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Showing Original Post only (View all)Urban Institute analysis of Sanders Single Payer Plan: May 2016 [View all]
Summary:
We estimate that current state and local spending will be $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026. Because this would be absorbed by the federal government under the Sanders plan, some might suggest requiring states to pay maintenance-of-effort costs to offset the increased federal acute care and long-term care costs. Some dispute exists about whether maintenance-of-effort requirements are legal, however, given National Federation of Independent Business v. Sebelius; that decision may call into question whether such payments amount to coercion.
However, many other issues would be raised by a single-payer system. Providers would be seriously affected. Hospitals would see only small financial effects in the aggregate because payment rates would be increased for those otherwise insured by Medicare and Medicaid and revenue from the otherwise uninsured would increase, but they would receive less revenue for providing care to those who would otherwise be privately insured. Different types of hospitals would be advantaged and disadvantaged, depending upon their patient mix. Growth in revenues over time would be slower than under current law, however. Physician incomes would be squeezed by the new payment rates because such rates would be considerably below what physicians are paid by private insurers. Again, whether providers were financial winners or losers from the reform would depend upon their current payer mix. The pharmaceutical and medical device industries would be squeezed perhaps more than is sustainable.
Behavioral responses by the range of health care providers to such a vast change are uncertain. If provider incomes fall, additional federal investment in medical education might be necessary to achieve a sufficient level of supply. Choices would need to be made about the treatment of existing private longterm care insurance contracts and the reserves the companies that issued these policies now hold.
We assume a 6 percent administrative cost across the board; this may be too low given the many functions that would need to be carried out, including a range of care management functions, rate setting, bill paying, and oversight responsibilities for a wide variety of providers across the nation. By eliminating copayments, coinsurance, deductibles, and service limits of all types, the Sanders plan would increase demand for services. We have assumed supply constraints such that not all of the increased demand would be met. But the failure to meet all demand could lead to public outcry. Any remaining role for private health insurance would also have to be determined. If higher-income people purchase private insurance, it could give them faster access to desired providers, increasing their satisfaction with the system. Yet it could also lead to longer queues for those relying on the remaining providers,
causing dissatisfaction in other quarters.
Finally, moving to a single-payer system would be highly disruptive in the near term. When the ACA required people to give up private insurance plans that were less costly than those available in the reformed nongroup market, some vocal complaints led to quick administrative action to increase opportunities for people to keep non-ACA compliant plans longer. The ACAs changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system.
However, many other issues would be raised by a single-payer system. Providers would be seriously affected. Hospitals would see only small financial effects in the aggregate because payment rates would be increased for those otherwise insured by Medicare and Medicaid and revenue from the otherwise uninsured would increase, but they would receive less revenue for providing care to those who would otherwise be privately insured. Different types of hospitals would be advantaged and disadvantaged, depending upon their patient mix. Growth in revenues over time would be slower than under current law, however. Physician incomes would be squeezed by the new payment rates because such rates would be considerably below what physicians are paid by private insurers. Again, whether providers were financial winners or losers from the reform would depend upon their current payer mix. The pharmaceutical and medical device industries would be squeezed perhaps more than is sustainable.
Behavioral responses by the range of health care providers to such a vast change are uncertain. If provider incomes fall, additional federal investment in medical education might be necessary to achieve a sufficient level of supply. Choices would need to be made about the treatment of existing private longterm care insurance contracts and the reserves the companies that issued these policies now hold.
We assume a 6 percent administrative cost across the board; this may be too low given the many functions that would need to be carried out, including a range of care management functions, rate setting, bill paying, and oversight responsibilities for a wide variety of providers across the nation. By eliminating copayments, coinsurance, deductibles, and service limits of all types, the Sanders plan would increase demand for services. We have assumed supply constraints such that not all of the increased demand would be met. But the failure to meet all demand could lead to public outcry. Any remaining role for private health insurance would also have to be determined. If higher-income people purchase private insurance, it could give them faster access to desired providers, increasing their satisfaction with the system. Yet it could also lead to longer queues for those relying on the remaining providers,
causing dissatisfaction in other quarters.
Finally, moving to a single-payer system would be highly disruptive in the near term. When the ACA required people to give up private insurance plans that were less costly than those available in the reformed nongroup market, some vocal complaints led to quick administrative action to increase opportunities for people to keep non-ACA compliant plans longer. The ACAs changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system.
https://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000785-The-Sanders-Single-Payer-Health-Care-Plan.pdf
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The Urban Institute is a creditable organization. They did much of the work establishing Medicare's
Hoyt
Sep 2017
#1
what? fuck that. You say some shit as if ..."it can't be all these 3 things" and you say that for
JCanete
Sep 2017
#67
It can't. This is an axiom of project management. A big & complicated project cannot be all three.
stevenleser
Sep 2017
#76
I did not see where the poster indicated that the bill was going for fast and cheap, only that it
JCanete
Sep 2017
#78
So insurance as it stands, which is gouging the fuck out of people, and granted, often has massive
JCanete
Sep 2017
#96
I am not going to read the whole thing, does it relieve employers buying health insurance
Eliot Rosewater
Sep 2017
#4
Taxes being much higher than anticipated were part of why VT single payer failed.(n)
ehrnst
Sep 2017
#8
That was the problem with the California proposal, and the Democratic Speaker....
George II
Sep 2017
#22
"The increases in federal spending that we estimated ($32 trillion between 2017 and 2026)"
TCJ70
Sep 2017
#24
I'm basing that on the fact that we currently spend around $3.8 Trillion annually...
TCJ70
Sep 2017
#30
Don't worry Sanders is only the sponsor/visionary-he did his part in moving the needle
andym
Sep 2017
#46
MFA would radically change things, could happen quickly and would be disruptive in a good way
andym
Sep 2017
#62
Delivery of care will not be disrupted if universal healthcare is engineered carefully
andym
Sep 2017
#94
We are jumping on board based on the principle of achieving universal health care
andym
Sep 2017
#95
America is the only industrialized nation in the world incapable of implementing universal coverage.
Orsino
Sep 2017
#20
Sanders has a say in what goes into the bill, but no more than any other co-sponsor.
Orsino
Sep 2017
#109
Bernie is not known for drumming up support among his colleagues to write a bill.
ehrnst
Sep 2017
#122
Your statement that he is tweaking it with other Senators has the burden of proof
ehrnst
Sep 2017
#124
So now you say who wrote and edits the bill isn't important but it DEFINITELY isn't just Bernie...
ehrnst
Sep 2017
#135
They would have been more trustworthy had they revealed their conflict of interest in the analysis
Major Nikon
Sep 2017
#48
People have been saying that on DU over and over again - anyone know if they REALLY....
George II
Sep 2017
#70
Do you also tell your students that a source that presents a barely edited Wikipedia copy/paste
ehrnst
Sep 2017
#80
You keep bringing up Sourcewatch and their inaccurate comment about Cigna and Pfizer. Why?
George II
Sep 2017
#51
Because it means they don't have to read or learn something they don't wanna. (nt)
ehrnst
Sep 2017
#56
According to the Urban League's annual report only 1.4% of their funding comes from....
George II
Sep 2017
#50
They have four or five annual reports and also audited financial statements on their site....
George II
Sep 2017
#63
More evidence why I think we should be working to architect a two-tier or dual-tier system from the
stevenleser
Sep 2017
#77