Pete Buttigieg announces "Medicare For All Who Want It"

[brooklynite]

In our country, the more than 27 million people who are uninsured are either paying too much for care or not getting the care they need because it’s too expensive.1 Uninsured individuals are less likely to access crucial preventive services—such as cancer screenings or cholesterol checks2—and more likely to forego care for chronic conditions, such as diabetes or heart disease. And 87 million people are underinsured, which means they’re also paying too much for care, in the form of high deductibles or out-of-pocket costs that make them more likely to struggle to pay for care or skip it altogether.3 We must ensure that everyone has an affordable option for health coverage that guarantees access to care when they need it.

Through Pete’s Medicare for All Who Want It plan, everyone will be able to opt in to an affordable, comprehensive public alternative. This affordable public plan will incentivize private insurers to compete on price and bring down costs. If private insurers are not able to offer something dramatically better, this public plan will create a natural glide-path to Medicare for All. The choice of a public plan empowers people to make their own decisions regarding the type of health care that makes sense for them by leveling the playing field between patients and the health care system. It gives the American people a choice and trusts them to set the pace at which our country moves in a better direction on health care.

Pete’s coverage and affordability plan includes the following policy proposals:

BECAUSE HEALTH CARE IS A HUMAN RIGHT, GUARANTEE UNIVERSAL COVERAGE THROUGH MEDICARE FOR ALL WHO WANT IT.

The Medicare for All Who Want It public alternative will help America reach universal coverage by providing an affordable insurance option to the currently uninsured. The public alternative will provide the same essential health benefits as those currently available on the marketplaces and ensure that everyone has access to high-quality, comprehensive coverage.

The plan will automatically enroll individuals in affordable coverage if they are eligible for it, while those eligible for subsidized coverage will have a simple enrollment option. A backstop fund will reimburse health care providers for unpaid care to patients who are uninsured. Individuals who fall through the cracks will be retroactively enrolled in the public option.

END SURPRISE BILLING.

Most commonly, unexpected bills arise when a patient receives care at an in-network hospital and, unbeknownst to them, is treated by an out-of-network physician.4 This mismatch is a deliberate business strategy fueled by profit-driven firms in private equity.5 About one in five visits to the emergency room is likely to lead to a surprise bill.

Pete will require that bills related to in-network facilities be billed as in-network. His plan will also place limits on what out-of-network providers, including ambulances and air ambulance services, can charge.

EXPAND PREMIUM SUBSIDIES FOR LOW-INCOME PEOPLE TO MAKE MARKETPLACE COVERAGE DRAMATICALLY MORE AFFORDABLE FOR INDIVIDUALS AND FAMILIES.

Pete will make premium subsidies more generous for low-income people. Today, a family of three making $31,000 a year pays about $1,200 annually for “silver” coverage on the marketplace.6 Under Pete’s plan, they will pay a maximum of roughly $600 a year for higher quality (i.e., gold-level) coverage.

CAP MARKETPLACE PREMIUM PAYMENTS AT 8.5% OF INCOME FOR EVERYONE, WHICH WILL PRIMARILY HELP MIDDLE-INCOME INDIVIDUALS AND FAMILIES.

This plan will also extend the subsidies to more middle-income people by capping premium payments for everyone. That means that the 60-year-old in Iowa making $50,000 and currently paying $12,000 annually in premiums will now pay no more than $4,250 annually for gold coverage. Pete will also lower out-of-pocket costs for consumers by increasing cost-sharing assistance.

CAP OUT-OF-POCKET COSTS FOR SENIORS ON MEDICARE, WITH A LOWER CAP FOR LOW-INCOME SENIORS.

One in four Medicare beneficiaries—15 million people—spend over 20 percent of their income on premiums and medical care.7 Costs run much higher for many, including those with chronic disease and disability. The traditional Medicare program does not have a cap on out-of-pocket spending, putting seniors at risk of having medical or drug costs wipe out their savings. Pete believes that seniors in traditional Medicare deserve the same financial protection. He will improve affordability in Medicare by capping out-of-pocket costs, with lower caps for low-income seniors.

ENSURE THAT NON-PROFIT HOSPITALS TRULY SERVE THEIR COMMUNITY BY STRENGTHENING HOSPITAL COMMUNITY BENEFIT REQUIREMENTS.

Non-profit hospitals do not pay federal taxes under the assumption that they benefit their communities. Many benefit their communities in a number of ways, such as by providing free care to uninsured patients and offering medical training.8 However, some non-profit hospitals are doing little to benefit their community—sometimes even harming their own patients through aggressive billing and predatory collection practices.9 Pete’s plan will strengthen community benefit requirements to ensure that hospitals are investing in the health of their patients and communities.

LIMIT WHAT HEALTH CARE PROVIDERS, INCLUDING HOSPITALS, CAN CHARGE FOR OUT-OF-NETWORK CARE AT TWICE WHAT MEDICARE PAYS FOR THE SAME SERVICE.

Health providers often charge private insurers exorbitant fees. As hospital prices for outpatient care increase at a rate four times faster than physician prices,10 hospital profits have risen to their highest levels in decades.11 As President, Pete will prohibit health care providers from pricing irresponsibly. This will also provide insurers with leverage to demand lower rates for in-network care.12 As noted in our rural health plan, for these providers in underserved areas, Pete’s administration will increase Medicare reimbursement rates and encourage states to increase Medicaid reimbursement rates.

MAKE IT EASIER TO AFFORD AND FIND CARE FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER BY ENFORCING PARITY.

“Mental health parity” means that coverage and treatment for mental health and substance use disorder are provided on equal terms as treatment for physical conditions. Pete will enforce parity in several ways, including requiring health plans to annually report how they manage and meet parity. Health plans that violate this policy will face fines and statutory penalties. Those plans most often out of compliance will be publicly named.

TACKLE HIGH ADMINISTRATIVE COSTS TO FURTHER BRING DOWN THE COSTS OF HEALTH CARE IN AMERICA.

Our health care system is the most costly in the world in part because it spends $496 billion annually on administrative costs—more than any other system globally.13 To lower cost and improve quality, we must make our health care system more efficient. Pete’s plan will do this by harmonizing standards for transactions and holding insurance companies accountable for adopting them. It will simplify billing by creating a central clearinghouse for claims,14 establish an All-Payer Claims Database that supports health care quality initiatives,15 and require integration of electronic records.

EMPOWER THE FEDERAL GOVERNMENT TO BETTER MONITOR AND CHALLENGE MORE HEALTH CARE MERGERS, WHICH OFTEN RAISE THE COST OF CARE WITHOUT IMPROVING OUTCOMES.

Health insurers, hospitals, pharmaceutical companies, and health care provider groups are all growing larger, but bigger has not been better for patients. Greater consolidation among providers and insurers results in higher prices for patients without improving quality. To ensure robust competition in health care markets and protect patients, Pete will increase funding for federal antitrust authorities to empower them to review more mergers and equip them to bring enforcement cases against activity that harms competition and hurts health care workers.

[BootinUp]

1. Hard chargin' Pete. Nt

[CaliforniaPeggy]

2. Yes, he is. The circumstances we find ourselves in demand this. n/t

[ZERTErYNOthe]

3. Why is this a question/issue?

Are any of the public options actually preventing anyone from having private insurance? Serious question. I may have missed something obvious, but I never thought having a public option would 'prevent'/outlaw private insurance. All it would do is make private companies compete in the free market. If they offer a compelling product at a reasonable price then they will sell their services (much like the 'concierge' medical services now offered to those who can afford it)

Has any candidate proposed outlawing private insurance? Or has it just been phrased as their current business model wont work?

[brooklynite]

5. " Warren backs eliminating private insurance for 'Medicare for All'"

Sen. Elizabeth Warren used Wednesday night's Democratic debate to come out unequivocally for a "Medicare for All" plan that would abolish private health insurers.

The Massachusetts Democrat was one of only two candidates to raise their hand when moderator Lester Holt asked for a showing of who would be willing to get rid of private health coverage in favor of a government-run system. New York City Mayor BIll de Blasio was the other.

https://www.google.com/amp/s/www.politico.com/amp/story/2019/06/26/warren-private-insurance-medicare-1558522

[VideoSteve]

6. Outlawing private health insurance has been in the conversation

this cut and paste from an ABC News piece on Sept 12, 2019.-

"In April, Sanders again introduced his signature health care legislation, which if passed and signed into law, would provide government-run, Medicare-style health insurance for all Americans and outlaw most duplicative private insurance in the process."

Depending on how much other candidates' Medicare for All plans reduce private insurance, is the debate we are having.

[ZERTErYNOthe]

7. Outlawing private health insurance ...

Thanks to those who have responded, especially brooklynite and VideoSteve (I'm new to DU and not sure how to individually thank people). That is actually new to me, and a bit surprising, based on my own assumptions. I've always assumed that Medicare for All was an Option, not the only choice (same way in the UK or other countries, even the US, you can purchase supplemental insurance). Now that I have cleared that up, well, it still seems like a mess, but perhaps less messy? Comments appreciated.

[radical noodle]

9. Taking away options seems wrong to me

I'm against outlawing private insurance. I'd prefer to see profits capped, and other affordability measures.

[Celerity]

14. This should help answer your question. WaPo : The insurance industry hates the public option, too

https://www.washingtonpost.com/politics/2019/live-updates/election-2020/third-democratic-debate-analysis-and-fact-checking/the-insurance-industry-hates-the-public-option-too/

Something getting lost in this Medicare-for-all exchange (30 minutes and counting) is that the insurance industry considers every Democratic proposal a threat to the private market. In its TV and digital ads, the Partnership for America’s Health Care Future warns that expanding Medicare in any way would ruin what Americans are comfortable with.

“The politicians may call it Medicare-for-all, Medicare buy-in, or the public option, but they mean the same thing: Higher taxes and higher premiums,” say actors in the industry group’s most recent spots.

Ironically, one of Joe Biden’s answers on the subject explained the industry’s thinking: His suggestion that the 50 million people who, on average, lose their insurance plans due to employer decisions (or layoffs) would be able to quickly buy into the public option. That’s the moral hazard the industry is talking about — if 50 million people jumped into the new government system every year, private insurance would go into a death spiral, unable to compete.

snip


also see this thread (substitute any of our candidates that are for the public option, not just Biden)

I have a couple replies there that go into a lot of depth


Biden in Cross Hairs of the Partnership for America's Healthcare Future

https://www.democraticunderground.com/1287207761

[Gothmog]

4. Buttigieg tells Medicare-for-all proponents to show their cards

Against my better instincts, I am slowly beginning to like Mayor Pete.

Link to tweet

Now, I’d like to get more detail on those “cost savings” and the “corporate tax reform” (and why aren’t Democrats promising to raise the capital gains tax rate to equal or nearly equal the rates for salary income, a much bigger revenue-generator?). Buttigieg also promises “additional plans to address issues such as drug pricing, innovation and health equity,” which will need to come with funding mechanisms.

Nevertheless, Buttigieg has a compelling argument: Candidates are obligated to offer bold ideas that are doable. He argues, “Rather than flipping a switch and kicking almost 160 million Americans off their private insurance, including 20 million seniors already choosing private plans within Medicare, my plan lets Americans keep a private plan if they want to.” The latter is a reference to Medicare
Advantage, which would go away under a strictly single-payer system.

The approach favored by Buttigieg, Biden, Sen. Amy Klobuchar (D-Minn.) and other moderates would be cheaper and allow people to gradually migrate to Medicare (if that is what they want). Moreover, if Democrats want to accomplish anything, it likely will require a Democratic majority in the Senate and use of reconciliation; they would at least need a majority. There is not, as we speak, a majority of Democrats in both houses who support Medicare-for-all.

Part of the problem with this discussion is that the Medicare-for-all advocates are adept at deflecting pesky questions about cost, logistics and political feasibility. They shouldn’t be allowed to skate by on ad hominem attacks (That’s a Republican talking point!) or non sequiturs (Let me tell you how great Medicare-for-all is!) or platitudes (We’re going to fight!).

[BootinUp]

11. Pete can win over a majority given enough time. Nt

[Gothmog]

13. US voters support expansion Medicare/Biden plan

Last edited Sun Sep 22, 2019, 09:19 PM - Edit history (1)

Link to tweet

[Sapient Donkey]

8. I am with him on this.

I would like to see something in which everyone can get medicare of all (or whatever you want to call it). One thing is that I would like for it to actually cover everything in a way similar to how the single payer system in Canada work. But I would also like to give people the choice to keep whatever they want, and also not feel like they are getting nothing tangible from the system. So, maybe something in which we figure out how much our MFA/public option/single payer/whatever costs per person on a monthly basis, and then we give all Americans their own healthcare account in which that money is deposited. They can then choose to stay with the government plan and that money is automatically deposited back into that system, or they can choose to apply that toward qualified private insurance from something like the exchanges or even their employer provided insurance. So maybe end up only paying $100/mo for their preferred plan instead of $400/mo.

In theory I would imagine the two systems would play against each other to drive innovation on both sides. The private insurance companies will have to give the customers a bit more priority in their plannings. If they don't, then people will stop using them. The same goes for the MFA/public option.

With this, everyone feels like they are benefiting from it, and they have the choice that they claim to want. Sure the republican lawmakers and talking heads will talk about socialism and other nonsense, but in the end they will have to make an argument that essentially boils down to "You, the American people, are benefiting at the expense of insurance company profits. This is wrong and it must end now because it's communisocialist." That's a difficult argument for them to sell. Isn't that part of why they had such a hard time totally getting rid of the ACA? The majority of Americans support the stuff about preexisting conditions and anti-rescission regulations. Nearly everyone saw that as a tangible benefit they received from it. That not only makes it easy to get support, but it also makes it much more difficult to tear apart if/when they gain power again. Particularly if we don't bungle it by making sure it's effective in getting people quality care.

[Blue_true]

10. Ultimately, all but one will back that approach. Senator Warren seems to be creeping toward it.

It is the most sensible approach, make MFATWI a public option of the ACA. Set up a Medicare-like organization, bring over a few experienced hands from Medicare to head it and staff it up.

[Politicub]

12. Great to see the details! I agree with Mayor Pete that a robust public option

will be a glide path to MFA.

[BlueMississippi]

15. The sensible and winning position. nt

[Gothmog]

16. The Biden/mayor Pete plans poll better than Warren/sanders' plans

Link to tweet

[Gothmog]

17. Obamacare Has Made People Healthier

Getting rid of Obamacare is a bad move https://politicalwire.com/2019/09/30/obamacare-has-made-people-healthier/

Washington Post: “Poor people in Michigan with asthma and diabetes were admitted to the hospital less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.”

“Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.”

[Gothmog]

18. 73% of people favor [the] public option that would keep private insurance in place

Link to tweet