Winning The Battle For Medicare For All Is Going To Take A While... But It's Worth Fighting

Carbon emissions are supposed to be going down. And they have been-- until Trump's policies started kicking in this year. This year they started increasing again, carbon dioxide up 3.4% according to a report in the NY Times on the work by the Rhodium Group. It's the biggest increase in eight years and it "occurred even as a near-record number of coal plants around the United States retired last year, illustrating how difficult it could be for the country to make further progress on climate change in the years to come, particularly as the Trump administration pushes to roll back federal regulations that limit greenhouse gas emissions." Remember when the tobacco industry's chief counsel-- then just a dishonest attorney named Kirsten Gillibrand, rather than a dishonest senator named Kirsten Gillibrand-- lied about the health effects of tobacco smoking? "More doctors smoke Camels than any other brand of cigarettes," said the ad. Should people who heard it and got lung cancer be able to sue the companies that made the ad? Should they vote for Gillibrand for president?



Tobacco and carbon emissions have something in common-- they both make Americans sick and sicker and contribute to lower lief expectancy rates. Trump supporters don't care because they hate life, have nothing to live for and just want the world to end anyway. But normal people are concerned and will be more concerned if they read a CNN report today that points out that the U.S. spends twice as much on health care as its peers. "Despite many efforts to rein in US health care costs in recent years," they began, "spending is still on the rise. Americans spend more than twice as much on health care per person as their peers in developed nations, according to a new analysis from Johns Hopkins Bloomberg School of Public Health. It's not because people in the US use more medical services. Instead, it's because drugs cost more, doctors and nurses are paid better, hospital administration is more expensive and many medical services have higher price tags, the study found." It's almost a warning about why we desperately need Medicare For All.

The new analysis-- an update of a well-known 2003 report by Princeton health care economist Uwe Reinhardt titled "It's the prices, stupid"-- found that the US remains an outlier when it comes to spending, which was $9,892 per person in 2016. That compares to a median of $4,033 for Organization for Economic Cooperation and Development countries in 2016 and to the $4,559 the US spent per person in 2000, adjusted for inflation.

Spending increased at an average rate of 2.8% annually in the US between 2000 and 2016, compared to the OECD median of 2.6%. This was driven in part by how much Americans shell out on drugs, which increased 3.8% per year, compared to a median of 1.1% for OECD nations.

"In spite of all the efforts in the US to control health spending over the past 25 years, the story remains the same," said lead author Gerard Anderson, a Johns Hopkins professor. "The US remains the most expensive because of the prices the US pays for health services."

One reason for the jump in spending increase is the widening gap between what the federal government reimburses for Medicare and what private insurers and employers pay for those with job-based coverage, Anderson said. In 2000, the difference was roughly 10%. Now, studies have shown it has widened to 50% or more.

Anderson attributes this to consolidation among hospitals and doctors' practices, which allows them to demand higher prices.

Despite paying higher prices, Americans actually have less access to doctors, nurses and hospital beds. There are only 2.6 practicing doctors per 1,000 people in the US, compared to a median of 3.2 active physicians in the OECD, for instance.

"It's not that we're getting more. It's that we're paying much more," Anderson said.

Politicians, policy experts, health care industry executives and employers have wrestled with the nation's high health care costs for decades. The efforts include raising deductibles to give consumers more incentive to shop around for health care services and paying doctors and hospitals based on patients' health outcomes rather than for every service rendered.

Currently in the spotlight are high drug prices, which are expected to be a major focus of both Congress and the Trump administration this year.

With John Conyers, annual sponsor of the Medicare-For-All bill, Pramila Jayapal has taken on that role. She just managed to get a first-time-ever agreement to allow a debate on the bill, which, as you know, has the support of over half the Democrats in Congress-- at least on paper. Jayapal also heads the Medicare-For-All Caucus in the House and there were already 76 members before the freshmen had started joining. These are the current members:

Pramila Jayapal (WA-07)
Debbie Dingell (MI-12)
Karen Bass (CA-37)
Joyce Beatty (OH-03)
Don Beyer (VA-08)
Earl Blumenauer (OR-03)
Suzanne Bonamici (OR-01)
Brendan Boyle (PA-13)
Anthony Brown (MD-04)
Andre Carson (IN-07)
Kathy Castor (FL-14) Judy Chu (CA-27)
David Cicilline (RI-01)
Katherine M. Clark (MA-05)
Yvette Clarke (NY-09)
Wm. Lacy Clay (MO-01)
Steve Cohen (TN-09)
Danny Davis (IL-07)
Pete DeFazio (OR-04)
Nanette Barragán (CA-44)
Mike Doyle (PA-14)
Eliot Engel (NY-16)
Adriano Espaillat (NY-13)
Dwight Evans (PA-02)
Lois Frankel (FL-21)
Marcia Fudge (OH-11)
Tulsi Gabbard (HI-02)
Ruben Gallego (AZ-07)
John Garamendi (CA-03)
Jimmy Gomez (CA-34)
Vicente Gonzalez (TX-15)
Al Green (TX-09)
Raúl Grijalva (AZ-03)
Alcee Hastings (FL-20)
Brian Higgins (NY-26)
Eleanor Holmes Norton (DC)
Jared Huffman (CA-02)
Hank Johnson (GA-04)
Robin Kelly (IL-02)
Ro Khanna (CA-17)
Brenda Lawrence (MI-14)
Barbara Lee (CA-13)
John Lewis (GA-05)
Ted Lieu (CA-33)
Zoe Lofgren (CA-19)
Alan Lowenthal (CA-47)
Carolyn Maloney (NY-12)
Jim McGovern (MA-02)
Jerry McNerney (CA-09)
Grace Meng (NY-06)
Jerrold Nadler (NY-10)
Grace Napolitano (CA-32)
Jimmy Panetta (CA-20)
Chellie Pingree (ME-01)
Mark Pocan (WI-02)
Jamie Raskin (MD-08)
Lucille Roybal-Allard (CA-40)
Tim Ryan (OH-13)
Jan Schakowsky (IL-09)
Bobby Scott (VA-03)
Jose Serrano (NY-15)
Albio Sires (NJ-08)
Adam Smith (WA-09)
Darren Soto (FL-09)
Mark Takano (CA-41)
Dina Titus (NV-01)
Paul Tonko (NY-20)
Marc A. Veasey (TX-33)
Nydia M. Velázquez (NY-07)
Maxine Waters (CA-43)
Bonnie Watson Coleman (NJ-12)
Peter Welch (VT-AL)
Frederica Wilson (FL-24)
John Yarmuth (KY-03)
Mark DeSaulnier (CA-11)
Andy Levin (MI-09)

You don't see your representative on the list? Don't ask me; ask him or her. And then let me know what they say. But at this point, why be a Democrat at all if you dion't believe in Medicare-For-All?

These are the caucus' founding principles: "Health care must be affordable and accessible to everyone in the United States. One of the best ways to ensure health care for all is to use the system that already exists for millions of seniors over the last half century: Medicare. No one should be one health care crisis from bankruptcy. No one should be worried about obtaining life saving medicine due to cost or access. This caucus is committed to making sure that every American across the country has quality, affordable health care. The path forward is through Medicare for All."

Audrey Denney hasn't begun her 2020 congressional campaign yet, but I'm sure that's just a matter of time. I asked her if I could use a video of hers from last year. It was filmed in her hospital bed 18 hours after she came out of massive abdominal surgery. I’m guessing she was talking REALLY slow in it because she must have been on a bunch of pain meds. At the 4:09 mark she gets into Medicare-For-All in a way you should listen to. She also talks about rural health, important in a district that's almost half rural. I especially like when she compares members of congress to tumors (at the end).  This is a more straightforward healthcare video her campaign did did. This morning, she told me that "Our healthcare system is broken. It is designed to provide profits to insurance and pharmaceutical companies. It is not designed to allow healthcare professionals to provide quality, patient-centered care to everyone. It is not designed to allow us to focus on the prevention of disease, rather than the late-stage treatment of it. It is not designed to allow people to feel comfortable knowing that if they are faced with a medical emergency, they will be treated and cared for without going into financial ruin. People across the political spectrum are ready for a solution-- and that solution is Medicare for All.



Late last year, the Health Affairs Blog noted that "Many observers dismiss single-payer health care as a political non-starter, but this traditional view ignores an explosion of support for the idea in recent years. In one recent poll, over 70 percent of Americans said they would support 'a policy of Medicare for All', including 85 percent of Democrats and even 52 percent of Republicans. A subsequent poll asked 'do you support providing Medicare for every American' and found nearly identical results, including majorities of support from respondents in the South, those who live in rural areas, and those who say they 'lean conservative.'"

In the 2018 elections, Democrats regained a majority in the House of Representatives, winning almost 40 seats back from Republican control in the biggest pickup for Democrats since the post-Watergate elections in 1974.

We analyzed the campaign platforms, bill co-sponsorship records, and public statements of the newly elected members of Congress, and found that the number of Representatives supporting Medicare for All has risen to at least 133, now representing almost 60 percent of the Democratic Congressional delegation.

These supporters include over 100 incumbent co-sponsors of H.R.676 who won re-election (H.R.676 is the Medicare for All bill in the House). There are also many new political faces who support Medicare for All, including progressive newcomers Alexandria Ocasio-Cortez (NY-14), Ayanna Pressley (MA-07), Rashida Tlaib (MI-13), Ilhan Omar (MN-5), and Jahana Hayes (CT-5). Medicare for All supporters also won elections in swing Congressional districts and traditionally conservative states. California’s 48th district has elected a Republican Congressman for nearly 30 years; Harley Rouda narrowly defeated the incumbent this year, calling for health care as a right and pursuing “Medicare for All as a long-term solution.” Sylvia Garcia is a first-time candidate who won election in Texas by promising, “I will fight for Medicare for All."

There are also a number of Representatives who have not explicitly declared their support for Medicare for All, but have signaled that they remain open to the idea. Joe Kennedy (MA-04), a rising star in the Democratic Party, did not co-sponsor H.R.676; however, he has said he would consider co-sponsoring an updated version of a Medicare for All bill if it addressed his concerns with the current version.

Medicare for All will not become law in the next two years, but the incoming 116th Congress could play an important role in determining the future of the proposed reform.

First, this Congress will have an opportunity to distinguish Medicare for All from other Democratic proposals to expand public coverage. To capitalize on the popularity of Medicare for All, some organizations have released more moderate proposals with sound-alike names such as “Medicare Extra for All”; others have started to brand Medicare buy-in proposals with slogans like “Medicare Available to All” or “Medicare for Anyone.” These alternatives are essentially variations on a public option. These proposals vary in their details and scope, and their relative merits are worthy of debate in the upcoming Congress. However, they differ substantially from the actual Medicare for All bills that have been proposed in Congress for many years. The 116th Congress will have an opportunity to clarify these differences, and to build further public understanding of Medicare for All.

Second, the 116th Congress can start building consensus on key policy elements of a Medicare for All proposal, including knotty issues such as determining the covered benefits of the plan, exploring alternative revenue sources and cost controls, deciding how providers would be paid and at what prices, how to pave a practical transition pathway from current health plans, how to craft a soft landing for the employees of the current insurance industry, and more. Ideally, this exploration will help foster a deeper and more mature discussion of Medicare for All among legislators in the future.

The legislative process provides a roadmap by which policy consensus can be pursued. Rep. Pramila Jayapal (WA-7), co-chair of the Medicare for All Caucus, will become the primary sponsor of the House Medicare for All bill, and a revised version of the bill will almost certainly be released early in the Congressional session. The bill will then fall to two key committees with relevant jurisdiction: Ways and Means, and Energy and Commerce. These committees have the opportunity to “mark up” the bill and hold public hearings. The degree to which Medicare for All receives hearings-- and whether it is ultimately voted out of committee-- will depend heavily on the degree of support from the leadership and membership on these two committees.

On the Energy and Commerce Committee, incoming Chairman Frank Pallone (NJ-6) has said he has “always been an advocate for Medicare for All or single payer”, but he has not co-sponsored H.R.676 and has said that his priority as Chairman will be to stabilize the Affordable Care Act. The member most likely to head the Health Subcommittee of Energy and Commerce is Anna Eshoo (CA-18), a co-sponsor of H.R.676 and supporter of Medicare for All. On the Ways and Means Committee, neither the incoming Chairman (Richard Neal, MA-1), nor the favorite to head its Health Subcommittee (Lloyd Doggett, TX-35), have indicated support for Medicare for All. Additionally, the likely Chair of the Budget Committee (John Yarmuth, KY-3) has stated that he plans to hold hearings on Medicare for All.

Though these procedural machinations don’t often make headlines, House committees have a critical opportunity to raise national awareness of Medicare for All, bring stakeholders to the table, and work toward consensus on policy details-- if the powerful members of these committees choose to do so.

Finally, it is possible that the 116th Congress could bring Medicare for All to a vote on the floor of the US House of Representatives. To pass the House, an additional 85 members of Congress would need to join the 133 supporters we have identified to compose a 218-vote majority. If Medicare for All passes the House, it would be a powerful symbolic step showing that Congress is serious about pursuing this reform, and underlining its widespread support. Even if Medicare for All does not pass the House, a vote would force Representatives to officially declare their positions. Holdouts may face increased pressure during the 2020 elections, especially if public support for Medicare for All continues to grow.