Medicare for All is
ironically, considering that Americans and especially Democrats have indicated
that access to affordable healthcare is their number one priority, is the issue
that could sink the 2020 presidential candidacy of progressives Bernie Sanders and
Elizabeth Warren. Now Sanders is heralding a new study by epidemiologists in
the medical journal The Lancet which found that Medicare for All would save
Americans $450 billion and prevent 68,000 premature deaths a year. Here is
Sen. Bernie Sanders on Saturday applauded a new study published
today by a team of epidemiologists in the peer-reviewed medical journal The
Lancet, which found that Medicare for All will save Americans $450 billion
and prevent 68,000 unnecessary deaths each and every year.
“This study confirms that Medicare for All will save the American people
$450 billion on health care costs and will prevent 68,000 unnecessary deaths –
each and every year,” Sanders said. “In other words, guaranteeing health care
as a human right by creating a Medicare for All system will cost substantially
less than our current dysfunctional health care system. It will save working
class families thousands of dollars and it will prevent tens of thousands of
Americans from dying each year. While the CEOs in the pharmaceutical and health
insurance industry may not like it, we will end their greed and enact Medicare
for All when I am president.”
According to the study, by replacing premiums, deductibles, co-payments
and out-of-pocket costs with a progressive tax system, Medicare for All will
save the average family thousands of dollars each year and will provide
lower-income households the greatest relief.
Struggling hospitals serving low-income communities would be
particularly helped by Medicare for All by eliminating uncompensated care,
increasing Medicaid reimbursement rates to Medicare levels, and reducing
administrative overhead, according to the study.
The study also debunks several attacks on Medicare for All from the
private health care industry that made well over $100 billion in profits last
year. Doctors and hospitals would see large savings in cost and time from
streamlining our bloated and inefficient administrative and billing system,
allowing doctors to spend more time with patients, the study found.
The study is the latest in a series of studies conducted over the past
three decades that have found that guaranteeing universal health care through a
single-payer health care system would not only dramatically improve the health
and well-being of the American people, it would cost less than our current
dysfunctional health care system that puts profits over people.
Last month, another medical journal found
that 19 out of 22 studies done over the past 30 years concluded that moving to
a Medicare for All, single-payer health care system would cost less than our current
health care system in the first year, and all of the studies showed that it
would cost less within a decade of implementation.
The vigorous contest of
Democrats seeking the 2020 presidential nomination has produced excellent
policy proposals to address major issues. Clearly
responding to the backlash against her radical plan to finance Medicare for
All, Senator Elizabeth Warren released details of how she would reduce health
care costs in America, eliminate profiteering from the health care system, and
complete a full transition to Medicare for All in her first term. Warren has
already released her plan to fully finance Medicare
for All when it’s up and running without raising taxes on the middle class by
“Medicare for All is
the best way to guarantee health care to all Americans at the lowest cost. I
have a plan to pay for it without
raising taxes on middle class families, and the transition I’ve outlined here
will get us there within my first term as president. Together, along with
additional reforms like my plans to reduce black maternal mortality rates,
ensure rural health care,
protect reproductive rights,
support the Indian Health Service,
take care of our veterans, and
secure LGBTQ+ equality, we will
ensure that no family will ever go broke again from a medical diagnosis – and
that every American gets the excellent health care they deserve. “
This is from the Warren campaign:
On Day One, Elizabeth will use her executive authority
Reverse Donald Trump’s sabotage of Obamacare
Improve the Affordable Care Act, Medicare, and Medicaid.
Protect people with pre-existing conditions
Drastically lower pharmaceutical costs for millions of
families for drugs including Insulin, EpiPens, and drugs that save people from
The first bill Elizabeth will pass is her comprehensive set
of anti-corruption reforms which include ending lobbying as we know it and
knocking back the influence of Big Pharma and insurance companies.
And in her first 100 days, Elizabeth will use a
fast-track legislative process called budget reconciliation to create a true
Medicare for All option that will:
Include all the health care benefits of Medicare for All
described in the Medicare for All Act.
Be immediately free for nearly half of all Americans,
Children under the age of 18
Families making at or below 200% of the federal poverty
level (about $51,000 for a family of four)
Give every American over the age of 50 the choice to enter a
substantially improved Medicare program.
Consumer costs will automatically decline, so eventually
coverage under this plan will be free to everyone
Throughout her first term, she will fight for additional
health system reforms to save money and save lives–including a boost of
$100 billion in guaranteed, mandatory spending for new NIH
And no later than her third year in office, she will pass
legislation to complete the transition to Medicare for All: guaranteed
comprehensive health care for every American, long-term care, vision, dental,
and hearing, with a single payer to reduce costs and produce better health
Elizabeth’s plan can deliver an $11 trillion boost to
families who will never pay another premium, deductible, or co-pay.
And her plan will protect unions and make sure that there’s
support for workers affected by these changes.
My First Term Plan for Reducing Health Care Costs in
America and Transitioning to Medicare for All
I spent my career studying why families went broke. I rang
the alarm bells as the costs for necessities skyrocketed while wages remained
basically flat. And instead of helping, our government has become more tilted
in favor of the wealthy and the well-connected.
The squeeze on America’s families started long before the
election of Donald Trump, and I’m not running for president just to beat him.
I’m running for president to fix what’s broken in our economy and our
democracy. I have serious plans to raise wages for Americans.
And I have serious plans to reduce costs that are crushing our families, costs
like child care, education, housing – and health care.
The Affordable Care Act made massive strides in expanding
access to health insurance coverage, and we must defend Medicaid and the
Affordable Care Act against Republican attempts to rip health coverage away
from people. But it’s time for the next step.
The need is clear. Last year, 37 million American
adults didn’t fill a prescription because of costs. 36 million people
skipped a recommended test, treatment, or follow-up because of costs. 40 million people
didn’t go to a doctor to check out a health problem because of costs. 57 million people
had trouble covering their medical bills. An average family of four with
employer-sponsored insurance spent $12,378 on
employee premium contributions and out-of-pocket costs in 2018. And 87 million Americans
are either uninsured or underinsured.
Meanwhile, America spends about twice as much per
person on health care than the average among our peer countries while
delivering worse health outcomes than many of them. America is home to the best
health care providers in the world, and yet tens of millions of people can’t
get care because of cost, forcing families into impossible decisions. Whether
to sell the house or skip a round of chemo. Whether to cut up pills to save
money or buy groceries for the week. The way we pay for health care in the
United States is broken – and America’s families bear the burden.
We can fix this system. Medicare for All is the best way to
cover every person in America at the lowest possible cost because it eliminates
profiteering from our health care and leverages the power of the federal
government to rein in spending. Medicare for All will finally ensure that
Americans have access to all of the coverage they need – not just what
for-profit insurance companies are willing to cover – including vision, dental,
coverage for mental health and addiction services, physical therapy, and
long-term care for themselves and their loved ones. Medicare for All will mean
that health care is once again between patients and the doctors and nurses they
trust–without an insurance company in the middle to say “no” to access to the
care they need. I have put out a plan to fully
finance Medicare for All when it’s up and running without raising taxes on the
middle class by one penny.
But how do we get there?
Every serious proposal for Medicare for All contemplates
a significant transition period. Today, I’m announcing my plan to expand public
health care coverage, reduce costs, and improve the quality of care for every
family in America. My plan will be completed in my first term. It includes
dramatic actions to lower drug prices, a Medicare for All option available to
everyone that is more generous than any plan proposed by any other presidential
candidate, critical health system reforms to save money and save lives, and a
full transition to Medicare for All.
Here’s what I’ll do in my first 100 days:
I’ll pursue comprehensive anti-corruption reforms to
rein in health insurers and drug companies – reforms that are essential to make
any meaningful health care changes in Washington.
I’ll use the tools of the presidency to start improving
coverage and lowering costs – immediately. I’ll reverse Donald Trump’s
sabotage of health care, protect individuals with pre-existing conditions, take
on the big pharmaceutical companies to lower costs of key drugs for millions of
Americans, and improve the Affordable Care Act, Medicare, and Medicaid.
I will fight to pass fast-track budget reconciliation
legislation to create a true Medicare for All option that’s free for tens of
millions. I won’t hand Mitch McConnell a veto over my health care
agenda. Instead, I’ll give every American over the age of 50 the choice to
enter an improved Medicare program, and I’ll give every person in America the
choice to get coverage through a true Medicare for All option. Coverage under the
new Medicare for All option will be immediately free for children under the age
of 18 and for families making at or below 200% of the federal poverty level
(about $51,000 for a family of four). For all others, the cost will be modest,
and eventually, coverage under this plan will be free for everyone.
By the end of my first 100 days, we will have opened the
door for tens of millions of Americans to get high-quality Medicare for All
coverage at little or no cost. But I won’t stop there. Throughout my
term, I’ll fight for additional health system reforms to save money and save
lives – including a boost of $100 billion in guaranteed, mandatory spending for
new NIH research over the next ten years to radically improve basic
medical science and the development of new medical miracles for patients.
And finally, no later than my third year in office, I
will fight to pass legislation that would complete the transition to full
Medicare for All. By this point, the American people will have
experienced the full benefits of a true Medicare for All option, and they can
see for themselves how that experience stacks up against high-priced care that
requires them to fight tooth-and-nail against their insurance company. Per the
terms of the Medicare for All Act, supplemental private insurance that doesn’t
duplicate the benefits of Medicare for All would still be available. But by
avoiding duplicative insurance and integrating every American into the new
program, the American people would save trillions of dollars on health costs.
I will pursue each of these efforts in consultation with key
stakeholders, including patients, health care professionals, unions,
individuals with private insurance, hospitals, seniors currently on Medicare,
individuals with disabilities and other patients who use Medicaid, Tribal
Nations, and private insurance employees.
And at each step of my plan, millions more Americans will
pay less for health care. Millions more Americans will see the quality of their
current health coverage improve. And millions more Americans will have the
choice to ditch their private insurance and enter a high-quality public plan.
And, at each step, the changes in our health care system will be fully paid for
without raising taxes one penny on middle class families.
Every step in the coming fight to improve American health
care – like every other fight to improve
American health care – will be opposed by those powerful industries who profit
from our broken system.
But I’ll fight my heart out at each step of this process,
for one simple reason: I spent a lifetime learning about families going broke
from the high cost of health care. I’ve seen up close and personal how the
impact of a medical diagnosis can be devastating and how the resulting medical
bills can turn people’s lives upside down. When I’m President of the United
States, I’m going to do everything in my power to make sure that never happens
to another person again.
The First 100 Days of a Warren Administration
Donald Trump has spent nearly every day of his
administration trying to rip health coverage away from tens of millions of
Americans – first by legislation, then by regulation, and now by lawsuit. When
I take office, I will immediately work to reverse the damage he has done.
But I’ll do much more than that.
In my first 100 days, I will pick up every tool Donald
Trump has used to undermine Americans’ health care and do the opposite. While
Republicans tried to use fast-track budget reconciliation legislation to rip
away health insurance from millions of people with just 50 votes in the Senate,
I’ll use that tool in reverse – to improve our existing public insurance
programs, including by giving everyone 50 and older the option to join the
current Medicare program, and to create a true Medicare for All option that’s
free for millions and available to everyone.
But first, we must act to rein in Washington
Anti-Corruption Reforms to Rein in Health Industry
In Washington, money talks – and nowhere is that more
obvious than when it comes to health care. The health care industry spent $4.7
billion lobbying over the last decade. And health insurance and pharmaceutical
executives have been active in fundraising and donating to
candidates in the 2020 Democratic primary campaign as well.
Today, the principal lobbying groups for the drug companies,
health insurers, and hospitals have teamed up with dozens of other
health industry groups to create the Partnership for America’s Health Care
Future – a front group whose members spent a combined $143 million on
lobbying in 2018 and aims to torpedo
Medicare for All in this election. The Partnership has made clear that “whether
it’s called Medicare for All, Medicare buy-in, or the public option,
one-size-fits-all health care will never allow us to achieve [our]
Let’s not kid ourselves: every Democratic plan for
expanding public health care coverage is a challenge to these industries’
bottom lines – and every one of these plans is already being drowned in money
to make sure it never happens. Any candidate who believes more modest reforms
will avoid the wrath of industry is not paying attention.
If the next president has any intention of winning any
health care fight, they must start by reforming Washington. That’s why I’ve
released the biggest set of anti-corruption reforms since Watergate – and why
enacting these reforms is my top priority as president. Here are some of the
ways my plan would rein in the health care industry:
Close the revolving door. My plan will close the revolving door between
health care lobbyists and government, and end the practice of large
pharmaceutical companies like Novartis, United Health, Roche, Pfizer, and
Merck vacuuming up senior
government officials to try and monopolize government expertise, relationships,
and influence during a fight for health care reform.
Tax excessive lobbying. My plan will also
implement an excessive lobbying tax on
companies that spend more than $500,000 per year peddling influence – like
Pfizer, Amgen, Eli Lilly, Novartis, and Johnson & Johnson. Money from the
tax would be used to strengthen congressional support agencies, establish an
office to help the public participate in the rule-making process, and give our
government additional resources to fight back against an avalanche of corporate
End lobbyist bribery. My campaign finance plan
will ban all lobbyists – including health insurance and pharma lobbyists – from
trying to buy off politicians by donating or fundraising for their campaigns.
This will shut down the flow of millions of dollars in
Limit corporate spending to influence elections. My
plan bans all election-related spending from big corporations with a
significant portion of ownership from foreign entities. That would block major
industry players like UnitedHealth, Anthem, Humana, CVS Health, Pfizer,Amgen, AbbVie, Eli Lilly, Gilead, and Novartis – along
with any trade associations that receive money from them – from spending to
Crowd out corporate contributions with small dollar
donations. I support a constitutional amendment to get big money out
of politics. But until we enact it, my plan would institute a public financing
program that matches every dollar from small donations with six more dollars so
that congressional candidates are answering to the people who need health care
and affordable prescription drugs, rather than health insurance and
Passing these reforms will not be easy. But we should enact
as much of this agenda as possible, as quickly as possible. I will also use my
executive authority to begin implementing them wherever possible – including
through prioritizing DOJ and FEC enforcement against the corrupt
influence-peddling game. And I will voluntarily hold my administration to the
standards that I set in my anti-corruption plan so that all our federal
agencies, including those involved in health care, serve only the interests of
Money slithers through Washington like a snake. Any
candidate that cannot or will not identify this problem, call it out, and
pledge to make fixing it a top priority will not succeed in delivering any
public expansion of health care coverage – or any other major priority.
Immediate Executive Actions to Reduce Costs and Expand
Public Health Coverage.
There are a number of immediate steps a president can take
entirely by herself to lower drug prices, reduce costs, and improve Medicare,
Medicaid, and ACA access and affordability. I intend to take these steps within
my first 100 days.
Dramatically Lower Key Drug Prices
As drug companies benefit from taxpayer-funded R&D and
rake in billions of dollars in
profits, Americans are stuck footing the bill. The average American spends
roughly $1,220 per year on
pharmaceuticals – more than any comparable country. As president, I
will act immediately to lower the cost of prescription drugs, using every
available tool to bring pressure on the big drug companies. I’ll start by
taking immediate advantage of existing legal authorities to lower the cost of
several specific drugs that tens of millions of Americans rely on.
Some drug prices are high because pharmaceutical companies
jack up prices on single-source brand-name drugs, taking advantage of
government-granted patents and exclusivity periods to generate eye-popping
profits. Pharma giant Gilead, for example, launched its
Hepatitis C treatment Harvoni at $94,500-per-twelve week treatment – leaving as many as 85 percent of more than 3 million Americans with
Hepatitis C struggling to afford life-saving treatments.
The government has two
existing tools to combat price-gouging by brand-name drug companies, in
addition to tough antitrust enforcement against companies that abuse our patent
system and use every trick in the book to avoid competition. First, the
government can bypass patents (while providing “reasonable and entire
compensation” to patent holders) using “compulsory licensing authority.” The
Defense Department has used this authority as recently as 2014.
Second, under the march-in provisions of the Bayh-Dole Act, the
government can require re-licensing of certain patents developed with
government involvement when the contractor was not alleviating health or safety
needs. Just in this decade, federal research investments have contributed to
the development of hundreds of drugs –
all of which could be subject to this authority.
But new drugs aren’t the only unaffordable drugs on the
market. Even older, off-patent drugs can be expensive and inaccessible. Lack of
generic competition allows bad actors like Martin Shkreli to
boost the prices of decades-old drugs. Some of the biggest generic drug
companies in the country are now being sued by forty-four states for
price-fixing to keep profits high. Limited competition and other market
failures can also lead to drug shortages. Fortunately, the government can also
act to fix our broken generic drug market by stepping in to publicly
manufacture generic drugs, stopping price gouging in its tracks and bringing
On the first day of my presidency, I will use these tools
to drastically lower drug costs for essential medications – drugs with high
costs or limited supply that address critical public health needs. And
during my administration, we will use these tools to make other drugs
affordable as well.
Insulin was discovered nearly 100 years ago as
a treatment for diabetes – but today the drug is still unaffordable for too
many Americans. Eli Lilly’s brand-name insulin prices increased over 1,200% since the 1990s.
Insulin costs are too high because three drug companies –
Novo Nordisk, Sanofi, and Eli Lilly – dominate the market, jacking up prices.
Americans with diabetes are rationing insulin, and
taxpayers are spending billions on it
through Medicare and Medicaid. It’s obscene.
No American should die because they can’t afford a century-old drug that can
be profitably developed for
$72 a year. I will use existing authorities to contract for manufacture of
affordable insulin for all Americans.
EpiPens deliver life-saving doses of
epinephrine, a drug that reverses severe allergic reactions to things like
peanuts and bee stings. Though epinephrine has been around for over a century, the pens
that deliver it are protected by a patent that
limits competition. In 2016, this lack of competition allowed Mylan, EpiPen’s
manufacturer, to jack up EpiPen prices by 400%, leaving
families unable to afford this life-saving medication. Though cheaper versions
have recently entered
the market, prices remain out of reach for
many American families. As president, I will use existing authorities to
produce affordable epinephrine injectors for Americans (and especially
children) who need it.
Humira is a drug with anti-inflammatory effects used
to treat diseases like arthritis, psoriasis, and Crohn’s disease. It
is the best-selling prescription
drug in the world, treating millions. AbbVie, Humira’s manufacturer, has doubled the price
of Humira to more than $38,000 a year. In 2017, Medicaid and Medicare spent over
$4.2 billion on it – while AbbVie, its manufacturer, developed a “patent thicket” to
shield itself from biosimilar competition. In May 2019, the company
entered into a legal settlement preventing a competitor from entering the U.S.
market until 2023 – probably because prices went down by up to 80% once
biosimilars entered in Europe. My administration will pursue antitrust action
against AbbVie and other drug companies that pursue blatantly anti-competitive
behavior, and, if necessary, use compulsory licensing authority to facilitate
production, saving taxpayers billions.
Hepatitis C drugs like Harvoni are part of
a class described as
“miracle” drugs. Harvoni’s price tag – $94,500-per-treatment – left 85% of the more than 3 million Americans living
with Hepatitis C without a lifesaving medication, while taxpayers foot a $3.8billion bill. Although
the price has come down in recent years, it is still expensive for
too many. One estimate suggests that by
using compulsory licensing, the federal government could treat all Americans
with Hepatitis C for $4.5 billion – just 2% of the $234 billion it would
otherwise cost. That is exactly what I will do.
Truvada is a drug that – until recently –
was the only FDA-approved form
of pre-exposure prophylaxis, which can reduce the risk of HIV from sexual
activity by up to 99%. Truvada’s
manufacturer, Gilead, relied on $50 million in federal grants to
develop it, but today they rake in multi-billion dollar profits while Americans
struggle to afford it. The CDC estimates a million Americans could benefit from
Truvada, though only a fraction do today – largely due to to its $2,000-a-month price tag, which is nearly thirty times what
it costs in other countries. My administration will facilitate the production
of an affordable version – reducing HIV infections and saving taxpayers billions of dollars each
Antibiotics provide critical protection from
bacterial and fungal infections, and we are in desperate need of new
antibiotics to combat resistant infections. Every year, nearly
three million Americans contract antibiotic-resistant infections – and more
than 35,000 people die. But antibiotics don’t generate much money,
discouraging pharmaceutical investment, causing shortages, and contributing to price hikes.
Earlier this year, one biotech firm filed for bankruptcy after
marketing a new antibiotic, Zemdri, for less than a year. My administration
will identify antibiotics with high prices or limited supply and help produce
them to combat resistance and provide patients with the treatments they need.
Drug shortages leave doctors and patients
scrambling to access the treatments they need, forcing many to ration
medications and use inferior substitutes. Our nation’s hospitals, for example,
are currently experiencing a shortage of
vincristine – an off-patent drug that is the “backbone” of childhood cancer
treatment. The vincristine shortage began when Teva, one of its two suppliers,
made the “business decision” to stop manufacturing the drug. When I am
president, the government will track drugs in consistent shortage, like
vincristine, and I will use our administrative authority to ensure we have
Finally, I will also direct the government to study whether
other essential medicines, including breakthrough drugs for cancer or high-cost
drugs for rare diseases, might also be subject to these interventions because
they are being sold at prices that inappropriately limit patient
Make Mental Health and Substance Use Treatment A
The law currently requires health insurers to provide mental
health and substance use disorder benefits in parity with physical health benefits.
But in 2018, less than half of
people with mental illness received treatment and less than a fifth of people
who needed substance use treatment actually received it. As
president, I will launch a full-scale effort to enforce these requirements –
with coordinated actions by the IRS, Centers for Medicare and Medicaid
Services, and Department of Labor to make sure health plans actually provide
mental health treatment in the same way they provide other treatment.
Reverse Trump’s Sabotage
I will reverse the Trump administration’s actions that have
undermined health care in America. Key steps include:
Protecting coverage for people with pre-existing
conditions. The Trump administration has abandoned its duty
to defend current laws in court, cheering on efforts to destroy protections for
pre-existing conditions, insurance coverage for dependents until they’re 26,
and the other critical Affordable Care Act benefits. In a Warren
administration, the Department of Justice will defend this law. And we will
close the loopholes created by the Trump administration, using 1332 waivers,
that could allow states to steer healthy people toward parallel, unregulated
markets for junk health plans. This will shut down a stealth attack on people
with pre-existing conditions who would see their premiums substantially
increase as healthier people leave the marketplace.
Banning junk health plans. The Trump
administration has expanded the use of
junk health insurance plans as an alternative to comprehensive health plans
that meet the standards of the ACA. These plans cover few benefits,
discriminate against people with pre-existing conditions, and increase costs
for everyone else. And in some cases they direct as much as 50 percent of
patient premiums to administrative expenses or profit. I will ban junk plans.
Expanding ACA enrollment. I’ll re-fund the
Affordable Care Act programs that help people enroll in ACA coverage, programs
that have been gutted by the Trump administration.
Expanding premium tax credits. I will reverse
the Trump administration rule that artificially reduced premium tax credits for
many people, making coverage less affordable –
and instead will expand these credits.
Rolling back Trump’s sabotage of Medicaid. I’ll
reverse the Trump administration’s harmful Medicaid policies that take coverage
away from low-income individuals and families. I’ll prohibit restrictive and
ineffective policies like work requirements – which have already booted 18,000 people in
Arkansas out of the program – as well as enrollment caps, premiums, drug
testing, and limits on retroactive eligibility that can prevent bankruptcy.
Restoring non-discrimination protections in health
care. I will immediately reverse the Trump administration’s
terrible proposed rule permitting
health plans and health providers to discriminate against women, LGBTQ+ people,
individuals with limited English proficiency, and others.
Ending the Trump administration’s assault on reproductive
care. I’ll roll back the Trump administration’s domestic and global
gag rules, which deny Title X and USAID funding to health care providers who
provide abortion care or even explain where and how patients can access safe,
legal abortions. And I will overturn the Trump administration’s embattled proposed rule to
roll back mandatory contraceptive coverage.
Strengthen the Affordable Care Act
As president I will use administrative tools to strengthen
the ACA to reduce costs for families and expand eligibility. Key steps include:
Stop families from being kicked out of affordable
coverage. Because of something called the “family glitch,” an
entire family can lose access to tax credits that would help them buy health
coverage if one parent is offered individual coverage with a premium less than
9.86% of their family income. I’ll work to make sure that a family’s access to
tax credits is based on the affordability of coverage for the whole family –
not just one individual – so families who don’t actually have access to
affordable alternatives don’t lose their ACA tax credits.
Expand eligibility to all legally present
individuals. I’ll also work to extend eligibility for ACA tax credits
to all people who are legally present, including those eligible for the
Deferred Action for Childhood Arrivals program.
Put money back in workers’ pockets. The
Affordable Care Act requires insurance
companies to spend at least 80 percent of total premium contributions on health
care claims (and, in many cases, at least 85 percent), leaving the rest to be
spent on plan administration, marketing, and profit. Insurers who waste money
must issue rebates – but too often, these are returned to employers who don’t pass
on the savings to their employees. Insurance companies are expected to pay
out $1.3 billion in
rebates in 2019, with employers in the small-group market receiving an average
rebate of $1,190 and employers in the large-group market receiving an average
rebate of $10,660. My plan will require employers to pass along the full value
of the rebate directly to employees.
As president I will use administrative tools to strengthen
Expand Dental Benefits. The Medicare statute
prohibits coverage of dental care that is unrelated to other medical care,
unless it is medically necessary. This has been interpreted to largely exclude
any oral health care. As a result, almost two-thirds of
Medicare beneficiaries, or nearly 37 million people, lack access to dental
benefits. I will use my administrative authority to clearly expand the
medically necessary dental services Medicare can provide, improving the health
of millions of Medicare beneficiaries.
Stop private Medicare Advantage plans from bilking
taxpayers. Roughly one-third of Medicare beneficiaries get coverage
through a private Medicare Advantage plan. Medicare payments to these plans for
each enrollee are supposed to reflect the cost of covering that person through
traditional Medicare, but overwhelmingevidence shows that
these private plans make their enrollees appear sicker on paper than they
actually are to earn inflated payments at the expense of taxpayers. Some suggest that this
adds $100 billion or more to Medicare spending over ten years. My
administration will put an end to this fraud.
As president I will use administrative tools to strengthen
Medicaid and potentially allow millions more to access the program.
Use waiver authority to increase Medicaid eligibility. With
the approval of the federal government, states can use Section 1115
demonstration waivers to expand coverage to people who aren’t otherwise
eligible for Medicaid. Currently, however, states can only obtain these waivers
if projected federal spending under the new program will not be higher than without the
waiver. While I pursue legislative reforms to expand coverage, I’ll
also change this administrative restriction to allow these demonstrations to
fulfill their promise of providing affordable health coverage, including
working with states that want to expand Medicaid to uninsured individuals and
families above the statutory upper limit of Medicaid (138% of the poverty
level). Any state that chooses to expand in this way will not be penalized for
doing so when full Medicare for All comes online.
Streamlining eligibility and enrollment. Far too
many people miss out on Medicaid coverage because of red tape. Some states take
coverage away if someone misses just one piece of mail or forgets to notify the
state within 10 days of a change in income. These kinds of harsh policies help
explain why more than a million children “disappeared” from the
Medicaid and CHIP programs in the past year. I will eliminate these kinds of
unfair practices, and instead work with states to make it easier for everyone –
families, children, and people with disabilities – to maintain this essential
Ensuring access to care for beneficiaries in managed care
plans. I’ll roll back the Trump administration’s proposed changes to
rules regulating Medicaid managed care plans, which would dilute important
standards, such as requiring health plans to maintain adequate provider
networks guaranteeing access to care for Medicaid enrollees.
Antitrust Enforcement for Hospitals and Health
For years, both horizontal
mergers (where hospitals purchase other hospitals) and vertical mergers (where
hospitals acquire physician practices) have produced greater hospital and
health system consolidation, contributing to the skyrocketing costs of health
care. Today, “not a single
highly competitive hospital market remains in any region of the United
States.” Study after studyshowsthat mergers mean higher prices, lower quality,
and increased inequality due to the growing wage gap between
hospital CEOs and everyone else. Bringing down the cost of health care means
enforcing competition in these markets.
As president, I will appoint aggressive antitrust enforcers
who recognize the problems with hospital and health system consolidation to the
Department of Justice and Federal Trade Commission. My administration will also
conduct retrospective reviews of significant new mergers, and break up mergers
that should never have taken place.
Bringing Health Records into the 21st Century
Congress spent $36 billion to get
every doctor in America using electronic health records, but we still do not have adequate digital
information flow in health care – in part because two big
companies make up about 85% of the market for
medical records at big hospitals. As they attempt to capture more of the
market, these companies are making it harder for systems to communicate with each other. My
administration will ramp up the enforcement against information blocking by big
hospital systems and health IT companies, and I will appoint leaders to the FTC
and DOJ who will conduct a rigorous antitrust investigation of the health
records market, especially in the hospital space.
Elevating the Voices of Workers in the Transition to
Medicare for All
The fundamental goal of my presidency will be returning
power to working people. Medicare for All accomplishes that by giving every
American high-quality coverage and freeing them from relying on the whims of
their employers or private insurance companies for the health care they need.
My plan to transition to Medicare for All will also put working people first,
and elevate their voices at each stage of the process.
My plan seeks to build on the achievements of generations of
working people and their unions who have fought for and won health care. I view
good health plans negotiated through collective bargaining as a positive
achievement for working people, and I will seek as part of the first phase of
my plan the elimination of the excise tax on those plans.
In my first weeks in office, I will issue an Executive Order
creating a commission of workers (including health care workers), union
representatives, and union benefit managers that I will consult at every stage
of the transition process. The commission will be responsible for providing
advice on each element of the transition to Medicare for All, including, at a
Ensuring workforce readiness and adequate access to care
across all provider types.
Determining national standards of coverage and benefits,
including long-term care.
Learning from successful existing non-profit health care
administrators and integrating them into the new Medicare for All system.
Ensuring a living wage for all health care workers and that
savings generated within the new system by hospitals and other health care
employers are shared fairly with all of the workers in the health care system.
Ensuring that workers are able to use the collective
bargaining process during the transition period and under the new Medicare for
All system to ensure both effective health outcomes and to ensure that savings
generated by the new system are fairly shared with workers.
In administering the Medicare for All system, my
administration will also rely on unions’ expertise on designing good benefits
for workers and helping workers navigate our health care system. During the
transition to Medicare for All – and even when we ultimately reach a full
Medicare for All system – my administration will seek to partner with
collectively bargained non-profit health care administrators. For example, we
will draw upon their expertise in helping workers choose providers, and look
for opportunities to enter into contracts with the administrators of unions’ collectively
bargained health plans to provide these services. And my plan will guarantee
that union-sponsored clinics are included within the Medicare for All system
and will continue serving their members.
Finally, Medicare for All will be an enormous boost to
the economy, lifting a weight off of both workers and businesses and creating
good new jobs, including in administering health care benefits. Still, the
Medicare for All legislation includes billions of dollars to provide assistance
to workers who may be affected by the transition to Medicare for All, and I
plan on consulting with the new worker commission and other affected parties to
ensure that money is spent as effectively as possible. In the past, transition
assistance programs have been underfunded and have not been as responsive as
they should have been to the actual needs of workers. That will not be the case
in my administration. No worker will be left behind.
Legislation to Expand Medicare and Create a True Medicare
for All Option
In 2017, Senate Republicans came within one vote of
shredding the Affordable Care Act and taking health care coverage away from
more than 20 million people. How did they get so close? By using a fast-track
legislative process called budget reconciliation, which only requires 50 votes
in the Senate to pass laws with major budgetary impacts. President Obama also
used this process to secure final passage of the Affordable Care Act.
I am a strong supporter of eliminating the filibuster, which
I believe is essential to preventing right-wing Senators who function as wholly
owned subsidiaries of major American industries from blocking real legislative
change in America. Any candidate for president who does not support this change
should acknowledge the extreme difficulty of enacting their preferred
legislative agenda. But I’m not going to wait for this to happen to start
improving health care – and I’m not going to give Mitch McConnell or the
Republicans a veto over my entire health care agenda.
That’s why, within my first 100 days, I will pass my own
fast-track budget reconciliation legislation to enact a substantial portion of
my Medicare for All agenda – including establishing a true Medicare for All
option that’s free for millions and affordable for everyone.
A True Medicare for All Option. There are many
proposals that call themselves a Medicare for All “public option” – but most of
them lack the financing to actually allow everyone in America to choose true
Medicare for All coverage. As a result, these proposals create the illusion of
choice, when in reality they offer tens of millions of Americans the decision
between unaffordable private insurance and unaffordable public insurance. A
choice between two bad options isn’t a choice at all.
My approach is different.
Because I have identified trillions in revenue to finance a
fully functioning Medicare for All system – without raising taxes on the middle
class by one penny – I can also fund a true Medicare for All option. The plan
will be administered by Medicare and offered on ACA exchanges. Here are its key
Benefits. Unlike public option plans, the
benefits of the true Medicare for All option will match those in the Medicare
for All Act. This includes truly comprehensive coverage for primary and
preventive services, pediatric care, emergency services and transportation,
vision, dental, audio, long-term care, mental health and substance use, and
Immediate Free Coverage for Millions. This plan
will immediately offer coverage at no cost to every kid under the age of 18 and
anybody making at or below 200% of the federal poverty level (about $51,000 for
a family of four) – including individuals who would currently be on Medicaid,
but live in states that refused to expand their programs.
Free, Identical Coverage for Medicaid
Beneficiaries. States will be encouraged to begin paying a
maintenance-of-effort to the Medicare for All option in exchange for moving
their Medicaid populations into this plan and getting out of the business of
administering health insurance. For states that elect to maintain their
Medicaid programs, Medicaid premiums and cost sharing will be eliminated, and
we will provide wraparound benefits for any Medicare for All option benefits
not covered by a state’s program to ensure that these individuals have the same
free coverage as Medicaid-eligible people in the Medicare for All option.
Eventual Free Coverage for Everyone. This plan
will begin as high-quality public insurance that covers 90% of costs and allows
people to utilize improved ACA subsidies to purchase coverage and reduce cost
sharing. There will be no premiums for kids under 18 and people at or below
200% of the federal poverty level. For individuals above 200% FPL, premiums
will gradually scale as a percentage of income and are capped at 5.0% of their
income. Starting in year one, the plan will not have a deductible — meaning
everyone gets first dollar coverage, and cost sharing will be zero for people
at or below 200% FPL. Cost sharing will scale modestly for individuals at or
above that level, with caps on out-of-pocket costs. In subsequent years,
premiums and cost sharing for all participants in this plan will gradually
decrease to zero.
Reducing Drug Prices. The Medicare for All
option will have the ability to negotiate for prescription drugs using the
mechanisms I’ve previously outlined,
helping to drive down costs for patients.
Automatic Enrollment. Anyone who is uninsured or
eligible for free insurance on day one, excluding individuals who are over 50
and eligible for expanded coverage under existing Medicare, will be
automatically enrolled in the Medicare for All option. Individuals who prefer
other coverage can decline enrollment.
Employee Choice. Workers with employer coverage
can opt into the Medicare for All option, at which point their employer will
pay an appropriate fee to the government to maintain their responsibility for
providing employee coverage. In addition, unions can negotiate to include a
move to the Medicare for All option via collective bargaining during the
transition period, with unionized employers paying a discounted contribution to
the extent that they pass the savings on to workers in the form of increased
wages, pensions, or other collectively-bargained benefits. This will support
unions and ensure that the savings from Medicare for All are passed on to
workers in full, not pocketed by the employer.
Provider Reimbursement and Cost Control. I
have identified cost
reforms that would save our health system trillions of dollars when implemented
in a full Medicare for All system. The more limited leverage of a Medicare for
All option plan will accordingly limit its ability to achieve these savings –
but as more individuals join, this leverage will increase and costs will go
down. Provider reimbursement for this plan will start above current Medicare
rates for all providers, and be reduced every year as providers’ administrative
and delivery costs decrease until they begin to approach the targets in my
Medicare for All plan. The size of these adjustments will be governed by
overall plan size and the progress of provider adjustment to new, lower
Expand and Improve Existing Medicare for Everyone Over
50. In addition to the Medicare for All option, any person over the
age of 50 will be eligible for expanded coverage under the existing Medicare
program, whose infrastructure will allow it to absorb new beneficiaries more
quickly. The expanded Medicare program will be improved in the following
Benefits. To the greatest extent possible,
critical benefits like audio, vision, full dental coverage, and long-term care
benefits will be added to Medicare, and we will legislate full parity for
mental health and substance use services.
Eventual Free Coverage for Everyone. Identical
to the Medicare program, enrollees will pay premiums in Part B and D, with a
$300 cap on drug costs in Part D. Plugging a huge hole in the current Medicare
program, out-of-pocket costs will be capped at $1,500 per year across Parts A,
B, and D, eliminating deductibles and reducing cost sharing. In subsequent
years, premiums and cost sharing will gradually decrease to zero.
Employee Choice. Identical to the Medicare for
All option, workers 50-64 can opt into expanded Medicare, at which point their
employer will pay an appropriate fee to the government to maintain their
responsibility for providing employee coverage.
Reducing Drug Prices. The expanded Medicare
program will receive the ability to negotiate for prescription drugs using the
mechanisms I’ve previously outlined,
helping to drive down costs for patients. And we will create a publicly run
prescription drug plan that is benchmarked off the best current Part D
Automatic Enrollment. Every person without
health insurance over the age of 50 will be automatically enrolled in the
expanded existing Medicare program.
Provider Reimbursement and Cost Control. Provider
reimbursement for new beneficiaries will start above current Medicare rates for
all providers, and be reduced every year as providers’ administrative and
delivery costs decrease until they begin to approach the targets in my Medicare
for All plan. It will be a new condition of participation that providers who
take Medicare or other federally subsidized insurance also take the Medicare
for All option. We will also adopt common sense reforms to bring down bloated
reimbursement rates, including reforms around post-acute care, bundled
payments, and site neutral payments.
Improving the Affordable Care Act. My reforms
will also strengthen Affordable Care Act plans – including the new Medicare for
All option – by making the following changes:
Expand Tax Credit Eligibility. We will lift the
upper limit on eligibility for Premium Tax Credits, allowing people over 400%
of the federal poverty level to purchase subsidized coverage and greatly
increasing the number of people who receive subsidies.
Employee Choice. We will allow any person or
family to receive ACA tax credits and opt into ACA coverage, regardless of
whether they have an offer of employer coverage. If an individual currently
enrolled in qualifying employer coverage moves into an ACA plan, their employer
will pay an appropriate fee to the government to maintain their responsibility
for providing employee coverage.
Lower Costs. Right now, people may pay up to 9.86% of their
income before they get subsidies. Under my plan, this cap would be lowered –
and to make sure those tax credits cover more, we will benchmark them to more
generous “gold” plans in the Marketplace. And we will increase eligibility for
cost sharing reductions, ensuring that more individuals can get into an
affordable exchange plan immediately.
Eliminate the Penalty for Getting a Raise. Right
now, if someone’s income goes up, they can be forced to repay thousands of
dollars in back premiums. We will change this and base tax credits on the
previous year’s income. And if someone’s income goes down, they will get the
higher subsidy for that year.
State Single-Payer Innovation Waivers. To help
states try out different payer arrangements and pilot programs, we will allow
states to receive passthrough funding to expand or improve coverage via the
ACA’s Section 1332 waivers. Combined with Medicaid waivers, these changes will
allow interested states to start experimenting immediately with consolidating
public payers and move towards a single-payer system.
Additional Financing. My plan to pay for
Medicare for All identifies $20.5 trillion in new revenue, including an
Employer Medicare Contribution, which will cover the long-term, steady-state
cost of a fully functioning Medicare for All system. The cost of this
intermediate proposal will be lower. Any revenue needed to meet the
requirements of fast-track budget reconciliation will be enacted as part of
this legislation from the financing options that I have already proposed.
Additional Health System Reforms to Save Money and Lives
After pursuing administrative changes, expanding existing
Medicare, and creating a true Medicare for All option, every person in the
United States will be able to choose free or low-cost public insurance. Tens of
millions will likely do so. But we can’t stop there. We must pursue additional
reforms to our health system to save money and save lives. Some of my
Investing in Medical Miracles. Many medical
breakthroughs stem from federal investments in
science – but in 2018, 43,763 out of 54,834 research
project grant applications to the National Institutes of Health (NIH) were
rejected. We will boost medical research by investing an additional $100
billion in guaranteed, mandatory spending in the NIH over ten years, split
between basic science and the creation of a new National Institute for Drug
Development that will help take the basic research from the other parts of NIH
and turn it into real drugs that patients can use. We will prioritize
treatments that are uninteresting to big pharmaceutical companies but could
save millions of American dollars and lives. Any drugs that come out of this
research and to American consumers can be sold abroad, with the proceeds
reinvested to fund future breakthrough drug development. And by enacting my
Affordable Drug Manufacturing Act, the government can manufacture generic drugs
that are not available due to cost or shortage.
Ending the Opioid Epidemic. The opioid epidemic
is a public health emergency. In 2017, life expectancy in the United States
dropped for the third year in a row, driven in large part by deaths from drug
overdoses. We will enact my legislation, the CARE Act, to invest $100 billion
in federal funding over the next ten years in states and communities to fight
this crisis – providing resources directly to first responders, public health
departments, and communities on the front lines of this crisis.
Improved Administration. To cut down on time
wasted on paperwork, we will create single standardized forms for things like
prior authorizations and appeals processes to be used by all insurers (private
and public), and we will establish uniform medical billing for insurers and
All-Payer Claims Database. Right now, there are so
many middlemen in health care that no one knows for certain how much we pay for
different services across the whole system. A centralized repository of
de-identified claims data will help the government, researchers, and the market
better understand exactly what we pay for health care and what kind of quality
it gets us. Demystifying what we pay for what we get will be a critical part of
ensuring fair reimbursement under Medicare for All.
Antitrust Enforcement. In addition to
administrative actions to rein in anti-competitive hospital and electronic
medical record practices, we’ll also ban non-compete and no-poach agreements
and class action waivers across the board, while making it easier for private
parties to sue to prevent anti-competitive actions. I’ll work with states to
repeal Certificate of Public Advantage, or COPA, statutes
that shield health care
organizations from federal antitrust review and can lead to the
creation of large monopolies with little to no oversight. And I’ll also push to
ensure our antitrust laws apply to all health care mergers.
Ending Surprise Billing. Imagine being a woman
who schedules her baby’s delivery with her obstetrician at an in-network
hospital, but it turns out that the anesthesiologist administering the epidural
isn’t in-network. Even though she had no choice – and probably had no idea that
doctor was out-of-network – under the current system she gets hit with a huge
bill. We will end the practice of surprise billing by requiring that
services from out-of-network doctors within in-network hospitals, in addition
to ambulances or out-of-network hospitals during emergency care, be treated as
in-network and paid either prevailing in-network rates or 125% of the Medicare
reimbursement rate, whichever is lower.
Preventing Provider Shortages. With more people
seeking the care they need, it will be essential to increase the number of
providers. I will make these
critical investments in our clinicians, including by dramatically scaling up
apprenticeship programs to build a health care workforce rooted in the
community. I will lift the cap on residency placements, allowing 15,000 new
clinicians to enter the workforce. I will expand the National Health Service
Corps and Indian Health Service loan repayment program to allow more health
professionals – including physicians, physician assistants, registered nurses,
nurse practitioners, and other licensed practitioners – to practice in
underserved communities. I will also provide grants to states that expand
scope-of-practice to allow more non-physicians to practice primary care. And I
will push to close the
mental health provider gap in schools.
Completing the Transition to Medicare For All
By pursuing these changes, we will provide every person in
America with the option of choosing public coverage that matches the full
benefits of Medicare for All. Given the quality of the public alternatives,
millions are likely to move out of private insurance as quickly as
No later than my third year in office, at which point the
number of individuals voluntarily remaining in private insurance would likely
be quite low, I will fight to pass legislation to complete the transition to
the Medicare for All system defined by the Medicare for All Act by the end of
my first term in office.
Moving to this system would mean integrating everyone into a
unified system with zero premiums, copays, and deductibles. Senator Sanders’s
Medicare for All Act allows for supplemental private insurance to cover
services that are not duplicative of the coverage in Medicare for All; for
unions that seek specialized wraparound coverage and individuals with
specialized needs, a private market could still exist. In addition, we can
allow private employer coverage that reflects the outcome of a collective
bargaining agreement to be grandfathered into the new system to ensure that
these workers receive the full benefit of their bargain before moving to the
new system. But the point of Medicare for All is to cut out the middleman.
Every successful effort to move the United States to create
and expand new social programs – like Social Security and Medicare and Medicaid –
has required multiple steps. In fact, every credible Medicare for All proposal
has a significant, multi-step transition built in. That’s why it’s important to
have both short-term goals and long-term goals to guide the process and to
deliver concrete improvements to people’s lives at every stage.
I believe the next president must do everything she can
within one presidential term to complete the transition to Medicare for All. My
plan will reduce the financial and political power of the insurance companies –
as well as their ability to frighten the American people – by implementing
reforms immediately and demonstrating at each phase that true Medicare for All
coverage is better than their private options. I believe this approach gives us
our best chance to succeed.
Why do we need to transition to Medicare for All if a robust
Medicare for All option is available to everyone? The answer is simple and
blunt: cost and outcomes. Today, up to 30% of
current health spending is driven by the costs of filling out different
insurance forms and following different claims processes and fighting with
insurance companies over what is and is not covered. I have demonstrated how a
full Medicare for All system can use its leverage to wring trillions of dollars
in waste out of our system while delivering smarter care – and I’ve made clear exactly
how I would do it. The experience of other countries shows that this system is
the cheapest and most efficient way to deliver high-quality health care. As
long as duplicative private coverage exists, we will limit our ability to make
health care delivery more effective and affordable – and the ability of private
middlemen to abuse patients will remain.
Medicare for All will deliver an $11 trillion boost to
American families who will never pay another premium, co-pay, or deductible.
That’s like giving the average working family in America a $12,000 raise. This
final legislation will put a choice before Congress – maintain a two-tiered
system where private insurers can continue to profit from being the middlemen
between patients and doctors, getting rich by denying care – or give everybody
Medicare for All to capture the full value of trillions of dollars in savings
in health care spending. I believe that the American people will demand
Congress make the right choice.
Senator Elizabeth Warren, Democratic candidate for President, has released details of her most controversial proposal, Medicare for All, promising that it will cover every person in America with health care, including long-term care, vision and dental, without increasing taxes on middle class families. Warren focuses on an overall restructuring taxes and spending – going after the loopholes and tax cheats and reining in military spending as well as drug costs and cutting healthcare costs by removing the for-profit insurance companies (gatekeepers) as middlemen. What her plan misses, though, is the obvious: collect the Medicare tax (1.45%, plus an extra 0.9% on income over $200,000) on all income, not just wages, and, if necessary raise the surcharge for incomes over $250,000. Interestingly, while employers would no longer pick and choose the private health insurance they subsidize, employers would still subsidize their employees’ Medicare cost. Health care is considered the leading issue for voters in 2020. Here is the detailed plan, from the Warren campaign: –Karen Rubin/news-photos-features.com.
– Today, Senator Elizabeth
Warren, candidate for President, released her plan to finance Medicare for All.
The coverage is identical to the coverage in the Medicare for All legislation
in the Senate and it will cover every single person in America with excellent,
high-quality health care, including long-term care and vision and dental.
Elizabeth will pay
for this plan without raising taxes one penny on middle class families. Instead, she will put about $11
trillion in the pockets of American families by eliminating what they would pay
in premiums, deductibles, co-pays, and other out-of-pocket costs over the next
Her numbers add up and
are backed by experts including:
Simon Johnson, the
former Chief Economist at the International Monetary Fund and a professor at
Dr. Donald Berwick,
one of the nation’s top experts in health system management and improvement,
who ran the Medicare and Medicaid programs under President Barack Obama
Mark Zandi, Chief
Economist of Moody’s Analytics
former Chief Economist for the Obama Labor Department
Elizabeth’s plan to
dramatically improve health care and cut family costs would cost the United
States less than our current broken system. It would require $20.5 trillion in
new revenue, nearly half of which comes simply from having employers pay
Medicare instead of private insurance companies.
Elizabeth will finance
the remainder of Medicare for All with targeted defense spending cuts, new
taxes on financial firms, giant corporations, and the richest 1% of Americans,
and by cracking down on tax evasion and fraud. The $11 trillion in household
insurance and out-of-pocket expenses projected under our current system goes
right back into the pockets of America’s working people — substantially larger than the
largest tax cut in American history — and no middle class tax increases.
My daddy’s heart attack nearly sent our family skidding over
a financial cliff. Today I think about all the kids this year who will face the
double blow of nearly losing a parent and then watching their lives turn upside
down as their families struggle to pay a growing stack of medical
I spent my career studying why so many hard-working middle
class families were going broke. For years, my research partners and I traveled
the country from bankruptcy courtroom to bankruptcy courtroom, talking directly
to people who’d seen their lives turned upside down. We interviewed lawyers,
judges, and families involved in bankruptcy cases. To save on printing costs,
we lugged around a Xerox machine (I nicknamed him “R2-D2”) to save money on
photocopying court records.
Eventually, we built the largest and most comprehensive
database of consumer bankruptcy data ever assembled. That first study surprised
us: we found that 90% of families went bankrupt because of job loss, medical
problems, and marital disruption. That finding was confirmed in 2007 by my
later research, which found that the number one reason
families were going broke was health care – and three quarters of
those who declared bankruptcy after an illness were people who already had
It’s been nearly thirty years since we published that first
groundbreaking study. And after all that time, here’s where we are: between
2013 and 2016, the number one reason families
went broke was still because of health care – even though 91.2% of Americans
had health insurance in 2016.
Families are getting crushed by health costs. Just look at
how much an average family of four with employer-sponsored insurance personally
spent per year on employee premium contributions and out-of-pocket
costs in 2018. And this figure has increased each
87 million. That’s
how many American adults in 2018 were uninsured or “underinsured” – meaning
either they have no insurance or their so-called health insurance is like a car
with the engine missing. It looks fine sitting on the lot, but inadequate if
they actually need to use it. Nearly one in every
two adults not currently on Medicare has no insurance or unreliable insurance.
adults didn’t fill a prescription last year because of costs. 36 millionpeopleskipped
a recommended test, treatment, or follow-up because of costs. 40 millionpeople
didn’t go to a doctor to check out a health problem because of costs. 57 millionpeople
had trouble covering their medical bills.
Today, in 2019, in the United States of America, the
wealthiest nation in the history of the world, inadequate health coverage is
crushing the finances and ruining the lives of tens of millions of American
I’m running for President based on a radical idea – calling
out what’s broken and speaking plainly about how to fix it.
All my plans start with our shared values. There are two
absolute non-negotiables when it comes to health care:
One: No American should ever, ever die or go bankrupt
because of health care costs. No more GoFundMe campaigns to pay for care. No
more rationing insulin. No more choosing between medicine and groceries.
Two: Every American should be able to see the doctors they
need and get their recommended treatments, without having to figure out who is
in-network. No for-profit insurance company should be able to stop anyone from
seeing the expert or getting the treatment they need.
Health care is a human right, and we need a system that
reflects our values. That system is Medicare for All.
Let’s be clear: America’s medical professionals are among
the best in the world. Health care in America is world-class. Medicare for All
isn’t about changing any of that.
It’s about fixing what is broken – how we pay for that care.
And when it comes to health care, what’s broken is obvious.
A fractured system that allows private interests to profiteer off the health
crises of the American people. A system that crushes our families with costs
they can’t possibly bear, forcing tens of millions to go without coverage or
to choose between basic
necessities like food, rent, and health – or bankruptcy.
We must fix this system. And over the long-term, the best
way to achieve that goal is to move from the system we have now to a system of
Medicare for All.
Medicare for All is about where doctors, hospitals, and care
providers send the bill – to a collection of private insurance companies who make billions off
denying people care or to the Medicare program for fair compensation. Under
Medicare for All, everyone gets the care they need, when they need it, and
nobody goes broke.
A key step in winning the public debate over Medicare for
All will be explaining what this plan costs – and how to pay for it. This task
is made a hundred times harder by powerful health insurance and drug companies
that makebillions of dollars
off the current bloated, inadequate system – and would be perfectly happy to
leave things exactly the way they are.
In 2017 alone, health industry players whose profiteering
would end under Medicare for All unleashed more than 2,500 lobbyists on
Washington. These industries will spendfreely on shady TV
ads and lobbying to convince people that a program that saves them massive
sums of money will somehow cost them money.
That being able to see the doctors and get the treatments they need regardless
of what their employer or
their insurance company thinks
is somehow actually a loss of choice. That a program that covers more services,
more people, and costs the American people less than what we
currently spend on health care is somehow too expensive.
Meanwhile, where are the 2,500 lobbyists for the people who
get sick and can’t pay their medical bills? Where are the hundreds of
millions being spent so that people who are trying to balance a budget around
rising health care premiums and growing deductibles and copays can make their
voices heard in Washington? Washington hears plenty from the giant health
insurance and giant drug industries, but not so much from families being
squeezed to the breaking point.
So let’s focus on families’ expenses and families’ health
Start with the Medicare for All Act – which
I have cosponsored. The bill provides a detailed proposal for how to achieve
our end goal. But as economists and advocates have noted, the legislation
leaves open a number of key design decisions that will affect its overall cost,
and the bill does not directly incorporate specific revenue measures. While
much of this ambiguity results from the reasonable choice to delegate
significant implementation discretion to the Executive Branch, it has also
allowed opponents of
Medicare for All to make up their own price tags and try to scare middle class
families about the prospect of tax increases – despite the conclusions of expert after expert after expert that it is
possible to eventually move to a Medicare for All system that gives both high
quality coverage for everybody and dramatically lowers costs for middle class
The best way to fight misinformation is with facts. That’s
why today, I’m filling in the details and releasing a plan that describes how I
would implement the long-term policy prescriptions of the Medicare for
All Act and how to pay for it.
Under my plan, Medicare for All will cover the full list of
benefits outlined in the Medicare for All Act, including long-term
care, audio, vision, and dental benefits. My plan will cover every single
person in the U.S., and includes common-sense payment reforms that make
Medicare for All possible without spending any more money overall than we spend
My plan reflects careful, detailed analyses from key
national experts in health policy, tax policy, and economics. By filling in the
details, we can strip away all the misleading political attacks and make plain
the choice facing the American people:
Option 1: Maintain our current system, which will cost
the country $52 trillion over ten years. And under that current system
63 million have
coverage gaps or substandard coverage that could break down if they actually
get sick. And millions who have
health insurance will end up going broke at least in part from medical costs
Together, the American people will pay $11 trillion of
that bill themselves in the form of premiums, deductibles, copays,
out-of-network, and other expensive medical equipment and care they pay for
out-of-pocket – all while America’s wealthiest individuals and
biggest companies pay far
less in taxes than in other major countries.
Option 2: Switch to my approach to Medicare for All,
which would cost the country just under $52 trillion over ten
years. Under this new system –
Every person in America – all 331 million people
– will have full health coverage, and coverage for long-term care.
Everybody gets the doctors and the treatments they need,
when they need them. No more restrictive provider networks, no more insurance
companies denying coverage for prescribed treatments, and no more going broke
over medical bills.
The $11 trillion in
household insurance and out-of-pocket expenses projected under our current
system goes right back into the pockets of America’s working people. And we
make up the difference with targeted spending cuts, new taxes on giant corporations
and the richest 1% of Americans, and by cracking down on tax evasion and
fraud. Not one penny in middle-class tax increases.
That’s it. That’s the choice. A broken system that leaves
millions behind while costs keep going up and insurance companies keep sucking
billions of dollars in profits out of the system – or, for about the same
amount of money, a new system that drives down overall health costs and, on
average, relieves the typical middle class families of $12,400 in insurance
premiums and other related health care costs.
No middle class tax increases. $11 trillion in household
expenses back in the pockets of American families. That’s substantially larger than the
largest tax cut in American history.
Not every candidate for president supports moving to a
system of Medicare for All. Some who support Medicare for All will have
different ideas about how to finance and structure it. And everybody knows that
there must be a real transition. But you don’t get what you don’t fight for –
and my view is clear.
Every candidate who opposes my long-term goal of Medicare
for All should explain why the “choice” of private insurance plans is
more important than being able to choose the doctor that’s best for you without
worrying about whether they are in-network or not. Why it’s more important than
being able to choose the right prescription drug for you without worrying about
massive differences in copays. Why it’s more important than being able to
choose to start a small business or choose the job you want without worrying
about where your health care coverage will be coming from and how much it will
Every candidate who opposes my long-term goal of Medicare
for All should put forward their own plan to cover everyone, without costing
the country anything more in health care spending, and while putting $11
trillion back in the pockets of the American people by eliminating premiums and
virtually eliminating out-of-pocket costs. Or, if they are unwilling to do
that, they should concede that they think it’s more important to protect the
eye-popping profits of private insurers and drug companies and the immense
fortunes of the top 1% and giant corporations, rather than provide
transformative financial relief for hundreds of millions of American
And every candidate who opposes my long-term goal of
Medicare for All should put forward their own plan to make sure every single
person in America can get high-quality health care and won’t go broke – and
fully explain how they intend to pay for it. Or, if they are unwilling to do
that, concede that their half-measures will leave millions behind.
And make no mistake – any candidate who opposes my long-term
goal of Medicare for All and refuses to answer these questions directly should
concede that they have no real strategy for helping the American people address
the crushing costs of health care in this country. We need plans, not
THE COST OF MEDICARE FOR ALL
A serious conversation about how to pay for Medicare for All
requires, first, determining how much such a system would cost.
In recent years, several economists and think tanks have
attempted to estimate the cost of a single-payer system in the United States.
Those estimates consider how much our nation’s health care spending will change
over a ten year window, and range from a $12.5 trillion decrease
to a $7 trillion increase.
They also consider how much additional money the federal government would need
to fund this system, and those estimates range from a low of $13.5 trillion to a
high of $34 trillion over
Because nobody can actually see the future, some of this
variation results from different assumptions about how parts of our health care
system might work differently under Medicare for All. But most of the
difference comes from policy choices. And while the Medicare for All
Act is clear about some of these choices – for example, generous
benefits, long-term care coverage, and virtually no out-of-pocket expenses – it
is silent on a number of really important ones. How much will we pay for
medical care and for prescription drugs? What do we do with the existing money
that states spend on Medicaid? How aggressively will we cut administrative
costs? Aggressive choices mean a lower total cost. Less aggressive choices
result in a higher total cost.
Serious candidates for president should speak plainly about
these issues and set out their plans for cost control – especially those who
are skeptical of Medicare for All. Because whether or not we make modest or
transformative changes to our health care system, cancer, diabetes, strokes,
Alzheimer’s, and Parkinson’s aren’t going to simply disappear. And without
leadership from the top, neither will the mushrooming cost of care in America
that’s bankrupting our families.
I’ve asked top experts to consider the long-term cost of my
plan to implement Medicare for All over ten years – Dr. Donald Berwick, one of
the nation’s top experts in health system improvement and who ran the Medicare
and Medicaid programs under President Obama; and Simon Johnson, the former
Chief Economist at the International Monetary Fund and a professor at MIT.
Their analysis begins with the assumptions of a recent study by the Urban
Institute and then examines how that cost estimate would change as certain new
key policy choices are applied. These experts conclude that my plan would slightly
reduce the projected amount of money that the United States would otherwise
spend on health care over the next 10 years, while covering everyone and giving
them vastly better coverage.
REDUCING INSURER ADMINISTRATIVE COSTS
The business model of private insurers is straightforward:
pay out less for medical care than they take in as premiums. This model is
located right in the center of our health care system, wasting huge amounts of
time and money documenting and arguing over who is owed what. Incredibly,
insurance companies spend a whopping $350 billion on
administration costs annually—and then, in turn, push huge additional
administrative costs onto hospitals, doctors, and millions of other health care
professionals in the from of complex billing—and then, in turn, drive up costs
incurred by employers as they attempt to navigate the complexity of providing
their employees with insurance.
Medicare for All will save money by bringing down the
staggering administrative costs for insurers in our current system. As the
experts I asked to evaluate my plan noted, private insurers had administrative
costs of 12% of premiums collected in 2017, while Medicare kept its
administrative costs down to 2.3%. My plan will ensure that Medicare for All
functions just as efficiently as traditional Medicare by setting net
administrative spending at 2.3%.
COMPREHENSIVE PAYMENT REFORM
In 2016, the United States spent nearly twice as
much on health care as ten high-income countries, and these costs have
been steadily rising for
decades, growing from 5.2%
of U.S. GDP in 1963 to 17.9% in 2017. But
instead of resulting in better health outcomes, Americans have the lowest
life expectancy of residents in high-income countries, the highest infant
mortality rate, and the highest obesity rates.
Why? As a group of health economists famously wrote, “It’s the prices,
Studieshave continued to
show that it’s not how much people use the health care system, often referred
to as “utilization,” but rather how much people pay that drives our high spending.
Compared to other high income countries, Americans simply pay more for health
care. We pay more for physicians and nurses. We pay more in administrative
costs. We pay more for prescription drugs.
A heart bypass surgery that costs nearly
$16,000 in the Netherlands costs an average of $75,000 in the United States. A
CT scan that costs $97 in Canada
costs an average of $896 here. And in the United States, hospitals can charge new parents
for holding their newborn after delivery.
Meanwhile, private equity firms fight bipartisan
legislation in Washington that might undermine the profitability of their
investments or prevent their hospitals from sending patients surprise bills.
And health care CEO salaries continue to soar. Between 2005 and 2015,
non-profit hospital CEO salaries increased by 93% to
an average of over $3 million, and last year, 62 health care CEOs raked in a
combined $1.1 billion – more
than the CDC spent on chronic disease prevention.
If we expect the American people to be able to afford health
care, we need to rein in these costs. Comprehensive payment reform, as part of
Medicare for All, will reduce this component of health care spending. Under my
approach, Medicare for All will sharply reduce administrative spending
and reimburse physicians and other non-hospital providers at current Medicare
rates. My plan will also rebalance rates in a budget neutral way that
increases reimbursements for primary care providers and lowers reimbursements
for overpaid specialties.
While private insurance companies pay higher rates, this system would be
expected to continue compensating providers at roughly the same overall rate
that they are currently receiving. Why? This is partially because providers
will now get paid Medicare rates for their Medicaid patients – a substantial
raise. But it’s also because providers spend an enormous amount of time on
billing and interacting with insurance companies that reduces their efficiency
and takes away from time with patients. Some estimate that hospitals will spend $210 billion on
average annually on these costs.
The nonpartisan Institute of Medicine estimates that
these wasted expenses account
for 13% of the revenue for physician practices, 8.5% for hospitals, and 10% for
other providers. Together, the improved efficiency will save doctors time and
money – helping significantly offset the revenue they will lose from
getting rid of higher private insurance rates.
Under my approach, Medicare for All will sharply
reduce administrative spending and reimburse hospitals at an average of 110% of
current Medicare rates, with appropriate adjustments for rural hospitals,
teaching hospitals, and other care providers with challenging cost structures.
In 2017, hospitals that treated Medicare patients were paid about 9.9% less than
what it cost to care for that patient. The increase I am proposing under
Medicare for All will cover hospitals’ current costs of care – but hospital
costs will also substantially decrease as a result of simpler administrative
processes, lower prescription drug prices, the end of bad debt from
uncompensated care, and more patients with insurance seeking care.
Of course, as Medicare currently recognizes,
not every provider situation is the same, and my Medicare for All program
maintains these base rate adjustments for geography and other factors. In
my plan for Rural
America, for example, I have committed to creating a new designation under
Medicare for rural hospitals due to the unique challenges health systems face
in rural communities. That’s why my plan allows for adjustments above the 110%
average rate for certain hospitals, like rural and teaching hospitals, and
below this amount for hospitals that are already doing fine with current
Medicare rates.Universal coverage will also have a
disproportionately positive effect on rural hospitals. Because people living in
rural counties are more likely to be
uninsured than people living in urban counties, these hospitals currently
provide a lot of uncompensated care. Medicare for All fixes that problem. And
I’ve previously laid out additional
investments to increase the number of Community Health Centers and grow our
health care workforce in rural and Native American communities, while cracking
down on anti-competitive mergers that lead to worse outcomes and higher costs
for rural communities.
We can also apply a number of common-sense, bipartisan
reforms that have been proposed for Medicare. Today, for example, insurers can
charge dramatically different prices for the exact same service based on where the service was
performed. Under Medicare for All, providers will receive the same
amount for the same procedure, saving hundreds of billions of dollars. We can
also make adjustments to things that we know Medicare currently pays too much
for – like post-acute care – by adjusting those payments down slightly while
accounting for the patient’s health status, bringing health care costs down
We will also shift payment rates so that we are paying for
better outcomes, instead of simply reimbursing for more services. We build on
the success of value-based reforms enabled by the Affordable Care Act,
including by instituting bundled payments for inpatient care and for 90 days of
post-acute care. Instead of paying providers for each individual service,
bundled payments reimburse providers for an entire “episode” of care and have
been shown to both improve outcomes and control costs. These
bundles help ensure that a patient’s different providers all communicate because
they are all tied to the same payment.
RESTORING HEALTH CARE COMPETITION
Health care consolidation has also contributed to
rising health care costs. One analysis found that over 90% of
metropolitan areas had health care provider markets that were either highly
concentrated or super concentrated in 2016. And despite the same kinds of empty
promises we see every time there’s industry consolidation – in this case, that
bigger hospitals would lead to better care – the data have not borne
this out. In fact, it’s theopposite: more
competition between providers creates incentives to improve care, and that
incentive will only increase under a
Medicare for All system where quality, not price, is the main differentiator in
Under Medicare for All, hospitals won’t be able to force
some patients to pay more because the hospital can’t agree with their insurance
company. Instead, because everyone has good insurance, providers will have to
compete on better care and reduced wait times in order to attract more
That’s why I will appoint aggressive antitrust enforcers to
the Department of Justice and Federal Trade Commission and allow hospitals to
voluntarily divest holdings to restore competition to hospital markets. I’ve
also previously committed to
strengthening FTC oversight over health care organizations, including
non-profit hospitals, to crack down on anti-competitive behavior. And I will
direct my FTC to block all future hospital mergers unless the merging companies
can prove that the newly-merged entity will maintain or improve care.
REINING IN OUT-OF-CONTROL PRESCRIPTION DRUG COSTS
Americans pay more for prescription drugs than anyone in the
world – $333 billion in
2017 alone. Americans spent $1,220 per person on
average for prescription drugs, while the next highest spending country,
Switzerland, spent $963 per person. That’s not because Americans use more
prescription medication – it’s because lax laws have allowed pharmaceutical
companies to charge insurance companies and patients exorbitant rates. In a
now-infamous example, when Turing Pharmaceuticals purchased the rights to the
HIV medication Daraprim, the company raised the price of
this life-saving drug from $13.50 per pill to a stunning $750 per tablet overnight.
The price of insulin has skyrocketed, forcing
people to risk their lives by rationing. And as prices continue to rise, more
Americans are turning to Canada in
search of affordable prices.
Reining in prescription drug costs should be a top priority
for any President – and there’s no better way to do it than through Medicare
for All. My administration will use a suite of aggressive policy tools to set a
net savings target that will bring down Medicare prices for brand name
prescription drugs by 70% and prices for generics by 30%, with an initial focus
on more expensive drugs.
Under Medicare for All, the federal government would have
real bargaining power to negotiate lower prices for patients. I will adopt an
altered version of the mechanism outlined in the Lower Prescription
Drug Costs Now Act which leverages excise taxes to bring manufacturers
to the table to negotiate prices for both branded and generic drugs, with no
drug exceeding 110% of the average international market price, but removes the
limit of the number of drugs Medicare can negotiate for and eliminates the
“target price” so Medicare could potentially negotiate prices lower than other
If negotiations fail, I will use two tools – compulsory
licensing and public manufacturing – to allow my administration to ensure
patient access to medicines by either overriding the patent, as modeled in
the Medicare Negotiation and Competitive Licensing Act, or by
providing public funds to support manufacturing of these drugs, as modeled in
my Affordable Drug Manufacturing Act. Medicare for All will also
incentivize pharmaceutical companies to develop the drugs we need – like
antibiotics, cancer cures, and vaccines. And it’s not just about driving down
drug prices. Making sure patients get important drug therapies up front that
keep them healthy and cost a fraction compared to more severe treatment down
the line can save money overall. Insurers, who may only cover individuals for a
few years of their lives, see those investments in long-term health as a cost
they’ll never recoup – so they have a financial incentive to deny patients these
treatments. But Medicare for All covers each patient for their entire lifespan.
There’s no perverse incentive to deny the prescriptions they need today because
the long-term benefits to their health won’t benefit their current private
STEMMING THE GROWTH OF MEDICAL COSTS
Year after year, U.S. health spending has grown at rates
above GDP growth, reaching a whopping 17.9% of GDP in
2017. Experts believe the changes to prescription drug spending and value-based
payment systems that I’ve already outlined will bring growth rates in line with
U.S. GDP, which CBO projects to be an average of 3.9% for
the next decade. And if growth rates exceed this rate, I will use available
policy tools, which include global budgets, population-based budgets, and
automatic rate reductions, to bring it back into line.
REDIRECTING TAXPAYER-FUNDED HEALTH SPENDING
Through Medicaid and public health plans for state
employees, state and local governments play a significant role in financing
health care coverage in America. Under my approach to Medicare for All, we will
redirect $6 trillion in existing state and local government insurance spending
into the Medicare for All system. This is similar to the mechanism that the
George W. Bush Administration used to redirect Medicaid spending to the federal
government under the Medicare prescription drug program.Under this
maintenance-of-effort requirement, state and local governments will redirect
$3.3 trillion of what they currently spend to support Medicaid and the
Children’s Health Insurance Program and $2.7 trillion of what they currently
spend on employer contributions to private insurance premiums for their
employees into Medicare for All. Because we bring down the growth rate of
overall health spending, states will pay less than they would have without
Medicare for All. They’ll also have far more predictable budgets, resulting in
improved long-term planning for state and community priorities.
Together, these policy choices represent significant
reductions in health care spending over current levels. Compared to the
estimate by the Urban Institute, they will save over $7 trillion over ten
years, bringing the expected share of additional federal revenue to just over
$26 trillion for that period. After incorporating the $6 trillion we will
redirect from states to help fund Medicare, the experts conclude that total
new federal spending required to enact Medicare for All will be $20.5 trillion.
PAYING FOR MEDICARE FOR ALL
Medicare for All puts all health care spending on the
government’s books. But Medicare for All is about the same price as our current
path – and cheaper over time. That means the debate isn’t really about
whether the United States should pay more or less. It’s about who should
Right now, America’s total bill for health care is projected
to be $52 trillion for the next ten years. That money will come from four
places: the federal government, state governments, employers, and individuals
who need care. Under my approach to Medicare for All, most of these funding
sources will remain the same, too.
Existing federal spending on Medicare and Medicaid will help
fund Medicare for All.
Existing state spending on health insurance will continue in
the form of payments to Medicare – but states would be better off because
they’d have more long-term predictability, and they’d pay less over time
because these costs will grow more slowly than they do today.
Existing total private sector employer contributions to
health insurance will continue in the form of contributions to Medicare – but
employers would be better off because under the design of my plan, they’d pay
less than they would have otherwise.
Here’s the main difference: Individual health care
Over the next ten years, individuals will spend $11 trillion
on health care in the form of premiums, deductibles, copays, and out-of-pocket
costs. Under my Medicare for All plan, that amount will drop from $11
trillion to practically zero.
I asked top experts – Mark Zandi, the Chief Economist of
Moody’s Analytics; Betsey Stevenson, the former Chief Economist for the Obama
Labor Department; and Simon Johnson – to examine options for how we can make up
that $11 trillion difference. They conclude that it
can be done largely with new taxes on financial firms, giant corporations, and
the top 1% – and making sure the rich stop evading the taxes we already have.
That’s right: We don’t need to raise taxes on the
middle class by one penny to finance Medicare for All.
Here’s how it would work.
REPLACING EMPLOYER HEALTH SPENDING WITH A NEW EMPLOYER
Let’s start with a basic fact: American companies are
already paying a lot for health care for their employees. They are projected to
pay nearly $9 trillion over the next ten years, mostly on employer
contributions for employee health insurance and on health-related expenses for
employees under workers’ compensation and long-term disability. My idea is that
instead of these companies sending those payments to private insurance
companies, they would send payments to the federal government for Medicare in
the form of an Employer Medicare Contribution.
In fact, it’ll be a better deal than what they have
now: companies will pay less than they otherwise would have, saving
$200 billion over the next ten years.
To calculate their new Employer Medicare Contribution,
employers would determine what they spent on health care over the last few
years and divide that by the number of employees of the company in those years
to arrive at an average health care cost per employee at the company.
(Companies would count part-time employees towards the total based on the
number of hours they worked during a year.) Under the first year of Medicare
for All, employers would then take that average cost, adjust it upwards to
account for the overall increase in national health care spending, and multiply
it by their total number of employees that year. Their Employer Medicare
Contribution would be 98% of that amount – ensuring that every company
paying for health care today will pay less than they would have if they were
still offering their employees comparable private insurance.
A similar calculation would apply to pass-through entities,
like law firms or private equity funds, even though many of the people that
work there technically aren’t employees. People who are self-employed would be
exempt from making Employer Medicare Contributions unless they exceed an income
Small businesses – companies with under 50 employees – would
be exempt from this requirement too if they aren’t paying for employee health
care today. When either new or existing firms exceed this employee threshold,
we would phase in a requirement that companies make Employer Medicare Contributions
equal to the national average cost of health care per employee for every
employee at that company. Merging firms would pay the weighted average cost of
health care per employee of the two firms that are merging.
Employers currently offering health benefits under a
collective bargaining agreement will be able to reduce their Employer Medicare
Contribution if they pass along those savings to workers in the form of
increased wages, pensions, or other collectively-bargained benefits. New
companies or existing companies who enter into a collective bargaining
agreement with their employees after the enactment of Medicare for All will be
able to reduce their Employer Medicare Contributions in the same way. Employers
can reduce their contribution requirements all the way down to the national
average health care cost per employee.
That way, my plan helps unions that have bargained
for good health care already, and creates a significant new incentive for
unionization generally by making collective bargaining appealing for both
workers and employers as a way of potentially reducing the employer’s Employer
Over time, an employer’s health care cost-per-employee would
be gradually shifted to converge at the average health care cost-per-employee
nationally. That helps make sure the system is fair but also gives
employers and employees time to adapt to the new system.
If we’re falling short of the $8.8 trillion revenue target
for the next ten years, we will make up lost revenue with a Supplemental
Employer Medicare Contribution requirement for big companies with extremely
high executive compensation and stock buyback rates.
There are a variety of ways to structure an employer
contribution to Medicare for All. This particular approach has the benefit of
helping American employers in a few ways:
Employers would collectively save $200 billion over the next
Employers receive far more certainty about how their health
care costs will vary over time and affect their finances.
Small businesses – who often suffer when competing for
employees because they can’t afford to
offer health care coverage – would no longer be at a competitive disadvantage
against bigger businesses.
Employers can reduce their Employer Medicare Contribution by
supporting unionization efforts and negotiating with workers to provide better
wages and benefits – reducing costs and promoting collective bargaining at the
Because my plan holds health care cost growth to GDP levels,
businesses will have stable balance sheets that grow with the economy instead
of crowding out other priorities.
By asking employers to pay a little less than what they
are already projected to pay for health care, we can get almost halfway to
where we need to go to cover the cost of my Medicare for All plan.
Automatic Increases in Take-Home Pay
Medicare for All puts a whole lot of money back in the
American people’s pockets. One way it does that is by taking the share of
premiums employees are responsible for paying through employer-sponsored
insurance – that line on pay stubs each week or month that says “health
insurance” – and returning it to working people. Congratulations on the
And higher take-home pay for workers also means additional
tax revenue just from applying our existing taxes – approximately $1.15
trillion if we apply average effective tax rates.
Medicare for All saves people money in other ways too. With
Medicare for All, nobody would need to put money in Health Savings Accounts or
medical savings accounts to try and protect themselves against the unthinkable.
And because individual spending on premiums, deductibles, copays, and
out-of-pocket costs will basically disappear, the tax break for medical
expenses in excess of 10% of Adjusted Gross Income becomes irrelevant.
Together, those changes would generate another
$250 billion in revenue.
All told, another $1.4 trillion in funding for Medicare for
All is generated automatically through existing taxes on the enormous amount of
money that will now be returned to individuals’ pockets from moving to a
Medicare for All system with virtually no individual spending on health
Here’s what that means: we can generate almost half
of what we need to cover Medicare for All just by asking employers to pay
slightly less than what they are projected to pay today, and through existing
So where does the rest of the money come from that allows us
to eliminate premiums, deductibles, copays, and most out-of-pocket spending for
every American? Four sources: (1) better enforcement of our existing tax laws
so we stop letting people evade their tax obligations; (2) targeted taxes on
the financial sector, large corporations, and the top 1% of individuals; (3) my
approach to immigration; and (4) shutting down a slush fund for defense
CRACKING DOWN ON TAX EVASION AND FRAUD
The federal government has a nearly 15% “tax gap”
between what it collects in taxes what is actually owed because of systematic
under-enforcement of our tax laws, tax evasion, and fraud. If that 15% gap
persists for the next ten years, we will collect a whopping $7.7 trillion less in
federal taxes than the law requires. By investing in stronger
enforcement and adopting best practices on tax reporting, withholding, and
filing, experts predict that we can close the tax gap by a third – generating
about $2.3 trillion in additional federal revenue without a single new
A big part of our current tax gap problem is that we’re letting
wealthier taxpayers get away with paying less than what they owe. Studies show that the
wealthiest 5% of taxpayers misrepresent their income more frequently than the
The wealthy and their allies in Washington have worked
to slash the IRS
budget, leaving it without the resources it needs. The agency today has about the
same number of revenue agents as it did when the economy was one-seventh its
current size in the 1950s. And the IRS insists on targeting low-income
taxpayers rather than wealthy ones, even though the amount of revenue we can
recover from wealthy taxpayers is far more.
We know how to fix this problem. We can draw lessons from
what works in other countries with much lower tax gaps and rely on the
recommendations of tax experts. Here’s a game plan:
Substantially increase funding for the IRS, including the
Criminal Investigation Division. The Treasury Department estimated in its
Fiscal Year 2017 budget request that every $1 invested in IRS enforcement
brings in nearly $6 in additional revenue – not even including an indirect
deterrence effect three times that amount.
Expand third-party reporting and withholding requirements.
Research shows that third-party reporting and withholding cuts down on the
tax misreporting rate substantially.
Strengthen enforcement of the Foreign Account Tax Compliance
Act (FATCA). FATCA requires foreign financial institutions to report the
holdings and income of U.S. taxpayers, but the IRS is generally not systematically matching these
reports to individual tax returns. We also don’t hold foreign financial firms
truly accountable for ignoring their reporting obligations. Automatically
matching FATCA reports to tax returns and instituting sanctions for
non-compliant foreign financial institutions would help narrow the tax gap.
Increase the nonfiler compliance program, strengthen
reporting requirements for international income, use existing currency
transaction reports to enforce cash income compliance, and increase reporting
requirements for virtual- or crypto-currencies, as suggested by the
Treasury Department’s Inspector General.
Allow employees who
disclose tax evasion and abuse to use the protections of the False Claims Act
and other whistleblower protections.
The experts who reviewed these ideas estimated that if we
implemented them, we could close the tax gap by one-third from 15% to 10%,
bringing us closer to the tax gap in countries like the United Kingdom (5.6%). That will
produce another $2.3 trillion in net federal revenue – without imposing a
single new tax.
TARGETED TAXES ON THE FINANCIAL SECTOR, LARGE
CORPORATIONS, AND THE TOP 1%
We can generate a whole lot of the remaining revenue we need
for Medicare for All just by eliminating bad incentives in our current tax
system and asking those who have done really well in the last few decades to
pay their fair share.
Let’s start with the financial sector. It’s been more than
ten years since the 2008 financial crisis, and while a lot of families
are still dealing with
the aftereffects, the financial sector is making record, eye-popping profits.
Meanwhile, the risk of another financial crisis remains unacceptably high. By
imposing targeted taxes and fees on financial firms, we can generate needed
revenue and also make our financial system safer and more secure.
For example, a small tax on financial transactions –
one-tenth of one percent on the sale of bonds, stocks, or derivatives – would
generate about $800 billion in
revenue over the next ten years. The tax would be assessed on and
collected from financial firms, and would likely have little to no effect on
most investors. Instead, according to experts, the tax could
help decrease what Americans pay in fees for their investments and reduce the
size of relatively unproductive parts of the financial sector.
We can also impose a fee on big banks that encourages them
to take on fewer liabilities and reduce the risk they pose to the financial
system. A small fee that applies only to the forty or so largest banks in the
country would generate an additional $100 billion over
the next ten years – while making our financial system more safe and
Next, we can make some basic changes to ensure that large
corporations pay their fair share and to fix some fundamental problems with our
current approach that actually encourage companies to shift jobs and investment
overseas. These changes will generate an estimated $2.9 trillion over
the next ten years.
For instance, our current tax system lets companies deduct
the cost of certain investments they make in assets faster than those assets
actually lose value. That means that if a company buys a machine for a million
dollars, it gets to deduct a million dollars from its taxes that same year –
even if the machine only loses $100,000 in value a year. Letting the company
write off the extra $900,000 all at once is like giving them an interest-free loan from
That might be worth it if the company responded to this tax
break by investing more and building out their businesses. But the datasuggest this isn’t
happening because companies don’t actually value these tax deferrals as much as
policymakers assume. Companies are mostly making the same investments they
would’ve made anyways – sometimes with small changes in timing – and getting a
write-off in exchange. Some experts even suggest that
accelerated expensing could induce less domestic investment,
That’s why I’m proposing to get rid of this loophole. Under
my plan, businesses will still write off the depreciation of their assets –
they’ll just do it in a way that more accurately reflects the actual loss in
value. This would generate $1.25 trillion over
We can also stop giant multinational corporations from
calling themselves American companies while sheltering their profits in foreign
tax havens to avoid paying their share for American investments.
Currently, a U.S. multinational corporation can make
billions in profits and attribute it to a company it set up in a tax haven like
the Cayman Islands, which has no corporate taxes. The Trump tax bill claimed to
address that problem by creating a global minimum tax rate for corporations,
but that minimum tax – the result of heavy lobbying by
multinationals – is too low and easily gamed. While Trump and congressional
Republicans claimed their
minimum tax would keep companies from shifting profits to tax havens and limit
offshoring, the opposite is happening. The current
approach bothencourages companies
to shift their profits to tax havens and actually incentivizes American
companies to outsource their operations overseas.
That’s why I’m proposing to institute a country-by-country minimum
tax on foreign earnings of 35% – equal to a restored top corporate tax rate for
U.S. firms – without permitting corporations to defer those payments. Under
my plan, corporations would have to pay the difference between the minimum tax
and the rate in the countries where they book their profits. For example, an
American corporation booking a billion dollars in profits in the Cayman
Islands, taxed at 0% there, would need to pay the federal government a 35% tax
rate – the difference between the new minimum rate (35%) and the foreign rate
(0%) – on the billion dollars in profits.
My plan would also collect America’s fair share of profits
that foreign companies make by selling their products to Americans. Today, we
have a “global tax deficit”: companies that sell their goods abroad don’t have
to pay the extra taxes that they would have to pay if they were subject to a
minimum effective tax rate in each country they operated in. Making U.S. firms
pay a country-by-country minimum tax effectively collects their whole global
tax deficit – but foreign companies should have to pay their fair share, too.
That’s why I’m proposing that the U.S. collect the fraction of this global tax
deficit that corresponds to the percentage of that company’s sales in the U.S.
In other words, if a foreign company should owe an additional $1 billion in
taxes if it were subject to a country-by-country minimum tax, the U.S. would
collect a fraction of that $1 billion based on the amount of sales that company
made in the United States.
Together, the country-by-country minimum tax and the
taxation of foreign firms based on their domestic sales would result in an
additional $1.65 trillion in
Finally, we can raise another $3 trillion over ten years by
asking the top 1% of households in America to pay a little more.
The tax burden on ultra-millionaires and billionaires is
less than half that of working families in the United States. In 2019, the
bottom 99% of families will pay 7.2% of their wealth
in taxes, while the top 0.1% of households will pay just 3.2%. My Ultra-Millionaire Tax, a
2-cent tax on the wealth of fortunes above $50 million, tackles this head on.
Under this tax, the top 0.1% – the wealthiest 75,000 Americans – would have to
pitch in two cents for every dollar of net worth above $50 million and three
cents for every dollar on net worth over $1 billion. With this version of the
Ultra-Millionaire Tax in place, the tax burden on the wealthiest households
would increase from 3.2% to 4.3% of total
wealth – better, but still below the 7.2% that the bottom 99% are projected to
Today, I’m going one step further. By asking
billionaires to pitch in six cents on each dollar of net worth above $1
billion, we can raise an additional $1 trillion in revenue and further close
the gap between what middle-class families pay as a percentage of their wealth
and what the top one-tenth of one percent pay.
Yes, billionaires will have to pay a little more, but they
will still likely pay less than what they would earn just from putting their
assets into an index fund and doing nothing. The average annual rate of return
of the S&P 500 has regularly topped 10%. And billionaires
have access to the kinds of fancy investment opportunities that can generate
even higher returns on average. Put it this way – should we ask billionaires to
pitch in an extra three cents on every dollar above $1 billion, or force
middle-class families to bear another $1 trillion in health care costs?
We can also change the way the government taxes investment
income for the top 1%. Today, taxes are only assessed on capital gains when securities are sold.
That means wealthy investors can put their money in the stock market, see it
grow, and not pay a dime in
taxes on those earnings unless or until it is taken out of the market. Under
the current system, they can then pass along those shares to their heirs when
they die and their heirs will be able to pay even less when
they choose to sell.
I’ve already proposed closing that loophole for how capital
gains are treated when shares are passed on to heirs. But we can go a step
further. Under a “mark-to-market” system for
the wealthiest 1% of households, we will tax capital gains income (excluding
retirement accounts) annually, rather than at the time of sale, and raise the
rates on capital gains to match the tax rates for labor income. Individuals
would still only pay taxes on gains and could use current losses to offset
Under this system, investment income will no longer be
treated differently than labor income for the top 1% of households.
Ultra-millionaires and billionaires won’t be able to earn income on giant
fortunes year after year without paying a penny in taxes. Andwe
can raise another $2 trillion over
ten years to pay for my Medicare for All plan.
I support immigration reform that’s consistent with our
values, including a pathway to citizenship for undocumented immigrants and
expanded legal immigration consistent with my principles. That’s not only the
right thing to do – it also increases federal revenue we can dedicate to
Medicare for All as new people come into the system and pay taxes. Based on
CBO’s analysis of the 2013 comprehensive immigration reform bill, experts
project that immigration reform would generate an additional $400 billion in
direct federal revenue.
REINING IN DEFENSE SPENDING
Since the attacks of 9/11, the United States has
appropriated $2 trillion to fund
combat and counterterrorism operations around the world via the Overseas
Contingency Operations fund, or OCO. On average this spending has amounted
to $116 billion per
year – and in total, an amount equivalent to nearly 10 percent of all
federal discretionary spending over that same time period.
including the President’s current Chief of Staff – and Democrats alike
agree that OCO is a budget gimmick that masks the true impact of war spending.
The emergency supplemental funding mechanism was never intended to fund the
costs of long-scale, long-term operations outside of the normal appropriations
process. And in recent years, OCO has also been used to fund so-called “base”
requirements unrelated to the wars, outside of the Budget Control Act caps – in
effect acting as a slush fund for increased Pentagon spending. And as
everything from more F-35s to massive bombs never
used in combat have migrated into the OCO account, the Department of Defense
has been spared from having to prioritize or live
within its means. It’s not just bad budgetary practice – it’s wasteful
I’ve called out this
slush fund for what it is. I’ve also called for an end to endless
combat engagements in places like Afghanistan, Iraq, and Syria, and to
responsibly bring our combat troops home from these nations. These open-ended
commitments are not necessary to advance American foreign policy or
counterterrorism interests, their human cost has been staggering, and their
financial cost has created a drag on our economy by diverting money better
invested in critical domestic priorities.
I’ve also called to reduce defense spending overall.
The Pentagon budget will cost more this year than
everything else in the discretionary budget put together. That’s wrong, and
it’s unsustainable. We need to identify which programs actually benefit American
security in the 21st century, and which programs merely line the pockets of
defense contractors – then pull out a sharp knife and make some cuts.
As I have said repeatedly, under my Medicare for All plan,
costs will go up for the very wealthy and big corporations, and costs will go
down for middle-class families. I will not sign a bill that violates these
commitments. And as my plan to pay for Medicare for All makes clear, we can
meet these commitments without a tax increase on the middle class – and, in
fact, without any increase in income taxes at all.
America’s middle class is facing a crisis. For a generation,
wages have remained largely flat while family costs have exploded. I’ve spent
decades sounding the alarm about it. I’m running for President to fix it. That
means doing whatever we can to reduce the overall strain on family budgets.
Medicare for All can be a huge part of the solution. When
fully implemented, my approach to Medicare for All would mark one of the
greatest federal expansions of middle class wealth in our history. And
if Medicare for All can be financed without any new taxes on the middle class,
and instead by asking giant corporations, the wealthy, and the well-connected
to pay their fair share, that’s exactly what we should do.
ACHIEVING MEDICARE FOR ALL
Of course, moving to this kind of system will not be easy and
will not happen overnight. This is why every serious proposal for Medicare for
All contemplates a significant transition period.
In the weeks ahead, I will propose a transition plan that
will specifically address how I would use this time to begin providing
immediate financial relief to struggling families, rein in out-of-control
health care costs, increase coverage, and save lives. My transition plan will
take seriously and address substantively the concerns of unions, individuals
with private insurance, hospitals, people who work for private health insurers,
and medical professionals who worry about what a new system will mean for them.
It will also grapple directly with the entrenched political and economic
interests that would spend freely, as they havethroughout modern
American history, to influence politicians and
try to frighten the
American people into rejecting a plan that would save them thousands of dollars a year on
premiums and deductibles while making sure they can always see the health care
providers they need with false claims and scare tactics.
But there’s a reason former President Barack Obama has called Medicare for
All a good idea. There’s a reason the American people support it. It’s
because when it comes to the cost of health care, we are in the middle of a
We are paying twice as much as
any other major nation for care – even as tens of millions lack
coverage, and even as family after family sees its finances destroyed by a
health issue. And the American people know that in the
long-term, a simple system that covers everybody, provides the care they need
when they need it, puts $11 trillion back in their pockets and uses all of the
public’s leverage to keep costs as low as possible is the best option for their
family budgets and for the health of their loved ones.
As President, I’ll fight to get it done.
Read the plan here
Read expert letter on cost estimate of Medicare for All here
Read expert letter on financing Medicare for All here
WASHINGTON – U.S. Senator Bernie Sanders, running to be the Democratic nominee for president, on July 17 delivered a major address on Medicare for All, coinciding with the 54th anniversary of Medicare being signed into law. In his remarks, Sanders outlined his plan to make health care a human right for all Americans. Here is highlighted transcript of remarks as they were prepared for delivery: – Karen Rubin, News & Photo Features
Thank you all very
much for being here to discuss one of the major crises facing our country.
Let me also thank the dozens of organizations throughout America who
support Medicare for All and the tens of thousands of doctors, nurses and other
health professionals who support my legislation. Let me thank the 14
Senate co-sponsors that we have on this legislation and the 118 Members of the
House who support similar legislation. And mostly, let me thank the
American people who by the millions understand, as I do, that health care is a
human right, not a privilege.
Together, we will end
the international embarrassment of the United States being the only major
country on earth that does not guarantee health care to all of its citizens.
It is not acceptable to
me, nor to the American people, that some 87
million people today are either uninsured or underinsured.
It is not acceptable
to me that we end up spending almost
twice as much as any other major country on health care, while our life expectancy continues to decline
and our healthcare outcomes lag behind many other countries.
Frankly, I am sick and
tired of talking to doctors who tell me about the patients who died because
they were uninsured or underinsured, and walked into the doctor’s office when
it was too late. And we are talking about over 30,000 Americans who die every year because they are uninsured or
under-insured. What a tragedy.
I am sick and tired of
seeing working class families and small
businesses pay far more for healthcare than they can afford, and 530,000 Americans declare bankruptcy each
year because they cannot pay off the outrageous cost of a medical emergency
or a hospital stay. Families should not be driven into financial ruin
because someone in the family became seriously ill. How insane is that?
I am sick and tired of
hearing from Americans who lost loved ones because they could not afford the unbelievably high cost of prescription drugs, or
hearing from constituents who are forced to cut their pills in half due to the
In fact, later this
month, I will be travelling from Detroit, Michigan to Windsor, Ontario with a
busload of Americans who have diabetes in order to purchase insulin in Canada
at one-tenth of the price that they pay in America.
I am sick and tired of
talking with people who are struggling with mental illness but cannot afford the mental health counseling they
I am tired of talking
to people who have teeth that are rotting in their mouths, but cannot afford the high cost of dental care.
Let me be very honest
and tell you that, in my view, the
current debate over Medicare for All really has nothing to do with healthcare.
It has everything to do with greed and the desire of the healthcare
industry to maintain a system which fails the average American, but which makes
the industry tens and tens of billions of dollars every year in profit.
It is about whether we
maintain a dysfunctional system which
allows the big drug and health insurance companies to make over $100 billion in
profits last year, while the top CEOs in that industry made $2.6 billion in
total compensation – all the while 1 out of 5 Americans cannot afford the
prescription drugs their doctors prescribe.
It’s about whether we
maintain a system in which the CEO of the Aetna insurance company, Mr. Mark
Bertolini, received a golden parachute worth nearly $500 million after his
company merged with CVS Health, while elderly people lack the resources to
purchase a hearing aid.
It’s about whether we
maintain a system that allows the former CEO
from Gilead (John Martin) to become a billionaire by charging $1,000 a pill for
a hepatitis c drug called Sovaldi that costs a dollar to manufacture.
Let us make no mistake
about it. The struggle that we are
now undertaking, to guarantee health care to all Americans as a right and to
substantially lower the cost of prescription drugs, will be opposed by some of
the most powerful forces in America – entities that have unlimited amounts of
money. We’re talking about the insurance companies, the drug companies,
private hospitals, medical equipment suppliers, Wall Street and other powerful
Let me make a
prediction. In order to defeat the Medicare for All movement, powerful special
interests will be spending millions on 30 second television ads, full page
magazine ads, and corporate-sponsored “studies” to frighten the American people
about Medicare for All – which is exactly what happened before the passage of
Medicare in the 1960s. They failed then and they’re going to fail now.
And let me give you an
example of the kind of money and power we are talking about.
Over the last 20 years, the insurance industry
and pharmaceutical companies have spent more than $330 million in campaign
contributions and over $4 billion in lobbying to get Congress to do its
The pharmaceutical industry alone has hired
some 1,200 lobbyists – including the former leadership of both political
I find it quite
interesting that Billy Tauzin, the
Republican Congressman who wrote the bill to prevent Medicare from negotiating
for lower drug prices and then went on to become the President and CEO of
Pharma, received over $11.6 million in compensation in 2010.
That’s how business is done in Washington. Well, I have a different vision of what
a rational healthcare system is all about. Instead of massive profits for the drug companies, the insurance
companies and Wall Street, we must provide a healthcare system that provides
quality healthcare to all in a cost effective way.
And that is exactly what Medicare for All does.
legislation, every family in America
would receive comprehensive coverage, and middle-class families would save
thousands of dollars a year by eliminating their private insurance costs as we
move to a publicly funded program.
The transition to the Medicare for All program
would take place over four years. In the first year, benefits to older people
would be expanded to include dental care, vision coverage and hearing aids, and
the eligibility age for Medicare would be lowered to 55. All children under the
age of 18 would also be covered. In the second year, the eligibility age would
be lowered to 45 and in the third year to 35. By the fourth year, every man,
woman and child in the country would be covered by Medicare for All.
Medicare for All will reduce – let me repeat,
reduce — overall health care spending while lowering the number of uninsured
and underinsured people in this country to zero.
We accomplish this
because Medicare for All creates a
system of health care insurance that isn’t designed to generate profits for
insurance and drug companies — it will be a system focused on delivering actual health care. It will save lives, save money, and end the
frustration of endless paperwork, denials, and desperate fights with an
insurance company to cover medically-necessary medications and procedures.
Medicare for All will
fully eliminate health insurance premiums, deductibles and co-payments. Make no
mistake about it: These are nothing less than taxes on the middle class.
And when we do that, the
average middle class family will save an estimated $3,000 each and every year.
Further, unlike the
current dysfunctional system, Medicare for All allows people the freedom to
choose any doctor, clinic, and hospital without worrying about whether their provider is in-network or
not. People will be able to make
the health care choices that are best for themselves and their families without
some insurance bureaucrat telling them which providers they can see or not
see. Medicare for All is at the end of the day empowering patients and health
In addition, a
Medicare for All system will allow us to
address the serious problem of medically underserved areas.
Just to demonstrate
how absurd our health care system is, I was in Philadelphia two days ago
rallying with the people of that city to try to stop the closure of Hahnemann
University Hospital, an important, safety net hospital in that community.
Why do the owners want to close this hospital? Because they can make more
money redeveloping that property into condominiums and hotels.
Let me address some of
the half-truths, misinformation, and, in some cases, outright lies that people
may be hearing about Medicare for All.
Medicare for All
critics tell us that Americans just love their private health insurance
companies. We heard this most recently from UnitedHealth CEO David Wichmann,
who by the way, made $83 million in 2017 and who said Medicare for All would
“destabilize the nation’s health system.”
But let’s remember: the current system is already disrupting
and destabilizing millions of people’s lives. In the current system, 50 million
Americans every year lose their existing health insurance when their employer
changes insurer, when they change jobs, or when they cannot afford their current
plan. For many of them, they will no longer be able to see the doctor they have
relied on for years. For others, important treatments for long-term
conditions or disabilities will be changed or stopped altogether.
Here is the simple
truth. The American people do not like their private health insurance
companies. In fact private health insurance companies are quite unpopular.
What the American people do like are their doctors, nurses and other
health care providers.
While our opponents
claim that Medicare for All is too expensive, the reality is that it is much more cost effective than our
The Center for
Medicare and Medicaid Services estimates that, if we do not change the system, this country will be spending $50
trillion over the next ten years –19.4 percent of our nation’s GDP.
This is unsustainable and will be incredibly harmful to the people of our
country, to the business community, and to the entire economy.
And the reason why we spend so much is obvious. It
is not just the huge profits in the insurance industry and the pharmaceutical
industry, but it is the incredible and wasteful bureaucratic maze developed by
thousands of different healthcare plans. Today, hospitals and doctors
must deal with patients who have different deductibles, different co-payments,
different networks of coverage, and different coverage for pharmaceuticals, or
no insurance at all. All of this is not only driving doctors and nurses
and hospital administrators to distraction, but it is wasting
up to $500 billion a year on unnecessary administrative costs.
Unlike our current
system, there is broad consensus – from conservative to progressive economists
– that Medicare for All would result in substantial savings to the American
people. Two of the most recent studies on this issue have estimated that Medicare
for All would save the American people between $2 trillion and $5 trillion over
a 10-year period.
Let us be clear, the
fight against Medicare for All today is not a new development. Powerful
special interests have always opposed healthcare programs that work for the
people and not for corporate interests.
Let us not forget that
when President Harry Truman first proposed a program guaranteeing health care
to seniors that idea was billed as radical, “un-American,” and an attack on
basic freedom. And because of that assault, the idea stalled in Congress for
years — until voters made their voices heard.
In 1960, America
elected John F. Kennedy after he campaigned in support of Truman’s idea. That
election prompted serious work on universal health care bill, and Kennedy at
the time noted that “what we are now talking about doing, most of the countries
of Europe did years ago.”
Finally, following the
1964 Democratic election landslide, the new Congress was able to pass what is
now known as Medicare despite intense opposition from the health insurance
industry and the pharmaceutical companies.
More than a
half-century after that achievement, the time is now to go forward. The
time is now to expand Medicare to every man, woman and child in this
Let us be very clear.
When it comes to health care, the insurance and drug industries have been
able to control the political process.
If we are going to break the stranglehold of
corporate interests over the health care needs of the American people, we have
got to confront a Washington culture that is corrupt, that puts profits before
That is why I am
calling on every Democratic candidate in this election to join me in rejecting
money from the insurance and drug industries. That means not accepting
donations over $200 from health insurance or pharmaceutical company PACs,
lobbyists or executives. Candidates who are not willing to take that pledge
should explain to the American people why those corporate interests believe
their campaigns are a good investment.
Of course, President Trump should do the same but I am not going
to even waste my breath suggesting that he will. His efforts to throw 32
million people off their health insurance to have it replaced with junk
insurance shows exactly what side he is on.
Finally, let me say,
eliminating health insurance and drug company money from the Democratic primary
won’t solve all the problems, but it is an important step forward. Now is the
time to tell the health care industry that your profits are not more important
than the lives of the American people.
During the Presidents Week recess when Congressmembers are supposed to meet with constituents, I attended two jam-packed rallies focused on saving Obamacare (this followed the rallies held coast-to-coast in the days before the inauguration). In each of these, desperate people (dismissed by Republicans as “paid professional agitators”) stood up to preserve the Affordable Care Act.
While not perfect (after all, how could it be when Obama had to thread a ridiculously tiny needle to get anything passed the Republican wall of opposition), Obamacare has brought coverage to 20 million previously uninsured people, reducing the percentage of uninsured Americans to a historic low of 8.6%, allowed children up to age 26 stay on their parents’ plan, mandated coverage for preexisting conditions, ended lifetime caps, capped the amount of premium that for-profit insurance pocketed for non-patient purposes at 20% (versus 97% that Medicare spends on patient care ), instituted basic standards of coverage that included, for the first time, wellness visits, coverage for certain regular tests (mammograms, colonoscopy).
The secret sauce? Mandating coverage or else pay a penalty, but if you didn’t earn enough to pay, you would be able to get subsidies from the government Why? Because the whole thing revolved around the idea that young and healthy people would pay into the system, bringing down the insurance premium for everyone. And every policy would cover certain basics, like child birth and prostate cancer, mammogram and colonscopy (ending the higher premiums for a woman).
And it was working: in the first place because if people can go to their doctors earlier, get diagnostic tests and catch illnesses earlier, they are less expensive to treat, let alone reduce the amount of suffering while increasing a person’s productivity during their prime years.
Let’s review: before Obamacare, nearly 50 million people were without health insurance and tens of thousands of families were losing health insurance as they were losing their jobs (and homes) to the Bush/Cheney Great Recession. 20,000 people a year were dying needlessly simply for lack of access to affordable health care.
And, for years, for-profit insurance companies, with a 33% margin, were raising premiums at three to five times the CPI each year; routinely dropping doctors, denying coverage, throwing people off for “preexisting conditions.” Companies were dropping health benefits for employees.
“Preexisting condition? Life is a preexisting condition, resulting from sexual contact and will invariable end in death,” Dr Martha Livingstone, vice chair of Physicians for a National Health Program, told an overflow audience at the Universalist Unitarian Church in Huntington. “We all have a preexisting condition. We all need health care because we are human beings. How we will get it?”
Congressman Tom Suozzi, who stood in front of SRO town hall at the JCC in Plainview, and again at the Huntington health care rally, and back in January, with Kathleen Rice, at a massive health care rally, said about Obamacare, “Mend it. Don’t End it.”
The key problems with Obamacare, people complained, are high deductibles (for the cheapest plans), that premiums rose significantly (after rising at the slowest rate of increase in 50 years and mainly because of the Republican sabotage that prevented the full implementation), and that doctors, and even insurers would change (which happened before, as well).
What Republicans are proposing now, though, doesn’t “fix” any of these problems. In essence, the Republican plan favors the healthy and the wealthy, shifting the burden of payment while providing fewer benefits onto working people, low-income people and the elderly, while – and here is the added bonus – exploding the budget deficit. Millions will lose insurance; costs will skyrocket, and Republicans are ramming it through without “scoring” its impact on the budget or people.
They concocted the bill in secret, are ramming it through without proper analysis, scrutiny or debate, or even “scoring” by the Congressional Budget Office, and here’s the added subterfuge: they are repealing the elements in stages: by 2018 for the first parts (to minimize impact on midterm elections) and by 2020 for the complete repeal (to ease the way for Trump’s reelection).
The Republican plan begins with ending that “freedom killing” mandate, which is the hinge upon which access to affordable health care rests, because by requiring everyone – young, healthy people who might otherwise defray health insurance costs – to purchase, the pool is large enough to keep premiums down for everyone, while covering everything from child birth to mental health to pre-existing conditions.
Instead of a mandate, enforced with a modest tax penalty, to insure that enough healthy, young people are in the pool to lower everyone’s premium while expanding care and access even if there is a pre-existing condition, the Republican plan provides for a 30% “surcharge” if you have let insurance lapse more than 60 days. So if you have lost your job, and therefore your health insurance, and can’t pay, you will only get further and further behind.
The other prime elements:
Instead of subsidies for people who don’t earn enough to purchase health insurance, Republicans want to give tax credits, which only are beneficial if you earn enough to pay. What is more, they want tax credits not to be based on income at all, but on age, so a 60 year old would get $4000 in tax credits while a 30-year old minimum-wage worker would get $2000 –still only a fraction of the cost of a minimally basic health plan – up to $14,000 in credits for a family.
The other big idea to “afford” health care is the Health Savings Account, which Republicans have wanted forever – another scheme to bolster Wall Street donors, and provide yet another device for the wealthiest to shield income from tax. The flaw is that you need to have enough money to stash away in HSA to begin with. But suppose you get a cancer diagnosis or are hit by a car before you have accumulated sufficient funds? Or you contract some illness that blows through your HSA? Tough luck.
The GOP plan would end the Medicaid expansion – when the federal government paid 90% instead of 50% of the state’s Medicaid cost — which will result in 10 million people in 31 states losing health insurance.
Another keystone of the GOP health care con is to give states block grants – a fixed amount that has no correlation to actual need. The interesting thing is that Governors tend not to use the money for its purpose (health care for the poorest residents), but for pet priorities like lowering taxes for businesses.
The Republicans say they want to shift “power” back to the states. But states always had the ability, before, to devise their own health care plan, as long as it met basic standards of the Affordable Care Act. What states want is the ability –and the excuse – not to provide universal coverage.
Republicans will claim that their plan will continue to cover pre-existing conditions. But their idea is to stick people with pre-existing conditions into high-risk pools, which could put the cost out of reach.
Indeed, no one has bothered to mention that Obamacare capped the amount that the for-profit insurance companies could charge for non-patient services – it was at 33% (versus a 3% administrative budget for Medicare) before the ACA, which required 80% of the premium to go to patient services. That is out the window.
An added zinger, just for good, is that the plan ends federal funding for Planned Parenthood. Gotcha!
Trump proposes to cure the cost problem making it possible to buy insurance across state lines, without saying how that would actually reduce the cost of the premium, under the pretext that “competition” will lower the cost. Except that the same few companies dominate the market in most states, and like airlines, can just raise premiums as they like. Also, this would negate New York’s ability to set standards on insurance companies. And wouldn’t it also mean that New Yorkers would pay the higher premium for Southern obesity?
Most of the changes are phased in – they don’t get implemented until after the 2018 midterm elections, and Obamacare is not completely repealed until after the 2020 elections.
But what Republicans claim is the “unsustainability” of Obamacare is the result of Republicans efforts to sabotage it from day 1. And the first thing that Trump did? Ended enforcement of the mandate and issue a proposal to cut next year’s enrollment period in half allow insurance companies to easily raise deductibles, limit patients’ choice of doctors, and restrict others from getting covered mid-year — even if they have a child or lose their employer-based insurance. Insurance companies are pulling out because the Republicans are intentionally making it impossible for them to do business.
By immediately repealing the mandate as well as the taxes that support Obamacare, it is truly unsustainable and more insurance companies that are planning premium rates and participation now, will either pull out or hike up premiums to ridiculous levels because essentially, they are only insuring sick, older people.
The taxes that pay for the Obamacare health care benefits are also being immediately repealed which will explode the budget deficit, which somehow, Republicans only care about when a Democrat is in the Oval office.
And here is the stunner: the Republicans, who have worked this up in secret, without any debate or public commentary (they dismiss the millions who have come out to town halls, rallies and protests as “paid professional agitators” instead of people with real concerns), plan to shove the legislation through without even scoring by the Congressional Budget Office. They can’t say how much health insurance will cost in TrumpWorld, or how many people will wind up losing health insurance or who wind up being woefully uninsured because they can only afford a minimal policy that doesn’t actually cover anything. They can’t say how many more employers (only about half were offering health insurance benefits before ACA) will simply stop providing any health care benefit at all. That’s Freedom! That’s Choice!
“Do we want people to have socialized medicine or individual accountability, personal choice, where businesses decide?” Congressman Chris Collins (R-NY) asked hypothetically.
Obamacare did not just benefit the 30 million people who were able to afford health insurance, 20 million of them for the first time. It benefited every American who also has insurance, and every American who has Medicare, as well. And remember the complaints with Obamacare? That deductibles were too high; premiums went up significantly from the first year (except they had traditionally gone up at 3 to 5 times the CPI, without any limits). That doctors left the plan or insurance companies changed the plan to exited the exchanges? The Republican plan does not improve any of this. Instead, it returns health care to the total control of for-profit companies, who can raise premiums at will, drop doctors at will, set lifetime caps or refuse to cover certain procedures.
Health care should be a right, not a privilege reserved with the means to pay for it. But the Republican mold would create a system of unequal protection throughout the land. If you happen to live in New York State, you are likely to have better access to life saving, life-affirming care for your family than if you live in Texas.
The Republican plan is a prescription for sicker people who don’t get the checkups, early diagnosis and wellness care to prevent more serious (and costly) and deadly maladies. But they don’t care. Indeed, the rightwingers like Freedom Caucus who are howling mad at the American Health Care Act are upset that it is not draconian enough, that it is “Obamacare Light”.
In TrumpWorld, people are back at the mercy of the for-profit health insurance and health care industry, back under the thumb of employers and abusive spouses. Now that’s freedom-killing, as much as it is a death penalty.
It is as Alan Grayson said early in the Obamacare debate: “The Republican health care plan: don’t get sick. The Republicans have a back-up plan in case you do get sick … Die quickly!”
Rightwingers, conservatives don’t hate Obamacare because it smacks of “socialized medicine.” They hate it because they believe when everyone is entitled to health care, there will be a shortage of doctors, of hospital beds. They will have to wait for appointments. They fear “rationing,” not caring that to avoid that feared scenario, it means that 50 million people will be excluded from health care system altogether.
The solution to having truly universal health care is to reform the health care system – more physicians assistants, nurse practitioners, online diagnosis and triage, more early diagnosis and wellness care.
Contrary to the rightwing hysteria (death panels!) Obamacare is not socialized medicine because it bent health care into a pretzel in order to retain for-profit health insurance entities as the gatekeeper between patients and health care. But the epic failure of the Republican plan, which more than restores ultimate control over people’s lives and quality of life to for-profit companies and employers and abusive spouses, will likely result in a true universal, Medicare-for-All, single-payer system.
Trouble is, that won’t happen for decades more, and not until after hundreds of thousands of people have suffered miserably, died needlessly, prematurely, for lack of access to timely, affordable, quality health care.
With the chaos and uncertainty at the federal level, New York Progressives see an opportunity to push for single-payer health care in the state – a plan that has been approved by the Democratic-controlled Assembly, but has been defeated by the Republican-controlled Senate (with the help of the so-called Independent Democratic coalition of state senators who were elected as Democrats but caucus with Republicans).
Irrespective of what Republicans do in Congress, Ron Widelec, a member of the steering committee of Long Island Activists (LongIslandActivists.org) said, “There is a lot we can do in New York – people forget we can act locally, not everything happens in Congress. Single payer is a real possibility in New York.”
Widelec exposed the lies that are used to beat back universal health care, despite the fact that every other industrialized nation has such a system:
That universal health care is too expensive, will add trillions of dollars to the national debt – but that is belied by the fact that the US spends twice as much on health care as any other industrialized nation, health care amounts to 1/6 of the entire economy, and the outcomes are poor, with the US ranked 32nd among nations, contradicting the claim that the US offers “the best health care in the world.”
Another lie is that universal health care will result in rationing, ”as if 20 million people with no insurance isn’t rationing, or people who have insurance but can’t afford deductibles or copays isn’t rationing, or insurance companies denying care isn’t rationing,” he said.
Janet Green, a nurse who lived in Canada for two years and now lives on Long Island, spoke of the difference: “We lived it, loved it – you could choose any doctor you like, be rid of billing, deductibles, copays; to be covered regardless of age, job status, preexisting conditions, personal wealth. No wonder the Canadians love their single payer universal health insurance system with private provision..
“When we moved to Long Island, the unfairness and inefficiency of an increasingly corporatized health care system was increasingly hard to take because I knew another system. I had coverage through husband’s job – but I was angry, not lucky, to be part of such an unfair system.” That included problems with doctors in/out network; merger/replacement of insurance plans, with changing rules, preferred provider lists not once but twice in 4 years. “There is none of that on single payer, no deductibles or copays or networks.
“I saw the misinformation spread by those most affected, the insurance industry –myths about Canadian system.
“North of the border and throughout the rest of the world, it is understood that to be a compassionate, enlightened society, there must be universal health coverage.
Dr. Martha Livingstone, vice chair of Physicians for a National Health Program, also spoke from experience about Canada’s health program, because she lived in Canada while getting one of her degrees.
“There are only two reasons we don’t have national health insurance Medicare for All – it is 1/6 of the economy and very powerful people are arrayed against us who will do everything in their power to persuade us we can’t have it. And our failure of imagination.
Indeed, it may well be that Republicans have overplayed their hand and the pendulum will swing back much more forcefully. If they succeed in repealing Obamacare and replacing it with Trumpcare, it can cost Republicans to lose Congress in 2018 and the White House in 2020, just as Obamacare cost Democrats control in 2010. Instead of Obamacare, which was Obama’s attempt to appease conservatives who demand a for-profit health care system, there will be universal health care, single-payer Medicare for All, a socialized health care system.
She told of a Victoria BC woman whose son had to go to five specialists before a rare brain tumor was diagnosed, treated, so he could survive. “In the states, he would have been one of 45,000 Americans dead of treatable medical conditions because he didn’t have access to timely medical care.
“Preexisting condition? Life is a preexisting condition, resulting from sexual contact and will invariable end in death. We all have a preexisting condition. We all need health care because we are human beings. How we will get it?
“We are the 99%. We don’t mind paying taxes when they provide for things we need. Who doesn’t want to pay taxes? it’s the billionaires – they want us to be uneducated, unhoused, unfed and if sick, they like us to die [and not be a burden on society]. It is a life/death fight.
“We have to protect the Affordable Care Act, but frankly my dears, ACA was written by the Heritage Foundation, a right wing think tank. It is a Republican plan first put into place by then Governor Mitt Romney in Massachusetts. You have piece a that‘s public, that funds the majority, and the piece that’s private.
“What Romneycare did, then ACA, was to build on the wildly expensive private for-profit sector of the system. We want to build in the wildly successful, inexpensively administered Medicare program…
“There are only two things wrong with Medicare: it doesn’t cover everything, doesn’t cover everybody. So improve it, Medicare for all.”
But regardless of what happens at the federal level, the state can create its own single-payer plan.
“Let New York be the first to have single-payer. What it will do for us in New York State is save us $50 billion, and save everybody but the very wealthiest New Yorkers money over what paying now for lousy access to care, where we have narrow networks, where some insurance genius can tell us at any moment, ‘Well, if you looked at p 793.’ The bill gets rid of all that – no copays, deductibles for a human right. We have to reinforce that. We know we won’t get it through the New York Senate this year, but 2018 if we hold their feet to the fire.”
“This event left me hopeful,” Widelec said before sending everyone off to their breakout sessions to come up with local actions. “The election of Trump wasn’t a hopeful time, but I am hopeful. I believe this is not a matter of left versus right, this is a matter of right versus wrong. One good thing about the 1%: we outnumber them 99 to 1.
Hundreds rallied at the Unitarian Universalist Fellowship of Huntington (UUFH), under the aegis of Long Island Activists, to strategize how to save Obamacare from Republicans who are moving swiftly to repeal it and replace it with something that is far more costly, would knock tens of millions off health insurance, would raise taxes for middle class and working Americans, and essentially be more costly for less care. But the Long Islanders went an extra step: to demand single-payer – that is, Medicare for All – beginning with New York State.
The rally was one of 150 across the country last weekend with some coordination of Bernie Sanders’ Our Revolution group.
The activists jammed a main room, overflowed the overflow room, and were lined up outside, producing a kind of echo-effect to cheers and boos inside the hall.
“Something feels wrong. Public policy in no way reflects public opinion,” said Ron Widelec, a member of the steering committee of Long Island Activists (LongIslandActivists.org).
“We live in the richest country in history, yet 20 million go without health insurance, tens of millions have insurance but can’t afford to use because the deductibles so high – choosing between feeding children or going to a doctor when not feeling well. These are unacceptable choices in a country this wealthy…
“These are life-or-death situations. That’s why people are out here. It turns out, if you try to take away people’s health care, get angry and show up. Tens of thousands die without access to health care, or can’t afford access so that is the same as not having access. People die if they can’t afford an Epipen.
The Affordable Care Act (Obamacare) was not perfect because it was designed to appease conservatives. Indeed, the framework came out of the right-wing think tank, The Heritage Foundation, and was first implemented by Republican Governor Mitt Romney in Massachusetts. Elements such as a public option or a Medicare buy-in were omitted in order to satisfy so-called moderate Republicans like Susan Collins of Maine, who nonetheless voted against the ACA.
“Many members of Congress are dedicated to the idea they can make the situation even worse . Our position is clear: health care is a human right,” he declared to boisterous cheers.
“While no one thinks ACA perfect, it did things we need to fight for,” Widelec said. “ACA didn’t go far enough – a human right doesn’t have co-pays or deductibles.
“On the federal level, there is very little we can do with Congress. We know Republicans want to overthrow ACA… We have to fight to protect Obamacare and put pressure even on those too cowardly to hold town halls [like Long Island Congressmen Peter King and Lee Zeldin].
But while progressives all along wanted universal health care – that is, single-payer or what is termed Medicare for All – the most immediate goal is to preserve the key elements of Obamacare: covering young people on their parents’ plan until age 26; pre-existing conditions; no lifetime caps; a cap of no more than 20% of the premium going for non-patient spending , and minimal standards for what insurance policies cover – which turns out can only be offered if there is a mandate so that healthy people purchase insurance; otherwise, deductibles or copays or premiums are so high, they are unaffordable.
“It’s not true that the Republicans don’t have a plan,” warned Doreen DiLeonardo, who hosts a progressive radio show. Indeed, the plan that was exposed by Politico is essentially the 2015 bill introduced by then Congressman Tom Price, now the Secretary of Health & Human Services.
According to Politico, the Republican plan would rescind the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Instead of subsidies to help people with low incomes afford health insurance, it would give tax credits based on age rather than income. That means that multi-millionaire Rex Tillerson, former CEO of Exxon-Mobil and now Trump’s Secretary of State would get a bigger tax credit than the 30-year old who works at Starbucks. In any case, tax credits mainly benefit wealthier people. Meanwhile, the other big Republican idea is for Health Savings Accounts, which once again, benefit wealthier people, while those who are barely affording food and rent will be unable to stash away money in untaxed accounts. (See: Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion)
What Democrats point to, though, are provisions that would wind up taxing middle class and working class families for the health insurance benefits they get from their employers, while at the same time ending taxes on the wealthiest Americans that funded the Obamacare subsidies.
“If it were such a good plan, they wouldn’t be hiding it,” DiLeonardo said.
This plan is moving swiftly, she warned.
The Republicans’ “destructive, nihilistic policy will ruin the ACA,” Assemblyman Charles Lavine, who has sponsored universal health care in the State Assembly, said. “They attempted to ruin it from beginning, based on lies. Each and every one here today, superheroesque, survivors of the ‘massacre at Bowling Green’, we know 20-30 million Americans would lose insurance, we know the tragedy that will flow from that – we will return to days preexisting conditions rob people of access to health care. You’re on your own. Lifetime caps – if someone had serious condition, cut off, no more insurance., – when that happens we all pay one way or another for their treatment. Women will pay more for identical coverage, young adults up to 26 no longer on parents’ coverage, you’re on your own.
“We know the lies being told. Trump said ACA robbed people of their insurance. We know that is just another lie. More than 20 million were able to get insured because of ACA, we now have a record low percentage of uninsured people, 10.9%.
“Trump said some plans were canceled [using this to accuse Obama of lying about ACA]. But that’s because they were deficient, illusory plans. What Trump and his confederates want to do, is to allow New Yorkers to go into market and buy insurance from other states. NYS is not going to allow that to happen. We will demand (because NY controls insurance product) that any insurance product sold here has to provide minimum requirements, or else people will get ripped off. Those are the kind of policies people lost because of ACA.”
Senator Chuck Grassley of Iowa lied when he said Obamacare would create death panels that would pull the plug on grandma. But a century ago, the worldwide flu epidemic killed off 50 to 100 million people, and bodies were piled up on street corners in Chicago waiting for the city to pick them up, people were on their own, too.
“That’s not that long ago – a blink in time of human history. We stand together you rebellious Americans to demand the human right of health care, and we stand together (big applause). This is a fight for our families, our communities. We are 36 years since the first days of Reagan Administration into a philosophy that says government isn’t the solution, it’s the problem, your enemy. You and I will fight for our families, communities, and damn well we stand up and fight for our government.”
Recalling that President Theodore Roosevelt, a progressive who busted up trusts and created the first national parks, whose home at Sagamore Hill is just a few miles from where this rally is taking place, Ron Widelec said, “Once republicans were progressives, put in policies that helped people, now they are wedded to the invisible hand of the American market, not noticing, it is a hand around throats of American people. We will fight back.”
Newly elected Congressman Tom Suozzi, who has pledged to support universal health care once Democrats take back Congress (and held a packed town hall this past week in which support for ACA was a key issue), said “I believe in health care as a human right. This is a matter of life-and-death for many families now. We have to do a couple of things: protect ACA is the first thing. There is great energy behind that. But we need to improve upon ACA because there are problems – insurance companies, drug companies had too much say in writing ACA and we’re paying the price. Mend it don’t end it. Fix the problems.”
Next: New Yorkers Mobilize for Single Payer Health Care