Proposed bills represent different visions of health care system
U.S. Senators on the left and the right have proposed health care reform bills in recent weeks. Senator Bernie Sanders (I-VT) announced the Medicare-For-All Act on Sept. 13, and within a few days roughly a third of Senate Democrats announced their support of the bill. Senators Lindsay Graham (R-SC) and Bill Cassidy (R-LA) have led the GOP’s latest effort to repeal-and-replace the Affordable Care Act, and many Senate Republicans have announced their support.
The Medicare-For-All Act would replace nearly all private health insurance with a single-payer, government-run insurance program, much like Medicare, the health insurance currently used by Americans over the age of 65. However, the proposed insurance would be significantly more generous than Medicare, covering a wide variety of health services at minimal cost to the patient. It is still unclear exactly how such an expensive program would be paid for.
The Republican’s bill, often called the Graham-Cassidy plan, takes a very different approach. It would lower the growth in federal health care spending and turn what remains of the revenue from Obamacare taxes into block grants for states to spend on the health care program of their choosing. The bill would also end many of the Affordable Care Act’s federal regulations on health insurers.
The Tartan spoke with Professor Martin Gaynor, who studies health policy at the Heinz College, to understand what impact each bill would have on the country if passed. Gaynor summarized the reform efforts by describing them as “two bills that represent completely different visions of what a health care system should be like in the United States.”
Gaynor said that Medicare-for-All would be successful in achieving universal health coverage and simplifying our complicated health insurance system, which he compared to a “Rube Goldberg machine.” But Gaynor also said that there are many “legitimate concerns” about the bill. One such concern is how to pay for the extremely expensive health insurance program, and whether a tax increase of the magnitude needed to pay for it would be politically feasible. Even if the program could be paid for, though, Gaynor noted that many countries with single-payer health care systems have the problem of patients waiting months for health services. Also, it is unclear whether middle-income Americans will be financially better off on balance if their taxes go up and their health care costs go down.
A key difference between the Medicare-for-All Act and previous single-payer plans is that Sanders’ new bill outlines a gradual transition process to achieve universal coverage over a few years. Even so, Professor Gaynor said that the bill would totally disrupt the health insurance system, and that Obamacare’s implementation was “peanuts” compared to what the transition to a single-payer system would involve. Such a transition would likely include major efforts by lobbyists to change the health insurance system in their favor.
Gaynor said that he doesn’t think the Graham-Cassidy bill is the way to go. He said that giving flexibility to the states makes sense superficially, but there are some health benefits and consumer protections which are important enough that the federal government should impose regulations and not leave these decisions for states to decide. Gaynor believes that healthcare is one area in which the government should provide a “helping hand” to consumers, arguing that the “invisible hand won’t quite get the job done in health insurance markets.” For example, insurers would once again be able to charge higher premiums to some Americans based on their medical history.
Given that both bills have policy flaws and political challenges, Gaynor proposed that Congress and the White House prioritize modest steps to stabilize and improve the current health care system. One such step would be continuing to give out subsidies known as Cost-Sharing Reductions to help low-income Americans afford health insurance. Another would be creating a public option for health insurance to promote competition in the market. Many Republicans seem to want to repeal the individual mandate that Americans have health insurance, but Gaynor suggests that if they do this, they should replace it with an alternative way of getting young, healthy people to purchase health insurance such as an automatic enrollment system.
As of right now, both U.S. Senators from Pennsylvania, Bob Casey (D) and Pat Toomey (R), have yet to come out for or against their own party’s bill. This offers an opportunity for constituents to share their thoughts with their Senators about which direction they would like health care reform to go.