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An Examination of Healthcare in 2020

By OZHAN ZARIFI and NIMA MOHAVEDI
Staff Writers

One of the most important issues in this coming election is what is going to happen to the nation’s healthcare options and what could potentially happen to Medicare and/or Medicaid. As of early March, there are three candidates still vying for the office of the Presidency, with former Vice President Joe Biden, House Representative Tulsi Gabbard, and Senator Bernie Sanders all vying for the nomination in July. One of the biggest issues that is asked when trying to differentiate between the candidates is their stance on health care. An expanded public plan alongside the existing private model noted was favorably looked upon by most candidates. However, Sanders and Warren both call for a Medicare for All system, while the rest want a public option that will continue private insurance. The Medicare for All option is a single government-run healthcare system that provides insurance for all Americans, while replacing the existing private insurance model. The fear of such a large healthcare system with many factors is primarily at fault for the recent skepticism concerning MFA adoption, with backlash mainly coming from corporate Democrats or Republicans. Additionally, to many it is a strategy we could gradually work towards in a more thought out process.

For many on the debate stage, the ability to allow for private health insurance to remain as an option is a viable solution. Former Vice President Joe Biden, and former candidates Bloomberg, Buttigieg, and Klobuchar  back this proposal, and support the expansion of the Affordable Care Act . These candidates agree that universal healthcare is not the best option for the nation. However, Senator Elizabeth Warren, who wants to expand Obamacare as well, proposed a transition into a full Medicare for all system, which would be completed within her third year in office. With a similar plan to his progressive counterpart, Senator Bernie Sanders further wants to 

Biden, a key figure who helped create and pass the Affordable Healthcare Act in 2010, sees protecting Obamacare as a necessity. In his bid for president, he promises to keep the Affordable Healthcare Act safe from Republican efforts to repeal, while allowing others the option to choose their healthcare provider. Furthermore, Biden promises to streamline his ‘Biden Care’ and ensure that around 97% of Americans will have access to some public health insurance. To cover many low-income families, Biden plans to make it more affordable by giving middle-class families a premium tax credit for coverage, with the Biden campaign claiming to save most families around $750 per month on health insurance. In his final pillar of his multi-step healthcare plan, Biden addresses the drug and pharmaceutical industry’s monopolization of  American healthcare. To resolve this, Biden promises to repeal the existing law that denies the government from negotiating drug prices with private corporations. While some see this as a radical proposition, it is very similar to other nations that allow governments to barter with privatized drug prices, such as the UK and Canada. However, BidenCare does not come without its own criticisms. Under BidenCare, the government would reimburse doctors 87 cents for every dollar spent treating a Medicare patient, 40% less than what private health insurance pays (Newsday). Due to medicare’s large scale, providers and hospitals have to accept the government’s payment methods, while private insurance is left without any leveraging power to dictate payments. Should BidenCare be implemented, the influx of people on the plan and loss of income for hospitals will initially result in hospital staff layoffs. Such actions will later dictate hospitals’ decisions to charge private health insurers more to compensate for such losses.As a result, private healthcare coverage would become even more expensive and exclusive, alienating middle-class Americans who previously paid for private health insurance plans. Still relying on former President Obama’s healthcare plan for success in 2020, Biden desperately needs to refine and restructure numerous aspects of his Biden Care plan, should he be hoping to make his proposed plan into a law in the future. Regarding a woman’s right to choose, Biden has had a much more popular and supportive plan of abortion and plans to allocate federal funds for the practice in some situations. Overall, Biden’s plan seems too attached to former President Obama’s existing policies, and does not recognize any compromises into implementing any other form of Healthcare outside of expanding Obamacare. While Obamacare was a great start to helping millions of uninsured people gain access to basic healthcare, Biden’s continued focus around the outdated and incomplete plan most likely will not sit well with most Americans who want a change to the current system. While improving Obamacare for Americans while devising a better plan may be viable, Biden however, has repeatedly refused to even consider any form of Medicare-for-all, since it would repeal Obamacare. Unless Biden can become more open and moderate about restructuring or amending the current public healthcare option, his vision for healthcare is no different than one over a decade ago.

Similar to Biden’s plan, Billionaire, and former New York Mayor and recently former presidential candidate Michael Bloomberg’s healthcare proposal focused on improving and expanding on the Affordable Healthcare Act. Bloomberg’s plan would have seeked to reverse any work done by the Trump Administration, implement lower drug prices through the act of repealing bills that prevents pharmaceutical negotiation by the government. Additionally he proposed the banning of surprise medical bills. Bloomberg further thought that “a public insurance option would improve consumer choice and increase competition in the private insurance market (which would) push down everyone’s premiums”. To accomplish this, Bloomberg would have had to rely on the framework of Obama’s Affordable HealthCare Act. However, many have questioned Bloomberg’s reliance on Obamacare and the Affordable Healthcare Act to push forward his plan. He repeatedly announced his opposition to the bill, when the legislation was first introduced in Congress. He further denounced the proposal when it was later made into a law. This aside, Bloomberg’s plan would have failed in a similar manner like Biden’s proposal, as the attempt to address the large influx of new patients in hospitals would cause longer waits and overcrowded hospitals. (Fox News). Until Bloomberg (who has recently dropped out) and Biden can properly address these critical concerns and provide viable options or alternatives, their plans to expand on Obamacare to improve the current healthcare system may ultimately have negative long term impacts if put into practice. Such ideas should warrant some concern when looking at their bids for the democratic primary nomination. Finally, as Bloomberg continues to oppose Medicare-for-all because of the high taxes it would incur, it is unlikely that should he have been elected into the office of presidency, he would have been successful in garnering partisan support, let alone bipartisan approval to pass his plan.

Medicare for All Who Want it was the plan that former candidate and former Mayor of South Bend, Indiana Pete Buttigieg proposed to implement if he became president. The key phrase here is “for all who want it”, as he proposed a strong public option that could compete with the private sector. He proposed that his plan would have allowed the American people to  choose their desired healthcare in a pragmatic way. Two options would have been available, his own “Medicare for All Who Want it” option or an employer based healthcare plan. Through Buttigieg’s website, the candidate states that the plan would have cost about $1.5 trillion over 10 years and it would have been paid for by rolling back Trump’s corporate tax cuts. This would have generated $1.4 trillion in revenue, while the remaining funds would be covered through cost savings from the federal government through the negotiation of drug prices with pharmaceutical companies. Pete’s plan for low income citizens suggested that premium subsidies would cost a maximum of $600 a year with higher quality care. Buttigieg wanted to put limits on how much out-of-hospital surprise billing could charge which included ambulances and air ambulance services. In the document that his campaign created, Pete Buttigeg would have tried to get more people insured into his public option from the States that won’t expand on Medicaid,  people who can’t afford any employer provided insurance would have been insured, and also people who couldn’t afford coverage and ended up being uninsured would have been insured by Pete’s plan. Would he have gone through his proposals though? He has stated two different positions on his stance of Medicare-For-All throughout the election cycle where you might not really be able to tell whether or not his statements are his own true personal beliefs. In a November 2019 interview with Full Court Press with Greta Van Susteren, Pete Buttigeg said that Medicare for All is a tough sell and that he didn’t think it was right that users of private insurance plans getting kicked out and liking a single payer system is fair. But in a February of 2019 interview with ABC This Week With George Stephanopoulos, he said that he is for a single payer system, he acknowledged the system in the United Kingdom, saying that he doesn’t trust health care purely by corporations, and calling Medicare for All the “best framework.” He did in the same interview promote a Medicare for All for all who want it path to an eventual universal conversion, but the way he treats the idea of a single payer system in one interview and flipping into another position is something people need to take notice. As a moderate, he would have been the best choice compared to Bloomberg, Biden, and the former candidate Amy Klobuchar, but as he dropped out, it would be interesting to see how Biden would incorporate Buttigieg’s supporters onto his boat.    

One of the former female candidates, Senator Amy Klobuchar representing Minnesota had her own plan of what healthcare should be like in this country if she was voted into office. But it still lacks any substance to make it unique from the other moderates that are also running. Klobuchar called for a public option, embracing a Medicaid like option while keeping private insurances open to compete. She wanted to improve the Affordable Care Act by expanding premium subsidies, and provide “cost-sharing reductions to lower out-of-pocket health care costs.” It’s also stated on her website that she wanted to stop surprise medical bills for things like unexpected charges, expand coverage for dental, vision, and hearing plans, and wanted to create a refundable tax credit to help with long-term care costs and reducing the costs of overall long-term care insurance. She made several promises that in her first one hundred days she would have wanted to stop the Trump administration’s efforts of stopping people with pre-existing conditions from getting insured, stopping the competitiveness that raises prescription prices, prevention and intervention programs for citizens who struggle with mental health and addiction, and invest in research programs such as Alzheimer’s prevention and institutes such as the National Science Foundation, National Institutes of Health, and the Veterans Health Administration. Some hypothetical laws that Amy Klouchar proposed is that she wanted legislation done on getting safe drugs imported from Canada, lifting a ban on prescription drug prices with Medicare users, and a law that bans pharmaceutical companies from banning generic medications. According to the Washington Post, unlike Pete Buttigeg, Klobuchar was part of the group of moderates that wanted to keep private companies, she never gave an answer when asked if undocumentated immigrants should be covered by government run program, and Klobuchar was a co-sponsore for the EACH Woman Act, which would prohibit state laws banning private abortion coverage. However her campaign did not say if she supported requiring private insurance covering abortion. There are inconsistencies on how specific she would have gone to make sure her proposals would go through, unlike Pete’s plan, her website at the time of this article doesn’t provide specific numbers that can be supported and again it’s hard to be unique when being grouped with several others that has a plan very similar to yours. 

Senator Elizabeth Warren of Massachusetts, who is considered to be the most progressive of the moderates has her own plan of what Medicare should be. She wants to implement a Medicare for All system, complete universal health care. Elizabeth Warren wants to implement a transition period in her four years where no later in her third year as President she would make a full Medicare-For-All transition. Elizabeth Warren would call for the passing of her Affordable Drug Manufacturing Act to make prescription drug prices lower and make the United States Department of Health and Human Services manufacture generic drugs where website stated that only in the cases of “in which no company is manufacturing a drug, when only one or two companies manufacture a drug and its price has spiked, when the drug is in shortage, or when a medicine listed as essential by the World Health Organization faces limited competition and high prices.” She also wants to focus on the abuse of pharmaceutical patents, and also get imports from other countries that cost less than the same drug that’s made in the States. Warren wants to make sure insurance covers mental health issues, and she wants to invest $100 billion in federal funding to help fight the Opioid Crisis under the CARE act she made with the late Representative Elijah Cummings that would work  provide prevention, treatment, and recovery services especially to people who already are addicted and would require treatment. She calls for an increase in coverage and coverage quality especially in rural areas by establishing a $25 billion dollar capital fund. On her website, she also wants a reduction of “administrative spending and reimburse physicians and other non-hospital providers at current Medicare rates.”Her goals are that she wants 331 million people insured, while ending the suffering from the people who get surprise bills, end up being not insured for certain treatments, and no more restrictive provider networks. This would all be covered through her proposed spending cuts, taxes on giant corporations, and cracking down tax evasion and tax fraud. According to Jacobin, the issue that is looked upon with Senator Warren’s Medicare plan is that she’s proposing a Medicare Head Tax, where the current system has a payroll tax. The difference is that the current system is that the tax is based on a percentage of each worker’s earnings, while the Medicare head tax would end up charging a specific dollar amount per worker. A head tax would charge low and middle classes more than a payroll tax. Companies could avoid having to adjust to this by getting their workers into an independent contractor status than having their workers as 100% employed under the company name. Another thing Warren proposed is that “employers with less than fifty employees would be exempt from the employer Medicare contribution both initially and forever.” Having the payroll tax would be easier to maintain and would be harder to evade. Having a head tax that can easily be evaded would send Warren’s Medicare for All into a spiral of destruction. 

With arguably the most iconic healthcare plan in a generation, Senator Bernie Sanders of Vermont has been a very strong, blunt and uncompromising figure on pushing his agenda of providing a single-payer national Medicare system for all Americans. Planning on achieving universal health care coverage for the nation’s first time, Sanders additionally hopes to eliminate networks, premiums, deductibles, copayments and surprise bills. His plan also wants to cover dental, vision, hearing,  and home and community-based long-term care, in-patient and out-patient services while trying to support mental health and substance abuse treatment, reproductive and maternity care, and prescription drugs prices. However, Sanders’ plan also comes with the most criticism out of all proposed healthcare plans, due to the fear of being such a large operation and the costs that come with it. Despite this, Sanders has offered a number of financing options, including creating a 4 percent income-based premium while exempting the first $29,000 in income for a family of four, requiring employers to pay a 7.5 percent income-based premium (payroll tax), getting rid of health tax expenditures and increasing the top marginal income tax to 52 percent on incomes over $10 million. (The Hill). Within a decade, Sanders expects to have allocated around $3.9 trillion for a long-lasting Medicare-for-all plan. He futher hopes to expand universal healthcare access to undocumented immigrants as well, as thousands of illegal migrants die annually from a lack of basic healthcare services. Equally important to Sanders, fighting drug companies and the pharmaceutical industry for lowered drug prices has been a life-long endeavor of his. Currently, 58 million Americans cannot afford their prescription drugs, with millions more forced into choosing between paying for their medicine or food/rent expenses.This outrageous statistic is not normal for a country of our magnitude. As Sanders states, no other industrialized nation in the world is so greatly affected by the massive greed and influence of the drug industry, which has literally led to the needless deaths of Americans without access to their predictions. Canada, for example, pays on average $30 for a vile of insulin, while in the States, the same medication would cost around $320 (Reuters). Bernie ultimately wants to repeal laws preventing him from negotiating drug prices to make it more affordable for people in the United States. In 2018, Reuters did a report on a study that the “U.S. spends about twice what other high-income nations do on health care but has the lowest life expectancy and the highest infant mortality rates.”(Reuters). According to the article, it is due to the steep drug prices, physician and nurse salaries, and administrative costs. Note that the high or low life expectancy can also be viewed on a state to state basis.  Stephen Parente of the University of Minnesota stated that “inequalities in innovation, costs and outcomes may be reasons the U.S. lags behind other high-income countries.” Reducing administration costs would substantially save us money because we would have one plan negotiating rates with providers. Around 22 studies examined by the University of California showed that a “A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money.”(The Hill). Early December, both Democrats and Republicans signed on a bill that would increase the United State’s military budget by $738 Billion for military spending for 2020. While we spend trillions in the wars in the middle east, supporting the the military industrial complex, there is no question on how we could invest in improvements for the domestic infrastructure of the United States. Both sides of the isle need to hear the voices of the people on focusing on issues that help people back home. 

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