Jeff Greenfield: The Land Mine that Just Got Laid for Elizabeth Warren

[brooklynite]

Politico

On several occasions in Wednesday night’s Democratic debate, the NBC moderators invited candidates to take a shot at Elizabeth Warren, and neither of her fellow senators, Amy Klobuchar or Cory Booker, took the bait. But one candidate may have planted a land mine under her candidacy—and she wasn't even his target.

The moment came when the 10 participants were asked, by a show of hands, who would dispense entirely with private health insurance. Only New York Mayor Bill de Blasio and Warren signaled “yes.” That's when former Rep. John Delaney, one of the least visible of the 24 announced candidates, weighed in.

After pushing back on the idea of taking something away from Americans that most are reasonably happy with, Delaney said this:

“Also it’s bad policy. If you go to every hospital in this country and you ask them one question, which is how would it have been for you last year if every one of your bills were paid at the Medicare rate? Every single hospital administrator said they would close. And the Medicare for All bill requires payments to stay at current Medicare rates. So to some extent we’re basically supporting a bill that will have every hospital closed.” And then he finished with a stinger about his electrician father on union health insurance: “He’d look at me, and he’d say ‘Good job, John, for getting health care for every American, but why are you taking my health care away?’”

As an argument inside the Democratic Party, where “Medicare for All” is a rallying cry, this may not resonate. But once there’s a general election, it’s a new landscape, and if Warren—or Bernie Sanders, who shares the “no private insurance” view—makes it to that stage, it could be a much bigger deal. We know from earlier races that moments with little impact inside a primary can have a powerful impact in the final fall.

[pnwmom]

1. He does have a point. The private insurers have been helping to subsidize Medicare and Medicaid.

How does a Medicare for All plan account for that?

[Turin_C3PO]

3. Maybe Congress

can up the reimbursement rates.

[SouthernProgressive]

4. Their profit margin is pretty impressive.

Removing it will help in many areas. I know that isn't enough but it should be a part of the discussion.

Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter. That’s up more about 29 percent from the same quarter a year ago — far outpacing the overall S&P 500 health care sector’s growth of 8.5 percent for the quarter, according to Thomson Reuters I/B/E/S data.

It's not play money. Not saying you said it was.

https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html

[marylandblue]

6. The problem with this debate is we throw numbers around without context.

We spend about $900 billion on health care every quarter. So $6 billion is about 0.66% of the total.

[SouthernProgressive]

10. It's a pretty impressive chunk of change.

I was clear in my statement that it wasn't all that's needed. It also doesn't hit on how medicare covers the highest cost individuals with our current system. Shifting less burdensome people over would have enormous benefits itself.

[marylandblue]

16. But just taking profit out of the equation isn't going to make much difference.

We need to figure where the money is actually going, and I've never seen a detailed breakdown of that. I have looked and.the most I've seen is a broad overview.

I do know that everyone, including Medicare, plays in funny money. Hospitals charge one amount, Insurance pays a different amount arbitrarily lower than the charged amount, and the actual cost is a secret number that nobody will tell you.

[Hoyt]

28. Exactly. The big money is profits made by providers.

Unless that is restricted, M4A isn’t going to make a lot of difference. Someone paying $1000 a month in premiums, might end up paying $940, at best. That helps, but people are still going to gripe.

But, we have to get everyone covered.

[Voltaire2]

7. Er, it is the other way around.

Keeping all the high cost older people in Medicare helps increase the profitability of the private insurance companies.

[pnwmom]

12. Medicaid has an even lower reimbursement rate. n/t

[Voltaire2]

13. Sure, but again private insurers don't

have to provide insurance to poor people.
The thing about a single payer system is that it covers everyone. One rate schedule, no profit motivation. Right out of the gate that is somewhere around 1/3 of current healthcare spending that can go to actual healthcare instead of profit.

[Hassin Bin Sober]

25. So when you say private insurers subsidize Medicare you mean us, yes?

Because insurance gets that money from us. Why not cut out the middleman and their profit motive.

[Hoyt]

33. Obama did. Limited big companies to 15% for overhead, including risk, and profit.

That overhead includes claims processing, big bucks for adjudication systems, etc.

Not supporting insurers, but many of those costs will still have to be paid. Point is, the savings from getting rid of middleman might be 6% or so. Not insignificant, but hardly life changing (except for people who don’t have adequate coverage now).

Now the profit motive among providers, drug companies, research, etc., is a big deal. When the doc gets cut, and cuts his nurses’ pay, we’ll see how it goes.

We have to get everyone covered, stop medical bankruptcy, etc., but it’s going to be ugly.

[Voltaire2]

45. that would be unfair

to billionaires.

[Raven123]

29. i do not believe private insurers subsidize Medicare/Medicaid

Those who pay for private insurance subsidize Medicare/Medicaid through

Those who have no insurance and pay “sticker price” for health care subsidize Medicare/Medicaid.

Frankly I think the health care system is so complex that no one really knows how much single payer or Medicare will cost. We do know that the US system is very expensive and not affordable for many.

[LiberalFighter]

31. Private insurers don't subsidize anyone but themselves.

[dlk]

2. The Low Medicare Reimbursement Rates Aren't Set In Stone

They can be raised.

[marylandblue]

17. Then it negates the promised cost savings of a single payer system.

[LiberalFighter]

39. Not when

1) considering the large number of insured in one plan or group of plans. That helps reduce costs.

2) reducing the administrative costs will have a major impact.

3) private insurers are there to make a profit and pay their execs big big bucks.


I belong to a VEBA which is the largest non-government group. Our health care plan is considered top of the line. At least for working people. Before I became Medicare eligible my monthly premiums were $17. Because I enrolled in the Medicare Advantage plan for our group my monthly premiums are now $0. Back in the early 90's my coverage was about $800 a month as a single person if I was paying.

Currently, Medicare is not 100%. It only covers 80% of covered costs after meeting deductibles.

Would Medicare for All be the 80% and we take care of the other 20%? Would Medicare Advantage plans be available? If so, private insurers would still be included but their impact on hospitals would not be as great. And it would require Congress to provide a more robust plan which would include paying reasonable payments. At the same time, it would be necessary for hospitals and doctors to reduce their outrageous costs. The same goes for pharma.

[marylandblue]

42. You are all over the map with things.

A VEBA is a trust fund not itself insurance and generally includes a employer contribution.

Medicare 4 All is defined as a thing that eliminates private insurance which means no Medicare Advantage, so not actually Medicare at all.

Then you talk about risk pools and cutting costs for salaries, admin, hospitals, doctors and drugs.

By the time you get through all that, you have something totally different from what we have now, isn't Medicare, and isn't spelled out in Bernie's plan.

And you still have not told me how much money we can actually save this way without hospitals closing up or doctors retiring en masse.

[Demsrule86]

43. It would cost more so people with employee plans pay more taxes,pay a medicare premium and

then pay unsubsidized insurance premiums....that will go over well.

[TygrBright]

5. Meh. The "providers would go out of business" argument is old...

...and has been refuted many times, many ways.

The fix I personally like best is something similar to how the State of Maryland manages hospital rates, but on a national scale: Setting rate payments based on what's required to maintain adequate provider viability, but then requiring providers to get approval to expand or contract services based on needs and existing availability of services.

The assumption that any single-payer (or "Medicare for All" ) option would look EXACTLY like existing Medicare programs is a straw man of the first order.

And Warren and all the others advocating for public-sector single-payer systems know it, and their plans accommodate the required balance between provider availability and patient access.

dismissively,
Bright

[marylandblue]

18. If they want a well-designed single.payer system that doesn't work like Medicare,

they should call it something else, because as.long as you call it "Medicare" people will assume that's what it is, then when you give them something else, they will call you a liar.

[customerserviceguy]

8. I was surprised

when I saw her hand go up. I guess de Blasio's did, too, but since he's never going to get the nomination, I didn't care. Even Sen. Harris backed away from the concept of taking away everybody's private insurance.

I doubt it will play well with union people who should be in our corner. They've negotiated for the wages and benefits they get, and they know that they can get seen and treated as quickly as is humanly possible so they can get back on the job again ASAP.

[Raven123]

30. I was surprised Booker didn't raise his hand as I believe he co-sponsored the bill

[BeyondGeography]

36. That's one reason why she's way ahead of him

Whatever your response to that question, as the nominee you will be portrayed as a flaming socialist, even if you didn’t sign on. Might as well offer some clarity to your own voters as a starting point for the conversation about how we get to M4A and how it works. Nothing to be gained by hedging when you’ve already co-sponsored the bill.

[Buzz cook]

32. Health care benefits as part of worker compinsation started during WWII

Wages were frozen and companies were looking for ways to attract workers. At the time it was a good deal for the companies and an OK deal for workers.
As medical costs increased it has become a bad deal for companies and a necessity for workers. If we remove private insurance that removes a huge burden from employers and frees money that hopefully will go to workers.

Yes unions have put lots of effort into getting better health care benefits. But if they are offered a better deal they will take it.

[LiberalFighter]

41. I would suggest that union members would support this IF

they receive the same level of health care coverage for less money that more money goes directly into their pockets.

[Demsrule86]

44. That wont happen and my son has uaw coverage...he pays nothing.

[LiberalFighter]

47. I'm a UAW retiree.

Health care coverage would definitely be a big sticking point. But, if costs to GM, Ford, and Chrysler could be less for the same coverage then it is something they should consider. It would mean the money not being paid for health coverage could be put in the pocket of the member. Or reinstate the pension plan or provide another benefit.

There is a VEBA plan that includes all retirees from GM, Ford, and Chrysler. Even though it is in one plan the money for each auto is kept separate. The money was paid by them but it is administered by people appointed by the UAW. There are other VEBA plans for other retirees from other companies. I know of only other and it is managed by the company.

Anyways, our VEBA has a good plan because of the combined numbers, about 600,000. Our costs are lower because of it. We have better coverage because of it.

Now if the actives were to be included it would make a big difference for them. GM has between 30,000 and 50,000 UAW members. Even though they would be separate from the retirees and other autos the numbers would give them power to negotiate with the different medical entities.

[Demsrule86]

50. The union now covers healthcare for hourly at GM.have since 2008.

The union gave up wages for this too. GM made single payment. MFA is a bad idea. Could cost us the election.

[LiberalFighter]

51. UAW members at GM have had health care coverage for a lot longer than 2008.

Long before I first worked at GM.

Yes members had wages diverted to health care, pension, and other benefits.

A version of Medicare for All would not necessarily be the same for everyone. Current Medicare does not pay 100%. Those covered are responsible for the 20% that is not covered. I am fortunate that my 20% doesn't cost me. But those not fortunate have to get their own coverage for it.

If union members could be covered by a universal health care plan. It would reduce their costs. Back in 2015 the average cost at Ford was $15,000 a year. And if we can do anything like Canada, England or other countries the cost could possibly be reduced by half for the same coverage. That could be about $7,500 a year in the pocket of the union member. It might be more or less.

If I could get the same coverage at reduced cost and pocket the difference I would go for it.

[Demsrule86]

52. No kidding. GM gave a one time amount of money and now the union

covers the cost. They gave up money for this and should not lose their healthcare and be forced onto MFA...bad idea.

[LAS14]

9. Warren must have something to say about this. Anyone know what it is? nt

[Bradshaw3]

11. Does anyone listen to Jeff Greenfield anymore?

Thought he was retired.

[brooklynite]

14. Bernie Sanders is two years older than Jeff Greenfield. Does anybody listen to him anymore?

Perhaps you could critique an actual comment, rather than his ability to make one?

[Bradshaw3]

20. Had nothing to do with age, had to do with his relevance due to past commentaries

That's my critique. Good enough for you?

[BannonsLiver]

24. He was past his sell by date in 1992.

He may not be wrong about this, or he may be, but he’s strictly D list when it comes to pundits. Conservadems love him though.

[Camaromjr]

15. Great Britain Sets the Example

For those that think that universal healthcare cannot be done, I want to have everyone look to 1948. Three years after WWII. Remember the Battle of Britain, the V1 and V2 terror strikes. Just think of the condition of that nation in 1948.

In 1948 Great Britain established the National Health Service. In 1948

We are the only first world nation not to have universal healthcare. We spend more than any other nation on earth on healthcare and do not have the best outcomes.

Bench-marking U.S. quality measures against those of similarly large and wealthy countries is one way to assess how successful the U.S. has been at improving care for its population, and to learn from systems that often produce better outcomes. The OECD has compiled data on dozens of outcomes and process measures. Across a number of these measures, the U.S. lags behind similarly wealthy OECD countries (those that are similarly large and wealthy based on GDP and GDP per capita). In some cases, such as the rates of all-cause mortality, premature death, death amenable to healthcare, and disease burden, the U.S. is also not improving as quickly as other countries, which means the gap is growing.

[url]https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start[/url]

[marylandblue]

19. Again, no Democrat is against is against Universal healthcare, but

we keep assuming that means NHS or Medicare. There are other models. Germany have a mixed system similar to the public option.

[Hoyt]

38. Canada's system is a mixture. And, the national system does not cover drugs.

There are many ways to get everyone covered. We need to come up with a plan that most folks can live with, and soon.

[KayF]

21. oh wow a candidate advocating single payer is going to get pushback

what a fascinating insight.

Next we'll hear that most of that pushback will appear in Politico.

[Demsrule86]

46. No she will probably lose rhe general. Health care is a big deal.

Taking away stuff is never good.

[karynnj]

22. Why does every other first world nation have government based insurance

and have world class hospitals.

I know that Medicare pays just a fraction of the "bill", but I also know that the same is true of the big company insurance plans. The fact is that the US pays substantially more than the rest of world on a per capita basis ... and the results are NOT better. Not to mention, every doctor's office has someone who spends a huge amount of time dealing with insurance companies.

Greenfield and Delaney seem reluctant to question the status quo - even when there is ample reason to do so.

[lindysalsagal]

23. Senator Warren is so good with numbers, I'm sure her plan will work. She may make the

hospitals non-profit and give them government support, put most doctors on salary, open free clinics that peel off much of the waste in hospitals. Who knows. If it's her plan, it will work and she can always tweak it if necessary.

Maybe leaving all else as is would result in the hospitals closing, but that's a foolish assumption, knowing the mind of that senator.

[marylandblue]

34. I couldn't find any healthcare plan from her, and I was disappointed that

she put all the blame on insurance companies. There are a lot of other places the money goes. I'm sure could figure it out, but has she tried? Seems like she just jumped onto Bernie's plan.

[emmaverybo]

26. Half of the nation's seniors on Medicare also carry another plan, one they buy into, or, in many

cases, one their retirement plan covers at no cost or group rates. Seniors do vote.

[Demsrule86]

53. The ones covered for free are bad for hospitalization...

My sis inlaw would have paid thousands...if she stayed five days inpatient.

[wasupaloopa]

27. Medicare pays 80% of what insurance pays for a procedure.

Nurses and doctors will have to work longer for less if everyone had Medicare.

[Hoyt]

40. Nurses I worry about, most docs can stand a cut.

[DeminPennswoods]

35. Status Quo is not an option on healthcare

Just ask the thousands of Pennsylvanians who have been held hostage by the UPMC/Highmark feud. They would take Medicare every day of the week and twice on Sunday and be able to see any doctor they wanted rather than re-live that fiasco. Although a 10 yr contract was just signed between the 2 healthcare giants, 10 yrs isn't forever.

[saidsimplesimon]

37. Greenfield should go pound sand. imo

This is a hit piece.

I just reviewed a hospital bill for an emergency visit for a relative. Diabetics do not have complete control over the peaks and valleys of insulin levels. Hospital visits are not a rare occurrence. Their insurance paid $12,096 for an emergency visit and one night's hospital stay. The hospital billed $15,678.

The hospital performed and billed for a pregnancy test without asking the patient. The hospital charged for a stay in a "private room", not patient approved or requested. $4,841 was charged for admissions critical care unit, $4.814 for lab fees, $3,827 for emergency dept., no details.

All human beings deserve affordable health care. Of course, I'm just a dreamer.

[marylandblue]

48. There is no rhyme or reason to Hospital costs.

There are other costs buried in the emergency room bill. Hospital doesn't allocate correctly, neither insurance cos. or Medicare do true cost accounting, employers don't demand insurance cos. put in appropriate cost control measures, and nobody tells you how any of part of the bill or payment was calculated. They also don't tell you how they figured out your premium.

[saidsimplesimon]

49. You are correct.

Working people are exploited when they work long hours and have no time to dispute charges. I wanted to bring attention to that fact. They are as vulnerable as those canaries in our coal mines.

Greed is a powerful aphrodisiac.