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https://www.nytimes.com/2020/10/05/opinion/joe-biden-health-care.html
We have bidencare guys

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Biden wants to defend the Affordable Care Act from legal and congressional challenges.
https://www.npr.org/sections/health-shots/2020/10/22/926372475/comparing-bidens-and-trump-s-different-visions-for-health-care

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Democrats want universal healthcare, so they support single-payer systems. Biden wants to improve the Affordable Care Act- he wants to add a public option and the elimination of the current income cap.

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Where Democrats stand Health care Immigration Voting Climate Education Foreign policy Economy Guns Criminal justice
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Do you support Medicare-for-all?

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SINGLE-PAYER PLAN

Government

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taxes

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treatment

SINGLE-PAYER PLAN

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SINGLE-PAYER PLAN

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SINGLE-PAYER PLAN

Pay taxes

Pays for treatment

Patients

Government

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SINGLE-PAYER PLAN

Pay taxes

Pays for treatment

Patients

Government

Providers

HOW PRIVATE INSURANCE WORKS NOW

Insurance

companies

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Providers

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premiums

Pay for

treatment

Pay co-pay

HOW PRIVATE INSURANCE WORKS NOW

Pay

premiums

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treatment

Patients

Insurance

companies

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Pay co-pay

HOW PRIVATE INSURANCE WORKS NOW

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premiums

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HOW PRIVATE INSURANCE WORKS NOW

Pay premiums

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companies

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HOW PRIVATE INSURANCE WORKS NOW

Pay premiums

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Patients

Providers

Insurance

companies

Pay co-pay

MODIFIED SINGLE-PAYER PLAN

Pay for

elective coverage

Pay for

procedures

Supplementary or

complementary insurers

Pay

taxes

Pays for

treatment

Government

Patients

Providers

MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

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taxes

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treatment

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MODIFIED SINGLE-PAYER PLAN

Pay for elective coverage

Pay for procedures

Supplementary or

complementary insurers

Pay taxes

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MODIFIED SINGLE-PAYER PLAN

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Pay for procedures

Supplementary or

complementary insurers

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Where 2020 Democrats stand on Medicare-for-all and other health-care issues

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The major Democratic presidential contenders have been vocal about the need to expand health-care coverage for more Americans. But they have split on how to do so.

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No. It will not work. There's too many people in America and the federal government will have too much stuff in their plate.

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Taiwan’s healthcare system involves a health card ID that can be used at every clinic (of all types, dentist, dermatologist, pediatrician). It proves their healthcare coverage and stores their medical records. The system was first established in the 1990s and is a healthcare system that covers everybody on the island. Citizens pay for healthcare through taxes. It’s a good deal, but it is hard on the doctors and the hospitals are always crowded. I think America should try this system even though it has its cons. America’s healthcare system is extremely flawed and discriminatory towards minorities and people of lower economic status. I constantly hear complaints over their system. Most Americans don’t have any health insurance and it’s STILL very expensive for the government.

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HUALIEN COUNTY, Taiwan - Thirty years ago, before she dyed her hair pink to cover up the white, Dr. Huei-wen Tien came to Xiulin, a township on the east coast of Taiwan severed from the island's urban centers by a formidable mountain range.

She had agreed to serve for 10 years in an aboriginal community in exchange for her medical education. Unconventional by nature - her motorcycle helmet says "Punk" - Tien says she wanted a challenge. She found one here, where about 15,000 people, mostly of the Taroko tribe, live near the lush gorges of a national park that shares their name.

Diabetes, alcoholism, and heart disease are common problems among the Taroko. The indigenous people have endured displacement, forced assimilation, and discrimination over the centuries. They are also poorer than the ethnically Han Chinese who make up most of Taiwan's population.

But they never have to worry about one thing: their health care. In Taiwan, everybody is covered. The Taiwanese health care system is built on the belief that everyone deserves health care, in Xiulin just as much as anywhere else. The costs to patients are minimal. And the government has set up special programs to deliver care to the people in Xiulin and their neighbors in Hualien County.

On a warm October afternoon, in a government health clinic in the foothills of the Zhongyang (Central) Mountain Range, Tien saw an older Taroko woman she's treated for decades. They have a comfortable rapport. The doctor teased the patient for her high blood sugar, asked what she had for breakfast, and insisted the woman take her diabetes medication that she skipped that morning. (The woman said she was busy.)

Tien then inserted the woman's national health insurance card into a chip reader to pull up her medical record on the computer. The cards are ubiquitous in Taiwan, the signature of its single-payer health care system, carried by everyone from the woman in Xiulin to a venture biotech executive I met in Taipei.

In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders's vision of Medicare-for-all as anything in the world.

I came here last October to learn what it takes to set up and sustain such a system. It's one of several stops around the globe that Vox made this past fall, in an effort to learn how other countries tried to achieve universal and affordable health care. Our project, Everybody Covered, was made possible by a grant from The Commonwealth Fund.

There's clearly a need for lessons. Compared to the rest of the developed world, America spends more money on health care and produces worse outcomes. By one advanced metric - mortality for causes that should be avoidable with accessible, high-quality health care - the United States ranked last among the G7 countries in 2016. America's infant mortality rate is almost double that of some of its peers. Nearly one in 10 Americans lack insurance. People go bankrupt over medical bills. Yet Americans still spend about twice as much money on health care per capita as the average comparable country.

No health care system is perfect. But most of America's economic peers have figured out a way to deliver truly universal coverage and quality care. The United States has not.

"Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good," health care economist Uwe Reinhardt wrote in his book Priced Out shortly before his death in 2017. "By contrast, we in the United States have never reached a politically dominant consensus on the issue."

Taiwan made its choice in the 1990s and embraced single-payer. It has required sacrifice: by doctors who believe they're forced to see too many patients every day; by patients with complex and costly conditions who can't always access the latest treatments; by citizens who have been asked from time to time, and will be asked again, to pay more for their health care than they did before.

The vast majority of Taiwan's citizens today approve of their health care system. They know it isn't a utopia. The country has made hard choices to keep this program sustainable, and it will need to do so again. That is what it takes to realize the single-payer dream.

Taiwan took a broken system and built a new national health insurance program

Extraordinary circumstances paved the road to Taiwan's single-payer system.

In the 1980s, Taiwan wasn't yet a democracy, but the stirrings of popular rule could be felt. At the time, about 40 percent of Taiwanese people lacked health insurance - some people lost everything, even their house, if they had a medical crisis. Desperate to outflank reformers, the ruling government convened high-profile meetings to fix its health care system.

One guest at a 1989 conference was the German-born Reinhardt, a Princeton economist who was married to Taiwan-born scholar Tsung-Mei (May) Cheng.

Reinhardt, who later co-wrote the seminal paper " It's The Prices, Stupid " about American health care and helped define the health policy debate in the US in the 2000s, was asked what system he thought Taiwan should adopt. He thought it over and talked about it with his wife for a couple of nights in their hotel room.

He finally delivered his answer: single-payer. One national health insurance plan, run by the government, covering everybody.

In Reinhardt's view, single-payer would be the most equitable and efficient program. It was similar to systems already in place in Canada and the United Kingdom. He came up with the metaphor of the "single pipe" - through which all the money for health care would flow - to convey the concept to public officials.

It was a convincing presentation. As Cheng and her husband left to return to the United States, they didn't know what would happen next. "We went back to Princeton," Cheng recalls, "and six months later, we were told the government would accept your recommendation to go single-payer."

The national government would eventually fast-track the implementation of the new system to 1995, hoping to get the chaotic transition period over before the first popular elections in 1996. There was plenty of skepticism leading up to it. Industry, experts, and the public alike doubted the program would succeed. Labor protesters threw paper money traditionally used in a funerary rite when the legislature passed the single-payer bill in 1994. A majority of people in Taiwan disapproved of the single-payer plan when it took effect.

But the program's reputation quickly improved once people started to enjoy its benefits. Approval has dipped (when premiums were hiked in the 2000s) and risen (when the rural health care program that employs Tien in Xiulin was implemented) over the years, but there has always been a solid baseline of support. Today, approval of the national health insurance program hovers near its all-time high, over 80 percent. The system endures 25 years after it was established.

Part of its appeal is its simplicity. Everybody in Taiwan is insured through the National Health Insurance Administration (NHIA). They receive an ID card as proof of coverage, which also stores their medical records. The Taiwanese program runs with extraordinary efficiency: About 1 percent of its funding is spent on administration, according to a 2015 review by Cheng. (Compare that to the US, where researchers have estimated that private insurers spend around 12 percent of overhead, and hospitals spend around 25 percent on administrative work.) Experts say Taiwan's advanced IT infrastructure deserves a good share of the credit.

The benefits are quite comprehensive: hospital care, primary care, prescription drugs, traditional Chinese medicine. Patients must make copays when they visit the doctor or fill a prescription or go to the ER, but they are generally low, 360 NTD (about $12) or less. Lower-income patients are given an additional break on their cost-sharing obligations. Higher-income patients can take out private insurance for certain things not covered by the single-payer program.

The system is mostly funded by payroll-based premiums, with contributions from workers and their employers, supplemented by more progressive income taxes and tobacco and lottery levies. Premiums have been raised twice in the past 18 years to cover the growing cost of the program. The most recent rate increase in 2010 moved the payroll income tax rate from 4.55 percent to 5.17, a 14 percent increase.

In the early 2000s, again at Reinhardt's recommendation, Taiwan converted to global budgets to pay for health care as another cost-control measure. This means that every year, government officials and private providers sit across a table and negotiate rates for services, with an annual cap set on the total payments to hospitals and doctors that the government will make. Health spending has stayed flat in recent years as a percentage of GDP, and it is growing at a slower rate in Taiwan than in the United States.

Taiwanese patients use a lot of health care, and it puts a strain on providers

What it all adds up to is a system that patients seem broadly happy with - maybe too happy, according to doctors and economists I met.

"I believe we are too kind to our patient[s]," says Shou-Hsia Cheng, a health economics professor at National Taiwan University (NTU) who has worked at NHIA on and off over the years, "which is not a good thing, actually."

Taiwanese people take advantage of their cheap, accessible health care. The average number of physician visits per year ( 12.1) is nearly twice that of other developed economies. There was a dramatic spike in use after single-payer was passed: A 1997 JAMA research paper led by Shou-Hsia Cheng found that physician visits among the newly insured doubled in the first year of the program compared to the year before.

That has had predictable downsides: Hospitals get crowded in Taiwan. The capacity of health care providers to attend to everyone in need can be stretched pretty thin.

I visited the National Taiwan University Hospital, a red-brick building in the heart of Taipei from the Japanese colonial period, one weekday afternoon. All of the clinic lobbies were full. The registration desk, run take-a-number style, was bustling, beeps constantly pinging over the PA system as patients' numbers were called.

On another morning, inside a north-central Taipei primary care clinic, several patients were already sitting along the walls, hooked up to machines receiving infrared therapy for chronic pain, just a few minutes after the doors opened. The one doctor on site looked a bit frazzled as he showed me around before his clinic filled up any further.

The scenes bring to mind something I heard from trauma surgeon Li-Jian Chien, a member of the Taiwanese doctors union that formed in 2012 out of the frustrations felt in the medical profession.

In Taiwan, he says, "the patient [is] in heaven" - but "the doctor is in hell."

It's the opposite of the United States, he elaborates, where high cost sharing leads people to skip necessary care for serious conditions.

Chien says national health insurance with negligible cost sharing has pushed doctors to the brink. His friend and fellow physician Bing-Hong Lin exclaimed at one point during our interview: "We are not the Avengers!"

Surveys conducted by the government show health care providers have rather mixed opinions on the single-payer system - a significant plurality, 43 percent, said they were "neutral" in 2018 - a sharp contrast to the public's sky-high favorability.

Chien says he sometimes sees the same patient dozens of times every year in the emergency department where he works, often for problems that aren't emergencies. The low costs mean patients have little incentive to avoid the ER.

"Everyone wants to live forever, but it's impossible," Chien says. "Some people abuse emergency, abuse health care."

At the same time, because Taipei has a lot of traffic accidents, injured drivers and pedestrians come through his emergency department's doors all the time. His attention is divided when it shouldn't be.

Lin has started doing cosmetic medicine for adults on the side because he has become so frustrated by his pediatric practice. It's a more lucrative field, paid for privately by patients, with a less demanding workload. His is not an uncommon choice, according to experts. Lin still bitterly remembers being called back early from leave he had taken in 2005 to attend his father's funeral, because there was a staffing shortage at the hospital where he was doing his residency.

Taiwanese hospitals and clinics are understaffed compared to the rest of the world: There are about 1.7 doctors in Taiwan for every 1,000 patients, which is well below the average of 3.3 in other developed countries. There are especially shortages of specialists in less urbanized parts of the country.

"Taiwan's low ratios would be considered inadequate by OECD standards," Tsung-Mei Cheng wrote in 2015, "especially in view of the high utilization of health care services in Taiwan."

The country does excel at keeping wait times short for services like cataract and hip replacement surgeries. But providers are feeling the strain.

Taiwanese doctors work about 10 more hours a week on average than those in the United States. A 2016 survey of hospital physicians found that working overtime was prevalent, and doctors who worked a lot of overtime were more likely to say they might leave the hospital where they worked.

Crowded facilities, like the NTU Hospital, are the norm. Hospitals supplement their medical payments with high-margin non-health care services - food courts, parking, and so on - to keep themselves solvent.

The worry is that Taiwan's national health insurance has given patients such a good deal on medical care that they are overwhelming the system.

Patients must make sacrifices, too, like when a drug is too expensive to cover

The patients have their own grievances. They've seen their premiums hiked and more taxes introduced over the past two decades, and they will probably be asked again soon to chip in more money.

And though the benefits are comprehensive for most people, Taiwan still doesn't cover everything. Costly treatments for rare conditions are sometimes excluded.

A new drug for spinal muscular atrophy - a genetic disorder that progressively breaks down the patient's muscle tissue, resulting in early death - came on the market in the US in 2017. The first year of treatment costs $750,000. Yi Jie Li, a 25-year-old woman with spinal atrophy and an outspoken advocate who wrote the 2017 book 7,300 Days: The Most Ordinary Luxury, penned a letter to the NHIA pleading with it to cover the drug for the patients it could help.

The department replied in a letter, and the president of Taiwan called her on the phone. They said they would do their best. But the drug still isn't covered.

New medicines sometimes debut in Taiwan a full five years after they came on the market in the United States. For patients who need those medications, every day of waiting is a trial.

"Now the medicine is there," Li says, "but you cannot use" it.

In some rural parts of the country, medical understaffing means less access to specialists and pediatricians. High use has frustrated doctors in the cities, but it's patients who suffer if it's hard for them to see a doctor or nurse.

Even though Taiwanese patients get a good deal on health care, they don't come across as entitled. Some of the patients I met, including those who have faced the gravest diagnoses, seem acutely aware of the trade-offs demanded of them to keep a single-payer system sustainable.

Gloria Lin was diagnosed with breast cancer shortly before national health insurance took effect; today she is president of the Taiwanese Cancer Patient Association. Her group plays a part in talks between government and providers about what will be covered (and for how much).

She told me that of course she wants to see every new cancer drug covered by the government plan. But she also understands why that's impossible: The system would become too expensive.

"We don't want it [to go] bankrupt," she says. "We have to work hand to hand together to solve the problem. ... We have to be sensible for each other."

Sustaining a single-payer system requires hard choices for patients, providers, and taxpayers

National health insurance achieved what the Taiwanese government hoped it would. Everybody can afford health care. People are living longer, healthier lives.But the ever-growing cost of providing health care to everybody makes it challenging for the program to remain financially sustainable.

The government keeps having to ask doctors, hospitals, and patients to make sacrifices to keep single-payer running. That's not usually a political winner. No elected official is running on a campaign of higher premiums and higher copays.

But it helps that national health insurance has proven so popular. People want to make it work because single-payer has clearly improved Taiwanese lives.

One metric tells the tale: a rating based on medically amenable mortality, which gives a sense of how often people die of causes for which medical interventions should be available. In 1990, before Taiwan's single-payer program was implemented, the country held a rating around 60, far behind the United States' rating of 80. In 2016, Taiwan had nearly caught up with the US, topping 85; the US sat at 88, trailing its socioeconomic peers in Europe.

There is no doubt that medical care in Taiwan is better under single-payer, though it improved from a much worse status quo than the American system.

Today, Americans die prematurely of heart disease and lung cancer at higher rates than the Taiwanese. People in Taiwan live a little longer in general, though there are populations that encounter early deaths from alcohol use and stroke, just as some disadvantaged groups do in the United States. Yet overall, Taiwan spends 6 percent of its GDP on health care, about a third of what the United States does.

There is no comparison between the Taiwanese system of yesteryear - a 40 percent uninsured rate and the risk of financial catastrophe - and the one that exists today.

But hard choices still loom.

In the early 2000s, with health spending growing too quickly, the national health insurance office decided to institute the global budgets, a set pool of money that would cover all the medical services in a given year. Hong-Jen Chang, then the NHIA director, remembers seeing his effigy being decapitated in protests by hospital supporters. The opposition was overwhelming, and he had to resign over that decision in 2004. That was also shortly after the first premium increase was approved.

NHIA Director-General Dr. Po-Chang Lee told me that, after the presidential election this month, he would pitch the new government on increasing copayments so patients pay more out of pocket if they visit the doctor or hospital.

It may take more than that. Shou-Hsia Cheng, the NTU professor, predicted Taiwan would soon have to reevaluate its payments for end-of-life care. The country is currently debating how to expand long-term care for an aging population; it's not covered by the national health plan.

The financial crunch is coming. The NHIA, which ran surpluses for a while after the last round of rate increases, is now about to see its reserves run out.

"Either we should increase the premium rate or increase the copayment, or we have to delete some coverage items," Chang, the former NHIA director, says. "That will happen - not in two years, perhaps in 10 years. It will happen."

But in Taiwan, the need for premium increases or hospital budget caps isn't considered an indictment of national health insurance, at least if approval ratings for the system are anything to go by. It's part of the evolution of the system they have built. And because the underlying program is so popular, Taiwanese leaders are confident patients will be willing to do what's needed to keep single-payer viable.

"They will adjust," Cheng, the professor, says. "I believe so."

Taiwan is realizing the dream of "health care as a human right"

Since the beginning, the debate in Taiwan has been about balancing the imperatives of equity and access that underpinned the national health insurance program. Perhaps there's been no greater demonstration of that than seeing the health care system at work in the mountain township of Xiulin, where Tien was making her rounds.

A decade into the single-payer experiment, when Hong-Jen Chang was in charge of NHIA, health care access in places like Xiulin was still lacking. So he decided to start the rural care delivery program that covers Tien and her patients.

On the same day she treated the Taroko woman at her clinic, Tien ventured out to visit a bedridden stroke patient in his home and showed the same warmth, offering him a cheerful thumbs-up as she went through her exam. A few doors down, a diabetes patient with gout welcomed a nurse into his house, parakeets chirping at the front door, so she could take his blood sugar readings, something she does two or three times a week. Meanwhile, in the town hall, a pop-up Chinese medicine clinic was set up, and patients filed in to get acupuncture treatments.

Chang told me a health care delivery program like this was the natural endpoint for the single-payer experiment, a necessary extension of its services to reach a vulnerable population. Without it, the work of Taiwanese health reform would always be incomplete.

"That's the essence of universal health coverage," he says. "The principle of health [as a] human right is that everybody regardless of geography, religion, gender, age should have the right to access."

The people here seem grateful. Wong Shin-Fa, a 63-year-old Taroko man, stopped me on the side of the road in Xiulin and asked me what I was doing there. When I said I was an American reporting on health care, he told me a story.

He had a Taroko friend in Los Angeles who broke his arm, he told me, with a government health worker interpreting. Rather than get it fixed in the United States, his friend decided to fly back to Taiwan and have it mended there because he said it would be cheaper.

Shin-Fa knew Tien and her shock of pink hair. He said she's famous around those parts. He told me, "The government takes good care of the Taroko people."
contributed reporting to this story. is an editorial photographer based in Taipei, Taiwan. The Everybody Covered project can be found at . This series was made possible by a grant from The Commonwealth Fund. All content is editorially independent and produced by our journalists.

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Taiwan's single-payer success story - and its lessons for America

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The first in a Vox series on how countries around the world achieve universal health care.

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Healthcare reform is beneficial.

Build/ expand on Obamacare

Expand medicare/ medicaid

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Yes, they should just like obama care in the past. Biden has been announcing that there will be "biden-care" if he gets elected.

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Don't dismiss it because it isn't Medicare for All.

Credit... Hilary Swift for The New York Times

On Monday morning America's most prominent beneficiary of socialized medicine, in the process of receiving expensive, taxpayer-financed care at a government-run hospital, was tweeting furiously. One of President Trump's manic missives particularly caught the eyes of health care experts: his exhortation to "PROTECT PREEXISTING CONDITIONS. VOTE!"

As always, it's not clear whether Trump is merely being cynical or whether he is also genuinely ignorant.

He's definitely lying when he claims to have a plan that's better and cheaper than Obamacare. No such plan exists, and he has to know that.

But does he know that Americans with pre-existing medical conditions are already protected by the Affordable Care Act, which his administration is asking the Supreme Court to overturn? Does he realize that the reason his party has never offered an acceptable alternative to the A.C.A., in particular an alternative that would protect pre-existing conditions, is that no such alternative is possible? That's less clear.

In any case, how the nation votes will indeed make a huge difference to the future of health care - and not just because Trump, if he holds on to power, will almost surely find a way to destroy Obamacare, causing tens of millions of Americans to lose health insurance. Joe Biden, if he wins (and gets a Democratic Senate), will make a big difference in the other direction, substantially expanding coverage and reducing premiums for middle-class families.

The second part of this statement may come as news to many readers, because Biden's health proposals haven't drawn much attention so far.

Why not? One reason is that the election is - rightly - being seen mainly as a referendum on Trump rather than on likely Democratic policy. Another is that since the Democratic primary fight pitted Biden against rivals calling for radical changes in health policy, many people assume that the winner of that fight, who rejected those radical proposals, wouldn't change much.

But while Biden is indeed proposing incremental change rather than Medicare for All, we're talking about some big increments. Independent estimates suggest that under Biden's plan, 15 million to 20 million Americans would gain health insurance. And premiums would fall sharply, especially for middle-class families.

What policy changes are we talking about? To the extent that the Biden plan has received any attention at all, this attention has largely been focused on his proposed introduction of a "public option" - a Medicare-like plan that individuals could buy instead of purchasing private insurance. This option might be a first step toward a single-payer system, but it would be a small step, and in the near term would be much less important than other aspects of the plan.

First and foremost, the Biden plan - Bidencare? ObamaBidencare? - would substantially increase the subsidies that currently help many but not all Americans who don't get insurance from their employers.

The Affordable Care Act, as passed in 2010, was underfunded, because Democrats wanted to hold down the headline cost. This meant that premiums and co-payments were and are too high for many families. Since then, however, the politics have shifted: Public opinion has shifted in favor of the A.C.A., the Democratic Party has moved somewhat to the left and Republican willingness to ram through expensive, unfunded tax cuts has encouraged Democrats to be more aggressive.

So the Biden plan would increase subsidies and also remove the upper-income limit that prevents many middle-class families from receiving aid. This would cost a fair amount of money: The Committee for a Responsible Federal Budget puts the price tag at $850 billion over a decade. But it would cost far less than the 2017 tax cut, much of which went to corporations, which were supposed to respond by increasing investment, but didn't.

The Biden plan would also automatically enroll low-income Americans in the public option, which is more important than it might sound. One of the defects of our system is that it's complex and confusing, and those who need help the most are often the least able to navigate their way to getting it. Ideally we'd just move to a simpler system, but for now auto-enrollment would be an important palliative measure.

Oh, and the plan would also provide significant aid for long-term care, rural health, and mental health.

None of this amounts to revolutionary change - in contrast to Trump's efforts to kill Obamacare, which would drastically change American health care, for the worse. But Bidencare would still be, as Biden didn't quite say when President Barack Obama signed the A.C.A. into law, a pretty big deal.

True, America would still fall somewhat short of achieving what every other advanced country has - universal health care. But we'd get a lot closer, and many who currently have insurance coverage would see their costs fall and the quality of coverage improve.

So health care, including to PROTECT PRE-EXISTING CONDITIONS, really does need your VOTE! If Trump wins, Americans will lose that protection and many will lose their health insurance or see their premiums soar; if Biden wins, Americans will keep that protection and many will gain insurance or see their premiums fall.
The Times is committed to publishing Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. a diversity of letters to the editor. We'd like to hear what you think about this or any of our articles. Here are some tips. And here's our email: letters@nytimes.com.

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Don't dismiss it because it isn't Medicare for All. On Monday morning America's most prominent beneficiary of socialized medicine, in the process of receiving expensive, taxpayer-financed care at a government-run hospital, was tweeting furiously. One of President Trump's manic missives particularly caught the eyes of health care experts: his exhortation to "PROTECT PREEXISTING CONDITIONS.

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I think that this may not the best solution for America, because Taiwan is actually having debts due to the "free for all" healthcare.

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It wouldn't make a difference to provide illegal immigrants healthcare, it's the same concept as emergency rooms, they get what they are needed without any form of ID or anything. They just get the attention that they need at that moment.

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Last week during one of their debates, all Democratic primary candidates supported government health care for illegal immigrants. This type of position is extremely damaging politically and, if enacted, would unnecessarily burden taxpayers for likely zero improvements in health outcomes. I expect the eventual Democratic candidate for president to not support this type of proposal, but it should be nipped in the bud.

After the debate, Democratic candidate Julian Castro argued that extending government health care to illegal immigrants would not be a big deal. "[W]e already pay for the health care of undocumented immigrants," Castro said. "It's called the emergency room. People show up in the emergency room and they get care, as they should." It is true that some illegal immigrants use emergency room services thanks to the Emergency Medical Treatment and Labor Act and to Emergency Medicaid, but Castro leaned heavily into a stereotype often used by nativists. According to a paper published in the journal Health Affairs, illegal immigrants between the ages of 18-64 consumed about $1.1 billion in government healthcare benefits in 2006 - about 0.13 percent of the approximately $867 billion in government healthcare expenditures that year. That's a fraction of the cost that would be imposed on American taxpayers by extending nationalized health care to all illegal immigrants. So, with all due respect to Mr. Castro, we do not already pay for their health care just because some illegal immigrants visit emergency rooms at government expense.

One of the reasons why immigrants individually consume so much less welfare than native‐​born Americans is that many of them do not have legal access to these benefits. Cato scholars have proposed making these welfare restrictions even stricter to deny benefits to all non‐​citizens and to not count work credit toward entitlements until immigrants are naturalized citizens - what the late Bill Niskanen called "build a wall around the welfare state, not around the country."

Many American voters are concerned about immigrant consumption of welfare benefits. In a 2017 poll, 28 percent of Americans agreed with the statement that "Immigration detracts from our character and weakens the United States because it puts too many burdens on government services, causes language barriers, and creates housing problems [emphasis added]." That level of concern exists under current laws that restrict non‐​citizen access to benefits and even chill eligible non‐​citizen participation. I'd expect that poll result to worsen if new immigrants, especially illegal immigrants, were put on government health care program.

Extending government health care to illegal immigrants and other new immigrants would probably not improve healthcare outcomes for immigrants. According to the wonderful The Integration of Immigrants into American Society report published by the National Academies of Sciences, immigrants already have better infant, child, and adult health outcomes than native‐​born Americans, while also having less access to welfare benefits like Medicaid. Immigrants also live about 3.4 years longer than native‐​born Americans do. Illegal Mexican immigrants had an average of 1.6 fewer physician visits per year compared to native‐​born Americans of Mexican descent. Other illegal Hispanic immigrants made an average of 2.1 fewer visits to doctors per year than their native‐​born counterparts. Illegal immigrants are about half as likely to have chronic healthcare problems than native‐​born Americans. Overall per capita health care spending was 55 percent lower for immigrants than for native‐​born Americans.

Immigrants also lower the cost of other portions of the health care system. In 2014, immigrants paid 12.6 percent of all premiums to private health insurers but accounted for only 9.1 percent of all insurer expenditures. Immigrants' annual premiums exceeded their health care expenditures by $1,123 per enrollee, for a total of $24.7 billion. That offset the deficit of $163 per native‐​born enrollee. The immigrant net‐​subsidy persisted even after ten years of residence in the United States.

From 2002-2009, immigrants subsidized Medicare as they made 14.7 percent of contributions but only consumed 7.9 percent of expenditures, for a $13.8 billion annual surplus. By comparison, native‐​born Americans consumed $30.9 billion more in Medicare than they contributed annually. Among Medicare enrollees, average expenditures were $1,465 lower for immigrants than for native‐​born Americans, for a difference of $3,923 to $5,388. From 2000 to 2011, illegal immigrants contributed $2.2 to $3.8 billion more than they withdrew annually in Medicare benefits (a total surplus of $35.1 billion). If illegal immigrants had neither contributed to nor withdrawn from the Medicare Trust Fund during those 11 years, it would become insolvent 1 year earlier than currently predicted - in 2029 instead of 2030.

American taxpayers should not have to pay for the health care costs of other Americans, let alone for non‐​citizens. For those reading this post who are very concerned about the well‐​being of immigrants, think of what would happen to public support for legal immigration if welfare benefits were extended in this way. Immigrants come here primarily for economic opportunity, not for government health insurance. They tend to be healthier than native‐​born Americans and lower the price of health care for others as a result - but the point would likely change if the laws were different. Let's not build public support for reducing legal immigration, or increase reluctance to expand it, by extending government health care, at enormous public cost, to people who don't need it.

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Illegal Immigrants - and Other Non-Citizens - Should Not Receive Government Healthcare

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Last week during one of their debates, all Democratic primary candidates supported government health care for illegal immigrants. This type of position is extremely damaging politically and, if enacted, would unnecessarily burden taxpayers for likely zero improvements in health outcomes.

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Trump is pushing for the termination (or a weaker version) of the Affordable Care Act (Obamacare). He doesn't support medicare for all and wants to move towards having all people having private insurers. He also would like to try to lower drug prescription costs.

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Comparing Biden’s And Trump’s Different Visions For Health Care

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From Medicare to Obamacare to controlling drug costs, the candidates mostly differ in their approach to health care. Here’s a quick guide to their views and proposals.

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Yes, but there should still be priority to those who qualify, since they have more severe conditions.

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Yes they should because healthcare in the US is so expensive and not a lot of people will be able to afford it so I think they should. Plus Taiwan had great success doing it so why not?

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For many years, the Democratic party has been trying to get basic security in health care for all American citizens.

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" Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act."

In March 2010, President Obama fulfilled a promise that Democrats have pursued for nearly a century: making quality, affordable health care available to all Americans. In all, seven presidents pushed for health reform over the years. We have finally made real the principle that every American should have access to quality health care, and no one should go bankrupt just because they get sick - and we'll never stop fighting to protect that principle. President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri.

For decades Democrats have fought for the simple idea that everyone should have some basic security in health care. When President Johnson signed Medicare into law in 1965, we were finally able to provide that security to America's seniors. In 1997, Democrats passed the Children's Health Insurance Program (CHIP), which currently covers 8 million kids.

But it took nearly a century to extend that basic measure of security to all Americans.

In 2010, despite unanimous opposition from Republicans, Democrats were finally able to pass comprehensive health reform into law.

Thanks to the Affordable Care Act, more than 20 million Americans have gained health care coverage and the uninsured rate has been cut almost in half. Among the newly insured are more than 2.3 million young adults who are covered because the Affordable Care Act allows them to stay on their parent's insurance until age 26. Discrimination based on pre-existing conditions is now illegal, and nearly 8 in 10 Americans who recently shopped for health insurance in the marketplace could get it for less than $100 per month.

The Affordable Care Act has also allowed states to expand Medicaid to help even more Americans get covered. Thirty-one states and the District of Columbia have expanded Medicaid, and Medicaid and SCHIP enrollment has risen 26 percent.President Obama signs the Affordable Care Act into law.

The Affordable Care Act also provides tax credits to small businesses to help offset the costs of employee coverage and tax credits to help families pay for insurance. We are also experiencing health care spending growth at its lowest level in 50 years.

Democrats are committed to preserving and protecting the Affordable Care Act and the peace of mind it has brought to millions of Americans, and they will fight all attempts by the Trump administration to repeal the law and take health care away from tens of millions of Americans.

We are proud of this progress we have already made and are will work to extend and preserve it for generations to come.

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" Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act." In March 2010, President Obama fulfilled a promise that Democrats have pursued for nearly a century: making quality, affordable health care available to all Americans.

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The single-payer system is called "Medicare for All". Medicare is not free as it still covers some costs, but it costs less for citizens older than 65 or with disabilities. Under a single-payer system, everyone will essentially be under this Medicare-like care (one insurance plan). If people have money, then they have more choices.

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Single payer healthcare: Pluses, minuses, and what it means for you - Harvard Health

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Trump thinks single-payer healthcare system works well in other nation but he doesn't support it to be a system in US.

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Healthcare Reform to Make America Great Again
Donald J. Trump for President
As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.

By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

Congress must act. Our elected representatives in the House and Senate must:

1. Completely repeal Obamacare.

2. Modify existing law that inhibits the sale of health insurance across state lines.

3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.

4. Allow individuals to use Health Savings Accounts (HSAs).

5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

6. Block-grant Medicaid to the states.

7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start. There are other reforms that might be considered if they serve to lower costs, remove uncertainty and provide financial security for all Americans.
https://www.donaldjtrump.com/positions/healthcare-reform
***

Comment:

By Don McCanne, M.D.

As the leading candidate for the Republican nomination for president, we should be aware of Donald Trump's health policy proposals. His descriptions to date have been vague - replace Obamacare with something terrific, remove the lines around states, and can't let people die in the streets. Responding to demands for specifics, Trump plays it safe and now releases a brief list of standard recommendations long held by mainstream Republican politicians.

Most of these proposals have been extensively analyzed and would have very little impact on resolving the problems with our health care financing. But repealing Obamacare and using block-grants to reduce Medicaid funding would further impair access to care for millions of Americans. Doesn't really sound like something terrific.

Trump has said that single payer systems work well in other nations, but his political base is not supportive of such a system here, and so it does not appear on his list of proposed reforms. Once again, politics trumps policy.
Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.

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Donald Trump releases his health reform proposals - PNHP

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Healthcare Reform to Make America Great AgainDonald J. Trump for PresidentAs it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.As the leading candidate for the Republican nomination for president, we should be aware of Donald Trump's health policy proposals.

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They want affordable healthcare for everyone, since healthcare is one of their most important focuses.
https://democrats.org/where-we-stand/the-issues/health-care/

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Republicans think that people should be able to choose not to pay for insurance, because it's not really effective for healthy people. He thinks that paying for healthcare is not beneficial if the person is already healthy, because they only visit the doctors once in a while. Trump wants to repeal the Affordable Care Act so that people don't have to pay more taxes.

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If the address matches an existing account you will receive an email with instructions to reset your password.

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Adding on to Honggi, Trump never mentioned specifically that he wanted a single-payer system, but he did mention that he wanted a universal health care. When interviewers asked about who was going to pay for the Medicare, he said that the government would and assured that people were going to get better treatment, no matter the price of it.

*same resource as honggi*

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I don't think it would work, because Taiwan is a lot smaller then the US population and size wise. Also many U.S citizens do not have health insurance, due to the fact that they can't afford it. Every hospital would be pact with patients if they went with Taiwan method of healthcare.

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Trump wants to invalidate the ACA, Affordable Case Act when he wins re-election.

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With the results of the presidential election and the race for control of the Senate still undecided, it's also not entirely clear what will happen to the many healthcare issues facing Congress, the president, and federal agencies. We asked experts to discuss the possibilities under a Trump administration or a Biden administration, and how a Democratic- or Republican-controlled Senate might play out. The Affordable Care Act and Other Reforms
If President Trump wins re-election, what can Americans expect to see as far as healthcare reform? "Nothing," said Kavita Patel, MD, MPH, a nonresident fellow at the Brookings Institution, and a primary care physician. "I think he'll be betting the Supreme Court decision could invalidate the ACA [Affordable Care Act], and there's no reason to try to do anything in advance of that," she said referring to the California v. Texas lawsuit, a case that centers around whether the law as a whole can stand now that the individual mandate penalty has been eliminated. Oral arguments in the Supreme Court case are expected on Nov. 10.

Asked about the possibility of a replacement plan were the ACA to be eliminated, Patel is suspect. "He hasn't been able to do that in the past 4 years, I have no faith he could do it now," she said.

Chris Pope, PhD, a senior fellow at the Manhattan Institute, also does not expect to see major healthcare reforms if Trump is re-elected. "I think on the Republican side, the appetite for touching healthcare again is very very low.... Assuming that [Republicans] somehow won the House again, I don't see where you get many Republicans who would want to touch healthcare again." Joseph Antos, PhD, a healthcare scholar at the American Enterprise Institute here, agrees that there will be very little movement on healthcare if Trump is re-elected but for different reasons. "Nancy Pelosi will still be Speaker of the House. Without the House, you really can't get significant legislation passed," Antos said.

With regard to Medicaid, many of the waiver invitations and work requirements were the ideas of Seema Verma, administrator of the Centers for Medicare & Medicaid Services, Antos said. "If Seema stays on, there's no question that she will continue to push in the directions that she's already pushed. If it's somebody new, then they may be less enthusiastic about it," Antos said.

Looking at the bigger picture, Pope said the Senate outcome matters more than who wins the presidency. "Instead of it being a Trump healthcare arrangement or a Biden healthcare arrangement, it really depends on who has the Senate majority, and who is that pivotal 51st senator or 50th senator," said Pope. Also, even "a 51-seat majority leaves a very different type of healthcare policy [vs] a 54-seat Senate majority or a 55-seat Senate majority," he noted.

If Biden wins the White House, said Antos, his first priority will be to respond to the pandemic and its associated economic crisis, and to pass a COVID relief bill, before turning to a "public option" health insurance reform. Despite Biden's "political problem" with so-called progressives who champion a single-payer system, "I think he's going to stay true to what he really believes in, which is ... to build off of the ACA," Antos said. "He wants to find a cheaper plan alternative within the exchange structure."

The focus on a COVID relief bill will buy Biden time to figure out the details of a public option "before he really has to push hard to get it to happen," Antos continued. "I could easily see that a public option could pass in the spring of 2022," he said, assuming an effective vaccine is in wide deployment and the pandemic is finally under relative control.

For his part, Pope anticipates that given the millions of people that are out of work and may have lost their healthcare, Biden would focus on expanding ACA subsidies and helping uninsured Americans in states that didn't expand Medicaid through a federal public option. But Pope sees that as ultimately failing.

"The idea that there's a free lunch out there" with a public option just isn't plausible, he said. Hospitals and doctors aren't going to give the same care for less money, just because a plan is stamped "public option"

"You only spend less if you give people less," Pope said.

Passing any significant plan to expand access to health insurance will be difficult without "sweeteners for industry," said Patel, irrespective of which party is in charge. Expanding coverage, whether through a public option or increasing access to ACA plans, would be expensive and likely lead to reimbursement cuts somewhere. So it will require some "creative negotiation" on both sides of the aisle, she said.

In the short term, Biden could take concerns about the California v. Texas lawsuit off the table. Pope said Biden could ask Congress to pass a law stipulating that the individual mandate is severable from the ACA. "Congress could easily do that ... and that would essentially make the lawsuit go away," he said.

As for the Medicaid program more broadly, "the Trump administration has spent their time in office trying to undermine and weaken the Medicaid program and think of new and different ways to prevent people from getting Medicaid coverage," said Joan Alker, a professor and the executive director and a co-founder of the Center for Children and Families at Georgetown University. "With a Biden administration we will see a strong fundamental commitment to the program and a welcome mat put out for children and families seeking Medicaid coverage and the welcome mat has very much been pulled back in the last few years," she said.

Some of the most important changes Biden could make would be personnel changes, said Patel. "We've really seen now how destructive people can be when you have the wrong leadership.... Having the right person at the CDC might be the most important change that could get made."
The COVID-19 Pandemic
Biden and Trump take very different approaches to the pandemic, said Robert Wachter, MD, of the University of California San Francisco. If Biden wins, "I think you'll see a pretty early and very strategic communication strategy," he said in a phone interview. "He'll have two months [before the inauguration] to position himself as a leader who'll have a new approach." That means "you'll see a naming of health leaders fairly quickly, a rollout of a strategy -- particularly on testing -- and a much more concerted strategy on public health maneuvers."

Regarding making mask-wearing mandatory: "Does the president or the CDC have the authority to make everybody in the country wear a mask? Probably not -- it's more using the bully pulpit to make the case that there should be universal masking and maybe even make the case that there should be more consistency in terms of local and regional policies regarding what's open and what's not open," Wachter said.

Increasing contact tracing depends on the state of the epidemic, he added. "If things are going as off the rails as they are now, then contact tracing is probably not all that applicable -- there's just too many cases for contact tracing to be super useful." On the other hand, "I think you're going to see a push for more testing -- more insistence on getting kits out into communities and more guidance from the CDC on who should be tested and when."

And if Trump wins? "You can expect more of the same -- which is chaos," said Wachter. "He's as predictable as my clock; he doesn't want to confront a hard problem." States will continue to be left to their own devices if there's a second Trump administration, he added.
Care for Older Americans
"If Biden wins the election, he is under pressure to expand Medicare (or a rough equivalent) to a somewhat larger slice of the near-elderly population," Thomas Miller, JD, resident fellow at the American Enterprise Institute, said in an email. "In the final analysis, this is easier to do as a somewhat-Medicare-like public option for those either 60-65 or perhaps 55-65, on a quasi-optional basis. In this manner, a Medicare expansion would not as directly threaten to eat away at some of the current Medicare coverage for the over-65, and it would not directly change the scoring of the over-65 Medicare budget and Part A Trust Fund projections. It also would allow the below-65 'new' Medicare coverage to differ somewhat from conventional Medicare."

In terms of expanding the Medicare population, "Without an overwhelming blowout win in the presidential race (closer to 60% than below a 55% share of the popular vote, accompanied by more than 55 Senate Democrats), Biden won't have the margins to move toward a 'Medicare for a Lot More' option for the rest of the below-65 population," Miller continued. "Pandemic and continued economic recovery needs will overwhelm a major move in federal health policy mega-expansion."

As for Medicare Advantage, it "has grown too large, and popular, to be placed back in political jeopardy," he added. "However, Medicare participation requirements could be leveraged to essentially try to mandate participation by insurers and providers in any new expansions of below-65 post-ACA public coverage options (the partial public options expansion that will be attempted)."

Biden's proposal to lower the age of Medicare eligibility to give adults ages 60-64 an option to get more affordable health insurance "would be a pretty big deal for older adults who have trouble finding affordable coverage," said Tricia Neuman, ScD, executive director of the Kaiser Family Foundation's Program on Medicare Policy. "It could also lead to savings for employers and state Medicaid programs."

Patel predicted that Biden would make good on his promise to lower the age of Medicare to 60, create a Medicare "buy-in," or establish a separate public option, Patel said. "Those three choices will shape what the 2021 landscape looks like in terms of healthcare," she noted. Patel said she also anticipates a "slate of executive orders" on day one of a Biden presidency reinstating Title X family services planning and "putting back into place everything that got decimated" under Trump.

One trend that's likely to continue under a Biden administration is the shift towards value-based care, Patel said. "I don't see Biden coming in and undoing value- based models that the Trump administration started," she said, such as the Kidney Care Initiative and the ' Primary Care First' payment model.

If President Trump is re-elected, on the other hand, "expect some deal-making proposed to change the mix of givebacks in prescription drug pricing between insurers and drug manufacturers," said Miller. "More permanent telemedicine reforms could be institutionalized in Medicare before trying to expand them to the rest of the health care sector. Luckily, Medicare would not run out of money any sooner than the rest of the U.S. government and economy does!"
Drug Pricing
Healthcare consultant Marsha Simon, PhD, said in an email that if Biden wins, she expected him to "rein in the more outrageous behavior of the drug companies. For example, several companies are denying 340B discounts to some safety net providers, which should result in the loss of access to the Medicaid market, but the Trump administration has done nothing." On the other hand, "whether Biden achieves reforms to drug pricing policy ... turns on Democrats also taking the Senate majority since [Republican leader] Mitch McConnell refuses to take up the Grassley bill" containing modest drug price reforms.

"Historically, Joe Biden has not been a champion of restraining drug prices -- reflecting both the role of drug manufacturers as important employers in Delaware and, after the Obama administration, his apparent greater interest in novel drug development to treat cancer than in access to these expensive new drugs," she added.

If Trump is re-elected, Simon expects him to "continue his approach to reining in drug prices -- proposing genuine reform such as European Union reference pricing, for example -- while implementing marginal policies such as the Medicare insulin demonstration that will have only a marginal impact on access to affordable drugs for a few seniors with insulin-dependent diabetes enrolled in certain Medicare drug plans."

Kaiser's Neuman noted, "While Trump and Biden have both talked about drug prices, a big difference between them is that Biden supports the proposal to let the [Health and Human Services] Secretary negotiate prices," adding that one of Trump's other promises -- a $200 discount drug card for seniors -- has not yet materialized.

Miller predicted that "more action (albeit more symbolic than real) is likely in the drug pricing arena, related in part of Medicare, due to the latter program's overall purchasing leverage. At least some entry into federal government price negotiations with drug sellers will begin, though far from what's been promised. Further gap-filling in cost sharing (lower catastrophic coverage ceilings) and pricing restrictions on sole source suppliers will be initiated."

Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow

Joyce Frieden oversees MedPage Today's Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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What Will a Biden or Trump Victory Mean for Healthcare?

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With the results of the presidential election and the race for control of the Senate still undecided, it's also not entirely clear what will happen to the many healthcare issues facing Congress, the president, and federal agencies. We asked experts to discuss the possibilities under a Trump administration or a Biden administration, and how a Democratic- or Republican-controlled Senate might play out.

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Rather than reforming the healthcare system, Trump wants to repeal/replace the system completely. He believes that people need to be taken care of well and during one interview, he mentioned that he would be willing to give out any cost for people to get insurance and coverage; best to get their insurance through jobs.

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I think that America should not try the single-payer system because I don't think it will work. US is a lot bigger than Taiwan, and Taiwan is having debts because of  healthcare. I think if America tried (since America is so big), the economy of the US will be affected.

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I think the benefits outweigh the costs. The benefits will last long term and it will help the people. America is supposed to be “for the people” so they should do what is best for the people, which is making it so that medical help is available to EVERYONE, from the poor to the rich, from children to adults. If we can change healthcare to become like this, where everyone will be able to get treated, then I think it’s worth the money. Lives are priceless, so even if we have to pay a huge amount of money to get it, I still think we need to prioritize life.

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Citizens aged 65 years or older qualify. If someone receives SSDI (social security disability insurance) they are also benefited. Medicare for all is essentially just single-payer healthcare which is talked about in the first question. Here are some pros and cons of Medicare for all citizens.
PROS:
1. Lowers healthcare costs for the economy.

2. There would be less health insurance agencies to deal with and it would be less confusing

3. All doctors/hospitals would be forced to be of the same quality

4. More people would have access to healthcare

CONS:
1. It’s very expensive for the government

2. It would definitely have some trouble getting started.

3. Doctors aren’t as well paid

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Medicare for All is a proposed new healthcare system for the United States where instead of people getting health insurance from an insurance company, often provided through their workplace, everyone in America would be on a program provided through the federal government. It has become a favorite of progressives, and was heavily championed by Senator Bernie Sanders (D-Vermont) during his runs for the Democratic presidential nomination in 2016 and 2020. If you are looking for help with medical planning under our current system, consider working with a financial advisor.

Medicare For All: How It Works

Sanders' bill would replace all other insurance, with limited exceptions, such as cosmetic surgery. Private insurance, employer-provided insurance, Medicaid, and our current version of Medicare, would all be replaced by Medicare for All. The Affordable Care Act, commonly referred to as Obamacare, would also be replaced by Medicare for All.

Medicare for All is actually more generous than your current Medicare program. Right now, Medicare is for Americans 65 and older. They receive care, but they're also responsible for some of the cost. However, Sanders' plan would cover medical bills completed, with no financial burden on the patient.

Sanders' Medicare for All would be a single, national health insurance program that would cover everyone living in the United States. It would pay for every medically necessary service, including dental and vision care, mental health care and prescription drugs. There would be no copays or deductibles, with the exception of prescription drugs, though the cost would be limited to $200 a year. There may also be additional out-of-pocket costs for long-term care.

The government would set payment rates for drugs, services, and medical equipment. Each year, the Secretary of Health and Human Services would come up with a national budget for all covered services and spending would be capped by that national budget. Just 1% of the total health spending budget would be used to provide job dislocation assistance for people working in the insurance industry.

Sanders' bill includes a four-year phase-in during which increasingly younger people could buy into Medicare. It would work like this: 55-year-olds would be able to buy into Medicare in the first year, 45-year-olds in the second year and 35-year-olds in the third year. Out-of-pocket costs would be reduced for everyone buying into Medicare. There would also be a public option insurance plan offered to people of all ages through the Obamacare marketplaces.

Medicare for All is effectively single-payer healthcare. Single-payer health care is where the government pays for people's health care. The new name just makes the concept more popular. A Kaiser Family Foundation poll found that 48% of people approved of single-payer healthcare, while 62% of people approved of Medicare for All.

Medicare for All Cost?

If everything stays the same as it is right now, the combined healthcare spending by private and public sectors is projected to reach $45 trillion by 2026.

The libertarian-oriented Mercatus Center at George Mason University estimated that the cost of Medicare for All would be more than $32 trillion over a 10-year period.

Kenneth Thorpe, a health finance expert at Emory University looked at a version of Sanders' Medicare for All during the 2016 campaign and estimated that the cost would be about $25 trillion over 10 years.

In order to pay for the program, Sanders has suggested redirecting current government spending of about $2 trillion per year into Medicare for All. To do that, he would raise taxes on incomes over $250,000, reaching a 52 percent marginal rate on incomes over $10 million. He also suggested a wealth tax on the top 0.1 % of households.

Medicare for All Pros and Cons

Pros and cons for this program partially depend on your income bracket. If you make less than $250,000, Sanders' additional tax will not affect you. If you make more than $250,000 a year, or are in the top 0.1 % of household, Sanders' tax to pay for Medicare for All would be a con for you.

In addition, universal health care requires healthy people to pay for medical care for the sick. However, that is how all health insurance programs work. Everyone buys in and pays the costs of health insurance, but the insurance company only pays when someone needs medical care or coverage. In every insurance plan, healthier people absorb the costs incurred by sicker people.

Pros

Universal healthcare lowers health care costs for the economy overall, since the government controls the price of medication and medical services through regulation and negotiation.

It would also eliminate the administrative cost of working with multiple private health insurers. Doctors would only have to deal with one government agency, rather than multiple private insurance companies along with Medicare and Medicaid.

Companies would not have to hire staff to deal with many different health insurance companies' rules. Instead, billing procedures and coverage rules would be standardized.

Hospitals and doctors would be forced to provide the same standard of service at a low cost, instead of targeting wealthy clients and offering expensive services so they can get a higher profit.

Universal healthcare leads to a healthier population. Studies show that preventive care lowers expensive emergency room usage. Before Obamacare, 46% of emergency room patients were there because they had nowhere else to go. The emergency room became their primary care physician. This type of health care inequality is a major factor in the rising cost of medical care.

Cons

Some analysts are concerned that the government may not be able to use its bargaining power to drive down costs as steeply and as quickly as Sanders predicts. Thorpe argues that Sanders is overly optimistic on this aspect of the bill.

Other analysts are concerned that insulating people from costs of care will drive up usage of medical care. Drew Altman, who heads the Kaiser Family Foundation, pointed out that "no other developed nation has zero out of pocket costs."

People may not be as careful with their health if they do not have a financial incentive to do so.

Governments have to limit health care spending to keep costs down. Doctors might have less incentive to provide quality care if they aren't well paid. They may spend less time per patient in order to keep costs down. They also have less funding for new life-saving technologies.

Since the government focuses on providing basic and emergency health care, most universal healthcare systems report long wait times for elective procedures. The government may also limit services with a low probability of success, and may not cover drugs for rare conditions.

Other Medicare and Medicaid Expansion Bills

Lawmakers have introduced other Medicare expansion options, which would be much more limited than Medicare for All.

Senators Debbie Stabenow (D-Michigan), Sherrod Brown (D-Ohio) and Tammy Baldwin (D-Wisconsin) introduced the Medicare at 50 Act in February of 2019. Under the Medicare at 50 Act, people between 50 and 64 could buy into Medicare. Other than expanding the age, the main difference to our current Medicare program would be that coverage would automatically include Medicare Part A (hospital), Part B (physician), and Part D (prescription drug) coverage. In addition, you could choose Medicare offered through private insurers, known as Medicare Advantage. If you qualified for a premium subsidy under the Affordable Care Act, you would still be able to apply that to extended Medicare. This bill would effectively create a new insurance option for those 50 and older.

Senator Michael Bennett (D-Colorado) and Rep. Brian Higgins (D-New York) introduced a bill called Medicare-X Choice. This bill would offer Medicare to people of any age through the Obamacare marketplaces. This bill would not be initially enacted nationwide. Instead, the bill would focus on adding the Medicare option in places with few hospitals and doctors, or areas that only had one insurer offering coverage.

Senator Brian Schatz (D-Hawaii) and Rep. Ray Lujan (D-New Mexico) proposed a bill called the State Public Option Act that would let people buy into Medicaid, rather than Medicare. The details of covered services could vary from state to state, since this would be offered through Medicaid rather than Medicare. However, no plan would be able to offer less than essential health benefits covered under the Affordable Care Act.

Where the Presidential Candidates Stand

Sanders, of course, did not win the Democratic Primary. Joe Biden, widely considered significantly more moderate, won. Biden has an extensive healthcare proposal which expands many parts of the Affordable Care Act, but does not include a single payer Medicare For All program. Instead, it is based around a public option - a government plan only for those who want it, while private insurance companies remain the main driver of healthcare in the US.

President Donald Trump has not offered a comprehensive healthcare plan this time around. Early in his term, he and the Republicans in Congress tried to "repeal and replace" The ACA, but were unsuccessful.

The Bottom Line

Healthcare is certainly a hot topic for the 2020 election process. Though Bernie Sanders' (D-Vermont) version of Medicare for All would eventually eliminate all other forms of insurance, other Democratic candidates have varying degrees of support and versions of Medicare for All as a universal healthcare system. Though Medicare for All would likely lower the healthcare costs in the economy overall and increase quality care while also facilitating more preventative care to avoid expensive emergency room visits, you could end up paying more if you make more than $250,000 a year or are in the top 0.1 % of households. What's more, some experts suggest that if costs are less onerous, patients will overuse the system and make setting up appointments for elective procedures more difficult.

Tips for Keeping Your Finances Healthy

A health savings account (HSA) may be a good option for younger people who are worried about potential healthcare costs. HSAs can greatly reduce monthly premiums.

Whatever the outcome on Medicare for All, it is important to keep yourself physically and financially healthy. If you are concerned about budgeting with health care costs, you may want to look into a financial advisor. SmartAsset can help you find your financial advisor match here.

Photo credit: ©iStock.com/Asawin_Klabma, ©iStock.com/wutwhanfoto, ©iStock.com/marchmeena29

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Medicare for All: Definition and Pros & Cons - SmartAsset

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Medicare for All is a proposed new healthcare system for the United States where instead of people getting health insurance from an insurance company, often provided through their workplace, everyone in America would be on a program provided through the federal government.

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Trump rejects universal healthcare because so many of the HMO (health maintenance organization) will lose the money they earn. Trump is almost all for the economy.

" based on the idea of promoting choice, competition, and the role of market prices."

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If the address matches an existing account you will receive an email with instructions to reset your password.

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There’s always a risk, that’s one of the main reasons why the US has never really reformed healthcare that dramatically. I personally think that the more people covered by healthcare the better it is for a country -- so the benefits do outweigh the costs in the long run. Once the American people adjust to a new system, it will be beneficial for all.

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Both parties are arguing that the drug pricing in the US are too high but the two parities cannot agree on how to deal with the problem

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Nancy Pelosi unveiled the Democrats' drug pricing bill back in September and brought the fight straight to the industry with a proposal to empower the US government to negotiate prices for select drugs. Republicans, who decried the bill reeks of heavy-handed government intervention which will stifle innovation, now have a counterproposal they claim will result in cheaper drugs and incentivize R&D - further clouding the prospects of a bipartisan compromise that could land on Donald Trump's desk.

"Only one of these bills has the potential to become law. While Speaker Pelosi's partisan plan is dead on arrival in the Senate and won't be signed by President Trump, H.R. 19 could be on President Trump's desk today," said Republican Whip Steve Scalise in a statement on Monday. And in an acknowledgment that the Republican effort would need Pelosi's sign-off to reach a vote - a highly unlikely event - Scalise continued, "Speaker Pelosi must come to her senses. I am calling on her to bring H.R. 19 to the House floor for a vote this week. Americans need a bipartisan solution to prescription drug prices, not another doomed proposal from the Democrats."

Republicans and Democrats both argue drug prices in the United States are too high - the industry holds the crown for the least favored sector by Americans, falling behind the federal government itself - but so far nobody can agree on just how to make the US health care system great again.

The 350-page Republican bill, HR19, proposes creating the role of a 'chief pharmaceutical negotiator' at the Office of the United States Trade Representative to advocate on behalf of American patients in trade agreements with respect to prescription drug prices.

In addition, the bill seeks to limit annual out-of-pocket costs for Medicare beneficiaries at $3,100; caps the cost of insulin for seniors in the Medicare Part D program; requires insurance companies to make information about drug prices transparent at doctor's offices so patients are apprised of the potential costs before a prescription is written; and 'streamlines' the regulation of over-the-counter products.

Some of the proposals in HR19 also mirror policies advocated by bipartisan legislation currently under consideration in the Senate, including the CREATES act which is designed to ensure generic drugmakers can access branded drugs to develop copycats, and prohibits "pay-for-delay" deals, where manufacturers of branded drugs maintain their monopolies by offering generic companies rewards for delaying the launch of knockoff products.

The Democrats' drug pricing bill - HR 3, which is set to face a vote this week - could compel manufacturers to comply with the prices set by the HHS, or face grave penalties and tethers the price of the some of the nation's most expensive drugs to an international price index. Unsurprisingly, the bill - which promises to cut federal spending by $345 billion between 2023 and 2029 - elicited the ire of the industry that has so far thrived by taking a laissez-faire approach to pricing. Various analyses have suggested the bill, which is unlikely to be signed into law, could result in between 8 to 100 fewer drugs from reaching the market over the next decade.

A raft of Republican lawmakers issued statements supporting HR19 on Monday, suggesting not only is HR19 superior to HR3, but is far more likely to be signed into law.

"This (bill) contains measures with bipartisan support in the House and Senate, can become law, and deserves a vote. Meanwhile, Speaker Pelosi's partisan drug pricing scheme is not only bad policy, it's never going to become law," said the architects of HR19, Kevin Brady, the senior Republican on the powerful Ways and Means Committee, along with Greg Walden (R-OR) and Virginia Foxx (R-NC).

That may well be the case - the White House last week issued a scathing review of HR3, accusing the Pelosi bill of favoring short-term savings over the "long-term cost of American patients losing access to new lifesaving treatments." But with Democrats firmly in charge of the House of Representatives, HR19 faces a similarly quixotic road to Trump's desk, with articles of impeachment threatening to overshadow the political calendar.

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Republicans unveil a drug price bill to rival the Democrats - promising lower prices and more cures

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Nancy Pelosi unveiled the Democrats' drug pricing bill back in September and brought the fight straight to the industry with a proposal to empower the US government to negotiate prices for select drugs.

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Trump guarantees a “smooth” transition in between the “reformation” of the healthcare system. He points out that he doesn’t see why government should not be involved through this process, and could be  achieved efficiently.

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I guess I agree with James in that we should consider the size of America and Taiwan. Taiwan is definitely so much smaller than Taiwan, and that's why the single-payer system works so well here. However, that might not be the case in America. And with situations such as Covid-19 and allat single-payer systems would be awful and hectic.

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Biden plans to lower the costs of healthcare in general.

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Even beyond Covid-19, healthcare is a major battleground in the US Presidential election that will be decided on 3 November. The two candidates - Democrat Joe Biden and Republican Donald Trump - clash on many aspects of the American healthcare system and the pharma industry.

According to a Kaiser Family Foundation (KFF) poll, healthcare policy in general was the third-largest issue in deciding who to vote for President with 12% of the poll share, while the coronavirus outbreak ranked second at 18%. A range of healthcare policy areas are driving voters. The KFF polling data found that 94% said protections for people with pre-existing conditions by the Affordable Care Act (ACA) was important to their vote, while 63% wanted to see the cost of healthcare lowered and 59% said lowering drug prescription costs was a very important element of their vote.

Polls are starting to suggest Biden has a general nine-point lead over Trump, including a New York Times survey and a Reuters/Ipsos one. According to the KFF poll, Biden has a clear edge on all healthcare issues. For instance, 56% of voters think Biden will maintain protections for people with pre-existing conditions, compared to 36% for Trump. In addition, in lowering healthcare costs and drug prices, Biden leads by 14% and 7% respectively.

Let's examine the pledges of the two candidates on various healthcare topics and establish what impact their victory in November could mean for the healthcare and pharma industries.

The ACA: exploring Trump's opposition

The ACA, or Obamacare as it is colloquially known, was signed into law in 2010 and aimed to extend health insurance coverage to millions of uninsured Americans. Central to its premise was to expand eligibility to Medicaid - an existing public insurance programme for low-income families and individuals - and preventing insurance companies from denying coverage or overcharging patients with pre-existing conditions.

During his term in office, Trump has repeatedly tried to "sabotage" the ACA, in the words of Rutgers University professor of public affairs and administration Frank Thomson in an article for The Brookings Institution. This has primarily been by reducing the opportunities for enrolment into insurance exchanges, encouraging access to cheaper coverage that does not meet the standards of the ACA and by undermining its regulatory structure.

In addition, Trump has backed a lawsuit, California v Texas, that calls for the elimination of the ACA. This lawsuit was first filed in Texas in 2018 and now has the support of 18 states, while 17 states, led by California, are defending the ACA. The case has now reached the Supreme Court, which will decide on four legal questions on 10 November. The importance of the striking down of the ACA to Trump is clear in his haste to confirm Judge Amy Coney Barrett, his pick for Supreme Court to fill a seat left empty by the death of Justice Ruth Bader Ginsburg at the end of September, before the 3 November election.

The impact the overturning of the ACA will have on the protections of those with pre-existing conditions is of concern to voters, according to the KFF poll. Of those surveyed, 79% said they do not want to see those protections removed. Interestingly, 66% of Republicans did not want these pre-existing condition protections removed, despite 76% saying they wanted to see the entire law overturned.

In his manifesto, Trump explicitly states his commitment to cover all pre-existing conditions, but he does not provide any indication of how this will happen if the ACA is overturned. This probably explains why 53% polled by KFF said they do not think Trump has a plan to maintain these protections, while 's editorial board concluded that Trump cannot be trusted on his pre-existing conditions pledge.

Looking generally at Trump's other insurance-based manifesto promises, he pledged to protect social security and Medicare - a provision for the over-65s and those with certain disabilities irrespective of income - as well as lower healthcare insurance premiums, but without any details of how this will be done if the ACA is overturned.

Biden defends the ACA

Unsurprisingly, Biden is a staunch advocate of the ACA; he was Obama's vice-president after all.

Biden's plan is to build on the Act to further reduce costs and make the system easier to navigate; this is the cornerstone of his healthcare policy platform.

His campaign also wants to give all Americans a public option for their health insurance along the lines of Medicare. According to his manifesto, Biden will ensure that state politics does not stop those with low-incomes being eligible for Medicaid by enrolling them in a federal option.

Biden plans to lower the costs of healthcare in general - which was supported by those surveyed by KFF - by tackling the concentration of power in the hands of a few corporations.

Controlling drug prices: what is Biden's plan?

As part of his promise to reduce the cost of healthcare, Biden is committed to driving down prices of prescription drugs in the US. The US has historically paid the world's highest prices for prescription drugs, which explains why this is at the top of voters' agendas.

Biden says his administration will "put a stop to runaway drug prices and the profiteering of the drug industry" by repealing the law that bans Medicare from negotiating lower prices with drug corporations.

He also calls for drugs that face no competition, which drives up the price companies ask for the product, to be reviewed by an independent board, which will recommend a reasonable price based on the average price of other countries - known as international reference pricing - or the evaluation of board members if the drug is only approved in the US. This will be the rate that Medicare and the public health insurance programme he has pledged to set up will then pay for this product.

If he wins the election, Biden has also promised to ban companies from increasing the prices of generic products above the general inflation rate; there will be a tax penalty on companies that break this limit. A major way that pharma companies keep the prices of their drugs high is by adopting strategies to delay the entrance of cheaper, generic alternatives onto the market once their patent has expired. Biden aims to tackle this by evaluating various proposals being suggested by lawmakers.

Another element of Biden's drug pricing plan is to allow consumers to buy prescription drugs from other companies, thereby driving more competition, so long as these drugs have been approved and certified safe by the US regulators.

Trump calls for 'most-favoured nation' drug pricing

Reducing drug prices is something Trump has talked a lot about during his term in office. It is also the first pledge in the healthcare section of his manifesto.

Although there is no detail in the manifesto about how he intends to do this, an executive order from mid-September sheds some light on Trump's plan.

This plan has similarities to Biden's in terms of enabling with the government to negotiate drug prices for products covered by Medicare. However, he has called for the "most-favoured-nation price" for Part B and Part D of the Medicare programme, which cover medical insurance and prescription drug coverage.

This means after the adjusting for volume and differences in national GDP, the US will pay the lowest price that the drug manufacturer has agreed for that drug with a member of the Organisation for Economic Co-operation and Development (OECD). Therefore, this proposal goes further than Biden's plan of using international reference pricing in Medicare drug cost decisions.

Related Companies

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Softgel Machinery and Technology

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US election: where do the candidates stand on other healthcare issues?

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Even beyond Covid-19, healthcare is a major battleground in the US Presidential election that will be decided on 3 November. The two candidates - Democrat Joe Biden and Republican Donald Trump - clash on many aspects of the American healthcare system and the pharma industry.

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Biden wants to give all Americans a public option for their health insurance along the lines of Medicare. He wants to ensure that state politics does not stop those with low-incomes being eligible for Medicaid by enrolling them in a federal option.

# data[].attributes.attachment_link.readable_text
Even beyond Covid-19, healthcare is a major battleground in the US Presidential election that will be decided on 3 November. The two candidates - Democrat Joe Biden and Republican Donald Trump - clash on many aspects of the American healthcare system and the pharma industry.

According to a Kaiser Family Foundation (KFF) poll, healthcare policy in general was the third-largest issue in deciding who to vote for President with 12% of the poll share, while the coronavirus outbreak ranked second at 18%. A range of healthcare policy areas are driving voters. The KFF polling data found that 94% said protections for people with pre-existing conditions by the Affordable Care Act (ACA) was important to their vote, while 63% wanted to see the cost of healthcare lowered and 59% said lowering drug prescription costs was a very important element of their vote.

Polls are starting to suggest Biden has a general nine-point lead over Trump, including a New York Times survey and a Reuters/Ipsos one. According to the KFF poll, Biden has a clear edge on all healthcare issues. For instance, 56% of voters think Biden will maintain protections for people with pre-existing conditions, compared to 36% for Trump. In addition, in lowering healthcare costs and drug prices, Biden leads by 14% and 7% respectively.

Let's examine the pledges of the two candidates on various healthcare topics and establish what impact their victory in November could mean for the healthcare and pharma industries.

The ACA: exploring Trump's opposition

The ACA, or Obamacare as it is colloquially known, was signed into law in 2010 and aimed to extend health insurance coverage to millions of uninsured Americans. Central to its premise was to expand eligibility to Medicaid - an existing public insurance programme for low-income families and individuals - and preventing insurance companies from denying coverage or overcharging patients with pre-existing conditions.

During his term in office, Trump has repeatedly tried to "sabotage" the ACA, in the words of Rutgers University professor of public affairs and administration Frank Thomson in an article for The Brookings Institution. This has primarily been by reducing the opportunities for enrolment into insurance exchanges, encouraging access to cheaper coverage that does not meet the standards of the ACA and by undermining its regulatory structure.

In addition, Trump has backed a lawsuit, California v Texas, that calls for the elimination of the ACA. This lawsuit was first filed in Texas in 2018 and now has the support of 18 states, while 17 states, led by California, are defending the ACA. The case has now reached the Supreme Court, which will decide on four legal questions on 10 November. The importance of the striking down of the ACA to Trump is clear in his haste to confirm Judge Amy Coney Barrett, his pick for Supreme Court to fill a seat left empty by the death of Justice Ruth Bader Ginsburg at the end of September, before the 3 November election.

The impact the overturning of the ACA will have on the protections of those with pre-existing conditions is of concern to voters, according to the KFF poll. Of those surveyed, 79% said they do not want to see those protections removed. Interestingly, 66% of Republicans did not want these pre-existing condition protections removed, despite 76% saying they wanted to see the entire law overturned.

In his manifesto, Trump explicitly states his commitment to cover all pre-existing conditions, but he does not provide any indication of how this will happen if the ACA is overturned. This probably explains why 53% polled by KFF said they do not think Trump has a plan to maintain these protections, while 's editorial board concluded that Trump cannot be trusted on his pre-existing conditions pledge.

Looking generally at Trump's other insurance-based manifesto promises, he pledged to protect social security and Medicare - a provision for the over-65s and those with certain disabilities irrespective of income - as well as lower healthcare insurance premiums, but without any details of how this will be done if the ACA is overturned.

Biden defends the ACA

Unsurprisingly, Biden is a staunch advocate of the ACA; he was Obama's vice-president after all.

Biden's plan is to build on the Act to further reduce costs and make the system easier to navigate; this is the cornerstone of his healthcare policy platform.

His campaign also wants to give all Americans a public option for their health insurance along the lines of Medicare. According to his manifesto, Biden will ensure that state politics does not stop those with low-incomes being eligible for Medicaid by enrolling them in a federal option.

Biden plans to lower the costs of healthcare in general - which was supported by those surveyed by KFF - by tackling the concentration of power in the hands of a few corporations.

Controlling drug prices: what is Biden's plan?

As part of his promise to reduce the cost of healthcare, Biden is committed to driving down prices of prescription drugs in the US. The US has historically paid the world's highest prices for prescription drugs, which explains why this is at the top of voters' agendas.

Biden says his administration will "put a stop to runaway drug prices and the profiteering of the drug industry" by repealing the law that bans Medicare from negotiating lower prices with drug corporations.

He also calls for drugs that face no competition, which drives up the price companies ask for the product, to be reviewed by an independent board, which will recommend a reasonable price based on the average price of other countries - known as international reference pricing - or the evaluation of board members if the drug is only approved in the US. This will be the rate that Medicare and the public health insurance programme he has pledged to set up will then pay for this product.

If he wins the election, Biden has also promised to ban companies from increasing the prices of generic products above the general inflation rate; there will be a tax penalty on companies that break this limit. A major way that pharma companies keep the prices of their drugs high is by adopting strategies to delay the entrance of cheaper, generic alternatives onto the market once their patent has expired. Biden aims to tackle this by evaluating various proposals being suggested by lawmakers.

Another element of Biden's drug pricing plan is to allow consumers to buy prescription drugs from other companies, thereby driving more competition, so long as these drugs have been approved and certified safe by the US regulators.

Trump calls for 'most-favoured nation' drug pricing

Reducing drug prices is something Trump has talked a lot about during his term in office. It is also the first pledge in the healthcare section of his manifesto.

Although there is no detail in the manifesto about how he intends to do this, an executive order from mid-September sheds some light on Trump's plan.

This plan has similarities to Biden's in terms of enabling with the government to negotiate drug prices for products covered by Medicare. However, he has called for the "most-favoured-nation price" for Part B and Part D of the Medicare programme, which cover medical insurance and prescription drug coverage.

This means after the adjusting for volume and differences in national GDP, the US will pay the lowest price that the drug manufacturer has agreed for that drug with a member of the Organisation for Economic Co-operation and Development (OECD). Therefore, this proposal goes further than Biden's plan of using international reference pricing in Medicare drug cost decisions.

Related Companies

Label Application Solutions for Pharmaceutical Packaging

Clean Room Doors, Emergency Escape Panels, Vision Panels, Hygienic Lift Trolleys, Air and Water Showers

Softgel Machinery and Technology

# data[].attributes.attachment_link.title
US election: where do the candidates stand on other healthcare issues?

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Even beyond Covid-19, healthcare is a major battleground in the US Presidential election that will be decided on 3 November. The two candidates - Democrat Joe Biden and Republican Donald Trump - clash on many aspects of the American healthcare system and the pharma industry.

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The democrat support a single payer system. Biden wishes to expand on the medicare act which support people with disabilities and adult over 65 year old. His goal is to provide quality affordable health care to everyone. He wishes to bring everyone the basic security in health care.

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" Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act."

In March 2010, President Obama fulfilled a promise that Democrats have pursued for nearly a century: making quality, affordable health care available to all Americans. In all, seven presidents pushed for health reform over the years. We have finally made real the principle that every American should have access to quality health care, and no one should go bankrupt just because they get sick - and we'll never stop fighting to protect that principle. President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri.

For decades Democrats have fought for the simple idea that everyone should have some basic security in health care. When President Johnson signed Medicare into law in 1965, we were finally able to provide that security to America's seniors. In 1997, Democrats passed the Children's Health Insurance Program (CHIP), which currently covers 8 million kids.

But it took nearly a century to extend that basic measure of security to all Americans.

In 2010, despite unanimous opposition from Republicans, Democrats were finally able to pass comprehensive health reform into law.

Thanks to the Affordable Care Act, more than 20 million Americans have gained health care coverage and the uninsured rate has been cut almost in half. Among the newly insured are more than 2.3 million young adults who are covered because the Affordable Care Act allows them to stay on their parent's insurance until age 26. Discrimination based on pre-existing conditions is now illegal, and nearly 8 in 10 Americans who recently shopped for health insurance in the marketplace could get it for less than $100 per month.

The Affordable Care Act has also allowed states to expand Medicaid to help even more Americans get covered. Thirty-one states and the District of Columbia have expanded Medicaid, and Medicaid and SCHIP enrollment has risen 26 percent.President Obama signs the Affordable Care Act into law.

The Affordable Care Act also provides tax credits to small businesses to help offset the costs of employee coverage and tax credits to help families pay for insurance. We are also experiencing health care spending growth at its lowest level in 50 years.

Democrats are committed to preserving and protecting the Affordable Care Act and the peace of mind it has brought to millions of Americans, and they will fight all attempts by the Trump administration to repeal the law and take health care away from tens of millions of Americans.

We are proud of this progress we have already made and are will work to extend and preserve it for generations to come.

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" Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act." In March 2010, President Obama fulfilled a promise that Democrats have pursued for nearly a century: making quality, affordable health care available to all Americans.

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I think that there should be a financial motive for medicine because that’s how we keep our economy moving. However, there should be limits placed by the government so that medicine are still affordable for the majority of the people. A balance needs to be made between the cost of medication and the qualification for people to receive medication.

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I think America should head towards that direction. However, I don't think it is fully possible that America will actually have a single-payer system because there are too many issues to consider. Also, the US is a big country so it will harder to execute a single-payer system than Taiwan.

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I think that the cost of reforms definitely outweigh the costs of the expenses. Human life > money

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I think it's fine to have a financial motive for medicine, but it shouldn't be the ONLY motive. A financial motive is a really good motive for people to keep going because they want money, but people might make medicine too expensive if they JUST want money. So I guess there should be limit on profits? But that might cause the quality of medicine to go down?

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I personally don’t think that the benefits will outweigh the costs. The better of a system we have, the worse problems we have with the system as well. The cost of reforming the system would only increasing the national debt, and there would be a whole lot of people who are against the reformation of the system. The reformation of the the healthcare system might be necessary, but the cost of doing it will outweigh the benefits.

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I don't like that there has to be a financial motive for medicine, but I think there does have to be one. It's just the unfortunate truth of the matter. Americans are very selfish.

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I think the government should extend the benefits to all citizens because we should all have easier access to healthcare. I think people hesitate going to the doctor because of the high costs, and end up having their conditions worsen. I think extending medicare can prevent this from happening.

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I think that human life should be a lot more valuable then money.

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However, without the circulation of money, human lives would be lost too.

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The Affordable care act help the patients access healthcare. However it actually cost patients more and hinder the doctor's ability to help the patient. Doctors state that this act only provide the basic solution and not the best solution. Doctors will have less time with the patient due to the easier accessibility to insurance. Doctors will be working more but not be able to provide the best for the patients.

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If there's one constant for physicians, it's change. And nothing has brought more change to healthcare in recent years than the introduction of the Affordable Care Act. Since the law was passed in 2010, nearly 17 million Americans have gained access to health insurance - putting major stress on doctors throughout the country.

CompHealth wanted to know how physicians feel about the ACA and what impact it's having on their jobs, so we surveyed about a thousand doctors working in private practice, group practice and hospitals.

Here are some of the things we learned.

The majority of physicians view the ACA unfavorably. The survey found 51 percent of respondents deem the law "very unfavorable" or "somewhat unfavorable." Just 30 percent gave the ACA a favorable rating.

Opinion of the ACA varies by practice type. The ACA is least favorable among physicians in private practice - only 20 percent view the law favorably - followed by group-practice physicians (26 percent), and hospital-based physicians (35 percent).

The ACA provides greater access to healthcare but at higher costs. Almost half of doctors surveyed think the ACA helps with the accessibility of healthcare for patients. However, they say it also costs patients more and hinders a doctor's ability to help patients. More than 40 percent of surveyed doctors stated that the ACA negatively impacted the cost of healthcare, overall medical practice, the ability to meet patient demand and their overall salary.

The impact of the ACA varies by practice type. As shown in the survey data below, private practice, group practice and hospital-based physicians rate the impact of the ACA differently. Physicians in private practice tend to have the most negative perspectives on the ACA and its impact on their work.

Believe they are not being properly compensated for their time

Private practice - 86%

Group practice - 75%

Hospital-based - 72%

Believe their overall salary has been negatively impacted

Private practice - 55%

Group practice - 46%

Hospital-based - 39%

Believe their salary has decreased greatly

Private practice - 28%

Group practice - 14%

Hospital-based - 10%

Believe their overall medical practice has been negatively impacted

Private practice - 58%

Group practice - 48%

Hospital-based - 38%

Doctors have less time with patients. With more accessibility to insurance under the ACA, 35 percent of physicians think the number of patients they see has increased since the statute went into effect. As a result, some physicians have had to cut the time they spend with each patient. According to the survey, 44 percent of physicians think they spend less time with their patients, while 54 percent of physicians say they spend the same amount of time with patients.

The ACA creates more busywork for physicians. Many doctors feel the ACA has created more billing and insurance paperwork. In fact, 68 percent claim they spend too much of their time at work entering data into electronic health records, and 59 percent state they spend too much time doing paperwork. Those in private practice (67 percent) are more burdened by paperwork compared to those in hospital-based practice (52 percent).

More doctors are taking second jobs. For many doctors, one job just isn't enough. The survey showed doctors are seeking additional employment, mainly to supplement their income. Among the 41 percent of physicians who took an additional job, half of them took it because their income had decreased. These employment opportunities include moonlighting, consulting and locum tenens, with locum tenens being the most popular second job.

What does this all mean?

It's not surprising that these challenges - less time with patients, more time on data entry and paperwork and reduced income - are taking their toll on physicians. Across all practice types, 36 percent of survey respondents said they were more inclined to leave the profession because of the ACA. The desire to leave medicine is even higher among private practice physicians, 45 percent of whom said they were more inclined to quit.

But with an ever-increasing physician shortage, we can't afford to have doctors leave medicine. Though there is no easy solution to the challenges facing our healthcare system, there are ways for physicians to find relief from some of the burdens brought on by the ACA.

Many doctors find that locum tenens assignments are a way to combat frustrations with the system.

Pay - Rather than receiving pay based on reimbursement, locum tenens physicians negotiate rates directly with their staffing agency.

Paperwork - Though locum tenens physicians need to be familiar with a wide range of electronic medical record systems, they don't have to deal with the same mountain of paperwork as full-time staff.

Time with patients - Because locums don't have to worry about staffing a practice, attending department meetings, or working with insurance payers, they have more time to focus on patient care.

Temporary assignments can be used as a part-time gig, a second job, or a replacement for a full-time job at any stage of your career. If you're thinking about leaving medicine, think about locum tenens first.
Find locum tenens positions across the country at shift.healthecareers.com! Related Articles:
Michael Sievert is vice president of the CompHealth locum tenens division, one of the nation's largest healthcare staffing companies. He has more than 20 years of experience in the recruiting industry.

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How Physicians Feel About the Affordable Care Act

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If there's one constant for physicians, it's change. And nothing has brought more change to healthcare in recent years than the introduction of the Affordable Care Act. Since the law was passed in 2010, nearly 17 million Americans have gained access to health insurance - putting major stress on doctors throughout the country.

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No, because medicine should be accessible to all, not just the rich. The government should mostly federalize healthcare/medicine so that there’s no financial incentive that can lead to corruption and inequality. That way, treating mass pandemics would be much more effective.