSA.12
Further concerns can also be raised regarding
the US promoting for the "Highest Common
Denominator" principle, which can potentially
increase the costs for other member countries to
match up to the standards set by the leading
counties which may erode their comparative
edge. Therefore there have been arguments
propounding the overarching advantages that
the leading countries would have over or even at
the cost of the development of the rest of the
members. Also, the absence of many leading
developing countries such as the BRICS and
Africa countries and LDCs in the negotiations
process brings out the lack of inclusivity. The
questions on legitimacy have also been raised
owing to the negotiations being outside of the
WTO framework.

Some analysts have gone to the extent of
arguing that the proposed agreement is the
direct result of systematic pressure by
transnational corporations in banking, energy,
insurance, telecommunications, transportation,
water, and other services sectors, working
through lobby groups like the US Coalition of
Service Industries (USCSI) and the European
Services Forum (ESF). As a result of which, due to
deregulation of the key industries and increased
liberalisation and competition, employment and
labour rights could also be seriously undermined.
In addition, foreign investors may be granted
protections through the TiSA against what they
deem to be trade—restrictive regulations (even if
these regulations were designed to protect the
environment, health, safety, financial stability
and the public interest). It has also been
advocated that in terms of national
commitments, the agreement poses potential
threat to public services due to excessive
deregulation.13

8 Major Issues & Questions
for EAC Countries

TiSA adopts a “negative list” approach to national
treatment. Under the TiSA, national treatment
obligations would automatically apply to all
measures and sectors unless these are explicitly
excluded.

[Vinca]

29. All I can say is I never thought I'd see the day people on DU would be campaigning

AGAINST single-payer. Has it occurred to any of you that you don't have to agree 100% with your candidate? You're not a bad Hillary supporter if you embrace independent thought.

[libtodeath]

31. To support Hillary is to attack FDR and New Deal programs as well.

It is sickening.