Monday, September 11, 2017

Elizabeth Warren is for single payer, sort of. And against healthcare profiteering...sort of.

Elizabeth Warren sent a letter to supporters last week announcing that she's co-sponsoring Bernie Sanders' Medicare for All bill and asking recipients to sign on as "citizen-co-sponsors."

That's interesting, as Warren herself does not sound exactly all-in.   My emphasis below:
I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans? Everything should be on the table – and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month 
Warren is for putting Bernie's bill on the table -- not necessarily for passing it. There's more hedging near the bottom of the letter:

Medicare for All is one way that we can give every single person in the country access to high quality health care. Everyone is covered. Nobody goes broke paying a medical bill. Families don’t have to bear the costs of heartbreaking medical disasters on their own.
As Harold Pollack and Ron Pollack (no relation) have recently reminded us, single payer is indeed "one way" to get to universal coverage -- and many countries with successful healthcare systems have gotten there by other means. Unlike existing single payer systems, moreover (and very unlike U.S. Medicare), Bernie's bill calls for zero cost-sharing from patients, whereas Warren's language suggests that she seeks a system where no one "goes broke" or bears the full brunt of major healthcare costs -- not one where citizens pay no out-of-pocket costs. To co-sponsor a bill is not necessarily to support its becoming law, as the many sponsors of the creative but disruptive 2008 Wyden-Bennett bill, which would have ended employer-sponsored healthcare, can attest.

There's one more hint that Warren is not entirely serious about single payer. Look at what healthcare industries she slams -- and doesn't slam -- while proposing incremental steps to reduce users' costs:
But there’s so much more we could do right now to bring down the costs of quality health care for every American. We could start by ending health insurance company price gouging – ending high deductibles, surprise bills, and endless fights with insurance companies over coverage for critical medical procedures or out-of-pocket costs. We could also cut the cost of prescription drugs by importing drugs from Canada, where the same prescription can sometimes cost far less than in the US. 
Warren here appears to blame insurance companies exclusively for high deductibles and for surprise billing. Conspicuously absent from the attack: doctors and hospitals. But healthcare providers would likely be the most formidable and unequivocal opponents -- along with pharmaceutical companies --  of a single payer system.  Insurers could conceivably be coopted via arrangements resembling those governing Medicare Advantage or managed Medicaid, in which insurers administer benefits funded by the government. That's not Bernie's bill, but it could be a component or even main delivery mechanism of single payer.

The letter's final paragraph takes another swipe at the usual suspects:
The American people have made it clear that they believe health care is a basic human right – but it will be a tough fight. The giant insurance and drug companies will send out their army of lobbyists to fight our Medicare for All bill every step of the way. Sign up now to join our fight and become a citizen co-sponsor of Medicare for All and fight back.
It's par for the course for Democrats to bash insurers and pharma while giving healthcare providers a pass. But if Warren is serious about single payer, she'll have to take on physician and hospital price gouging as well.




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