Shefali Luthra: Do 160 million people 'like' their health care? Kind of
Articulating his proposal for health-care reform, former Vice President Joe Biden emphasized the number of Americans who, he said, were more than perfectly satisfied with the coverage they have.
“One hundred sixty million people like their private insurance,” Biden said during the November Democratic presidential primary debate.
That argument is at the heart of many moderate Democrats’ criticism of the “Medicare for All” proposal backed by two presidential candidates from New England — Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.). We decided to take a closer look.
We reached out to the Biden campaign for comment. The campaign directed us to his next point — that people who don’t like their private coverage could, under his health plan, opt into government-sponsored coverage.
160 Million, And Some Squishy Polling
The figure appears to refer to the number of Americans who receive health benefits through work — so-called employer-sponsored health insurance. Under Medicare for All that would no longer be an option.
On first blush, polling seems to suggest that most people with employer-sponsored coverage like it.
Polling done earlier this year by the Kaiser Family Foundation with the Los Angeles Times found that most beneficiaries are “generally satisfied” with this insurance. (Kaiser Health News is an editorially independent program of the foundation.)
But that doesn’t get at the whole story.
“Most like their policy, but not all,” said Robert Blendon, a health-care pollster at Harvard T.H. Chan School of Public Health.
The context matters.
In the same KFF/L.A. Times poll, about 40% of people with employer-sponsored coverage said they had trouble paying medical bills, out-of-pocket costs or premiums. About half indicated going without or delaying health care because — even with this coverage — it was unaffordable. And about 17% reported making “difficult sacrifices” to pay for health care.
Beneficiaries who have higher-deductible plans — that is, they are required to pay larger sums of out-of-pocket before health coverage kicks in — are also less likely to be happy with their coverage, and more likely to report problems paying for health care.
And it’s also worth noting that these high-deductible plans have grown increasingly common, even for the 160 million Americans who get insurance from work, though that trend may now be losing steam. Research from the Commonwealth Fund, meanwhile, notes that increasing numbers of “underinsured” people do, in fact, have employer-sponsored health insurance. Underinsured people are those who have coverage but delay care because they still can’t afford it.
Meanwhile, other polling, such as a January Gallup survey, suggests that about 7 in 10 Americans believe the nation’s health-care system is in crisis.
So while Americans may individually not express frustration with their specific private plans, more are learning that, when they try to use that coverage, it doesn’t meet their health needs..
These findings cast significant shade on the idea that all 160 million Americans with employer-sponsored coverage actually like it.
Biden argued that “160 million people like their private insurance.”
A cursory look at polling would suggest that most of the people he’s talking about — Americans who get coverage through work — are happy with their plans.
But once you dig a little deeper, that narrative gets more complicated. Even while Americans say they like their plans, large proportions indicate that the private coverage they have still leaves meaningful gaps, requiring them to skip or delay health care because they cannot afford it.
Biden’s argument is technically correct, but it leaves out important context and relies on a somewhat squishy number. We rate it Half True.
Shefali Luthra is a reporter for Kaiser Health News.
Shefali Luthra: ShefaliL@kff.org, @Shefalil
Shefali Luthra: Warren's projection of out-of-pocket health-care costs holds up to scrutiny
“If we make no changes over the next 10 years, Americans will reach into their pockets and pay out about $11 trillion on insurance premiums, copays, deductibles and uncovered medical expenses.”
— Massachusetts Sen. Elizabeth Warren in an Instagram post about her “Medicare for All” plan.
Promoting her much-discussed plan to create a single-payer “Medicare for All” health system, Sen. Elizabeth Warren emphasized a striking figure.
“If we make no changes over the next 10 years, Americans will reach into their pockets and pay out about $11 trillion on insurance premiums, co-pays, deductibles and uncovered medical expenses,” the Democratic presidential candidate said in an Instagram video posted Monday.
This fact check was produced in partnership with PolitiFact.
The Democratic health-care debate has been full of competing analyses and estimates about what Medicare for All might cost, what it might save and who would bear the brunt of paying for it. But this precise number was new to us.
If true, it would be a figure both staggering and significant to the unfolding debate, as Americans try to understand how Warren’s brand of a single-payer health system could affect their pocketbooks. So we decided to dig in.
A Reasonable Estimate
We contacted the Warren campaign, which redirected us to a report from the Urban Institute, a Washington think tank, as well as to federal estimates of household out-of-pocket expenses and premium costs over the next decade.
The Urban report doesn’t include the $11 trillion figure. But economist Linda Blumberg, who authored the paper, told us the statistic is “perfectly consistent” with the analysis.
If anything, she said, the number is a lowball figure. When Blumberg and her team crunched the numbers, they found that, under the existing health-care system, Americans can expect to pay $11.7 trillion between out-of-pocket costs — the co-pays, deductibles and uncovered medical expenses — and premiums over the next decade. That calculation comes from Urban’s model for projecting what individual households might expect to spend, factoring in inflation, on these types of health costs.
“Talking about the amount of money we expect households to be spending over time is a very important part of trying to educate people on what single-payer would do, and what the tradeoffs are for them,” said Blumberg, who previously advised the Clinton White House on health policy. On the numbers, “they’re roughly in the right neighborhood,” she added.
We consulted other analysts, too, and as far as we can tell, no one else has done a similar calculation.
Experts told us that Urban’s estimate — and the Warren campaign’s use of it — checks out, based on what we know about American health care spending.
Cynthia Cox, a vice president at the Kaiser Family Foundation and expert on the Affordable Care Act, pointed to what a typical American family currently spends on health care: about $5,000 per year, when you look at out-of-pocket costs and premiums combined. Extrapolating from there, she said, Warren’s claim seems reasonable. (Kaiser Health News is an editorially independent program of the foundation.)
“Over the course of 10 years, when you add it up — that sounds about right,” Cox said. “The reality is, people do spend a lot on health care out of their pockets, and there’s a lot spent on their behalf by employers or taxpayer-funded programs that they never see.”
Under Warren’s health-care plan, Americans would pay nothing directly out-of-pocket — no premiums, copays or deductibles — for health care. So that $11 trillion would disappear from the cost side of the ledger.
The figure Warren sited also tracks with national health expenditure projections for out-of-pocket health costs and health premium growth.
The Bigger Picture
Still, there are serious questions about the financing such a shift would require.
And Warren’s Medicare for All plan has been under intense scrutiny since she unveiled it earlier this month, with many critics suggesting it’s too optimistic in its estimates of how much money a single-payer system would cost.
Warren suggests the federal government would need to come up with $20.5 trillion — well below Urban’s estimate of $34 trillion. The difference comes largely from assumptions about how much the government could save, as well as decisions about how much to pay doctors and hospitals.
Warren’s financing structure includes cracking down on tax evasion, new taxes on financial institutions and the wealthiest Americans, and maintaining what many employers currently pay into the system. Critics say that could yield its own inefficiencies.
For instance, the way employer payments are structured could disproportionately harm small businesses, or lower-wage workers, noted Paul Ginsburg, who directs the USC-Brookings Schaeffer Initiative for Health Policy. He also argued that doctors and hospitals —represented by powerful lobbying organizations in Washington — could successfully battle any effort to pay them less, driving up what the government needs to spend.
Still, those disputes are separate from the question of this particular statistic. Here, Warren’s on firm ground.
Analysts also said the $11 trillion number gets at a larger point. Americans currently pay a lot out-of-pocket on health care. Certainly, some might see a tax hike under Warren’s proposed reform, or see downward pressure on their salaries.
Still, others could experience major pocketbook relief.
To be sure, Medicare for All is not the only approach to ameliorating what families pay for health care. Other, more incremental proposals — such as building on the ACA’s coverage expansions or pursuing a “Medicare for all who want it” approach touted by former Vice President Joe Biden and Pete Buttigieg, the South Bend, Ind., mayor — would cut into the $11 trillion as well, Cox said.
While it wouldn’t eliminate that household cost burden, it would require less in taxes to finance.
“There’s a lot of ways to bring down what people spend on health care,” Cox said. “Any expansion of the role of public programs is likely to bring down individuals’ costs. It’s just a question of how much taxes have to go up to pay for that.”
Our Rating
In her explanation of how she would structure and finance Medicare for All, Warren highlighted what Americans currently pay for “insurance premiums, copays, deductibles and uncovered medical expenses.”
The $11 trillion figure is staggering — and it checks out. Whether and how to address that issue is fiercely controversial, but on this particular stat, Warren’s statement is accurate. We rate it True.
Shefali Luthra is a reporter for Kaiser Health News
Shefali Luthra: ShefaliL@kff.org, @Shefalil
SOURCES:
Instagram, “Medicare for All” post, Elizabeth Warren, Nov. 4, 2019
Medium, “Ending the Stranglehold of Health Care Costs on American Families,” Elizabeth Warren, Nov. 1, 2019
Centers for Medicare & Medicaid Services, “NHE Fact Sheet,” April 26, 2019
The Urban Institute, “From Incremental to Comprehensive Health Reform: How Various Reform Options Compare on Coverage and Costs,” Oct. 16, 2019
Peterson-Kaiser Health System Tracker, Household Health Spending Calculator, Nov. 5, 2019
Email Interview with Warren 2020 presidential campaign staff member, Nov. 4, 2019
Telephone Interview with Linda Blumberg, institute fellow in the Health Policy Center at the Urban Institute, Nov. 4, 2019
Telephone Interview with Cynthia Cox, vice president at the Kaiser Family Foundation and director for the program on the ACA, Nov. 4, 2019
Telephone Interview with Paul Ginsburg, director of USC-Brookings Schaeffer Initiative for Health Policy, Nov. 5, 2019
Llewellyn King: The business case for national health insurance
WEST WARWICK, R.I.
The leading Democratic candidates for president want differing degrees of major surgery done on health insurance. During the Oct. 14 debate, they contrived only to cut themselves.
The smell of blood from Bernie Sanders, Elizabeth Warren and Joe Biden must have been a near-divine scent to Republican operatives who haven’t had an easy time of it lately.
Sanders and Warren have signed on to an idea favored by many on the left: Medicare-for-all. Joe Biden, seeking to carve out a position as the seasoned centrist, favors not surgery but Band-Aids all over the patient.
The problem with Medicare-for-all is money. Or, it is advertised as money.
Yet the reason for single payer — a national health insurance system — isn’t to spend more money but less.
Much less.
The United States spends about double what other countries spend, but the coverage is patchy and has non-medical consequences that are severe. One of these is the effect on the mobility of labor. Workers stay in dead-end jobs because they fear the loss of their health insurance.
A bigger effect is the burden on business of saddling it with health care. The price tag for business is huge. Transferring that expense to the government would have the effect of a big tax cut. A new Social Security tax designed to compensate for the loss of business support in health care would be reasonable. Business would be ahead, and the national misery of paying in multiple ways for health care would be ended. Simple is cheaper.
One benefit would be the leveling of the playing field for business and employees. The employer-provides-system is a burden on business as well as a distorter of society.
The Milliman Medical Index calculates the cost of health insurance for a family of four, on a standard plan, at $28,386. Unsurprisingly, many employers are now seeking to share health-care costs with employees. In 2019, according to Milliman, companies are paying 82 percent of employees’ health insurance premiums.
The current system costs everyone in every possible way. Doctors employ staff whose only job is to wrestle with health insurance companies, and hospitals have armies of people working on claims. An attorney working for a big city hospital told me that it has 150 people whose only job is to struggle with insurance claims.
The mistake the leading Democrats are making, especially those of the left, is just looking at health insurance from the humanitarian point of view. Sanders sounds off on the uninsured and the bankruptcies. Democrats are all heart and not enough numbers — or courage to suggest necessary tax adjustments.
What they should do is look at the business case against the sustained chaos that passes for health care. Businesses of all sizes should be enthusiastic about being relieved of the health care burden: a burden carried only by U.S. businesses.
Americans pay roughly twice as much of the Gross Domestic Product for health care — about 19 percent — as does any other advanced country. The driving issue should be to reduce that; to get the fat out, to curb profiteering, to end rent-taking by insurance companies, and to end the wasted effort in negotiations on nearly every claim. Patients and business would both be winners.
The business cavalry has an expeditionary force already saddled up with a group called Business for Medicare for All. Its chairman, Richard Master, says: “You don’t need to be a progressive to see why single-payer is a logical option for America. For a growing number of business leaders, including myself, transitioning to a single-payer, centrally financed health care system makes sense from a purely economic perspective.”
From the doctors’ corner, John Perryman, a Roscoe, Ill.-based pediatrician, says the leading Democrats missed out. “The system is chaotic and failing. The debate was very disappointing. Biden said it would cost $3.6 trillion a year to switch over — the amount we now spend on health care every year. But that is growing by 4 percent a year which means in 10 years, we will be spending $30 trillion, with 20 percent going to insurance companies. The only way to get that down is with a single-payer system,” he says.
Perryman is a member of Physicians for A National Health Program, a 23,000-strong group of doctors with offices in Chicago. A different prescription is being written.
On Twitter: @llewellynking2
Llewellyn King is executive producer and host of White House Chronicle ,on PBS. He’s based in Rhode Island and Washington, D.C.
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Negin Owliaei: No one should have to bargain for health care
Via OtherWords.org
Nearly 50,000 members of the United Auto Workers began striking earlier this month, demanding that General Motors pay them their fair share of the billions in profits the company raked in last year.
The response from General Motors was shocking. The automaker, which accepted billions in government bailouts during the last recession, cut off its payment of insurance premiums for the striking workers.
As the news broke, former Vice President Joe Biden was at an AFL-CIO event, campaigning against a single-payer Medicare for All plan that would replace employer-provided insurance. “You’ve broken your neck to get it,” Biden told the crowd. “You’ve given up wages to keep it. And no plan should be able to take it away.”
But what if that’s actually the problem? Why should union workers — or anyone — be breaking their necks to get health care, a basic human right?
Health care has been a constant subject of debate among Democratic presidential candidates. Biden and others have argued that a single-payer system would be unfair to union workers who’ve taken pay cuts in exchange for better health care plans.
But, as GM showed, our current system turns health coverage into leverage for employers. What could unions could fight for if they didn’t have to constantly play defense against employers trying to gut their health care?
If we already had Medicare for All, the United Auto Workers could be using their collective power to fight for higher wages and better benefits. Instead, GM gets to use the health of its employees as a bargaining chip.
Auto workers aren’t the only union workers fighting for health coverage.
West Virginia teachers kicked off a strike wave last year thanks, in large part, to their own fight over insurance. The state offered educators two options: use a fitness-tracking app that forced them to earn a certain number of fitness points, or watch their premiums rise. They chose to strike instead.
Meanwhile, Americans already lose their health insurance all the time. That’s actually one of the biggest problems with the health care system as it stands.
Tying health care to employment is a terrible idea. In addition to failing anyone without a full-time job, it forces people to stay in bad positions just to keep their coverage. And when workers lose their jobs, they lose their insurance too.
That wouldn’t happen under Medicare for All, which would allow workers to make decisions about leaving a job or working part-time without panicking over their insurance coverage.
Then there’s the cost.
Health insurance alone makes up, on average, 8 percent of total wages and benefits, according to the Bureau of Labor Statistics. But workers are seeing their share of the costs rise at a higher rate than their wages. They’re getting stuck with a larger chunk than ever before.
Data shows that this burden falls heaviest on low-wage workers, who are already forced to spend a much higher share of their income on extra costs like premiums and out-of-pocket expenses.
By contrast, the Medicare for All plan now before Congress would cover all medically necessary services without co-pays and deductibles — an advantage critics like Biden rarely address.
Right now, the U.S. spends about two times as much as other high-income countries on health care, only to have poorer health outcomes. It’s obvious that the current system isn’t working — for union workers, or for anyone else.
No one should have to bargain for a human right.
Negin Owliaei is a researcher and co-editor of Inequality.org at the Institute for Policy Studies.