There are two distinct visions for the future of American health care. “Medicare for All: Leaving No One Behind,” has been proposed by Sen. Bernie Sanders. Budget Committee Chairman Steve Womack of Arkansas has a much different plan that is included in next year’s Republican budget called, “A Budget for a Brighter American Future.”
The Bernie Sanders website offers this description of the Medicare for All plan: “Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs. As a patient, all you need to do is go to the doctor and show your insurance card. Bernie’s plan means no more co-pays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.”
The plan has been estimated to save the American people and businesses over $6 trillion over the next decade: “Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year. The average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to just $3,100.”
Sen. Sanders has outlined seven ways to raise revenue to pay for his plan:
• A 6.2 percent income-based health care premium paid by employers. This is estimated to raise $630 billion in revenue per year.
• A 2.2 percent income-based premium paid by households. A family of four taking the standard deduction would not owe any tax on their first $28,800 of income. A family of four making $50,000 a year taking the standard deduction would pay $466 this year. This is estimated to raise $210 billion in revenue per year.
• An income tax rate increase for high earners. Rates would increase to 37 percent for those making over $250,000; 43 percent for those making over $500,000; 48 percent for those making over $2 million; and 52 percent for those making over $10 million. Estimated to raise $110 billion in revenue per year.
· Taxing capital gains and dividends the same as ordinary income. Estimated to raise $92 billion in revenue per year.
• Placing a 28 percent limit on the value of itemized deductions. Estimated to raise $15 billion in revenue per year.
• Increase the estate tax on the wealthiest three-tenths of one percent of Americans who inherit over $3.5 million and close loopholes in the estate tax. Estimated to raise $21 billion in revenue per year.
• Eliminating tax breaks that would no longer be needed to subsidize health care, such as the cost for employer provided health care. Estimated to raise $310 billion in revenue per year.
There is a wide range of expert opinion on the costs to implement the Medicare for All plan. An analysis by University of Massachusetts-Amherst economics professor Gerald Friedman estimated that Sanders’ single-payer system would cost $13.8 trillion over the next 10 years and that the seven tax increases proposed by Sanders would raise $13.9 trillion, making the system fully paid for. The Committee for a Responsible Federal Budget estimated that Sanders would need an additional $2.6 trillion over a decade to fully fund his plan. The Tax Policy Center analysis found that as much as $16 trillion in additional sources of revenue would need to be identified to fully finance the plan.
Womack’s plan for a “Brighter American Future” would gradually raise the age of Medicare eligibility to age 67. He told a Fort Smith town hall audience: “If we do nothing, Part A (Medicare) will be insolvent in 2026 and that’s just not an acceptable outcome for people who have planned their lives around these programs. We’re not trying to privatize Social Security. And we’re not privatizing Medicare. We’re just simply giving people a choice on programs that are structured like Medicare Part C, the Medicare Advantage Program, that we think will be a much better solution for people entering that age.”
The House budget plan calls for cutting mandatory programs by $4.6 trillion over ten years (2019-2028). According to the Center on Budget and Policy Priorities (CBPP) these cuts include $1.5 trillion from Medicaid and the Affordable Care Act; $157 billion from the SNAP (food stamp) program; $766 billion from other income security programs such as SSI and child nutrition; $231 billion from education (Pell Grants) and other social service programs; and $537 billion from Medicare.
In addition to increasing the Medicare eligibility age, the budget would replace Medicare’s guarantee of health coverage with a flat premium-support payment (voucher) that beneficiaries would use to help buy either private health insurance or a form of traditional Medicare. This is a back-door plan to kill traditional Medicare as most people remaining in traditional fee for service (FFS) Medicare would pay much higher premiums.
The Congressional Budget Office (CBO) analyzed two different premium support options which would be based on insurers’ bids. One would set the federal government contribution on the basis of the second lowest bid in each region. The other would use the region’s average bid. The CBO found: “Most who wished to remain in the FFS program would pay much higher premiums under either option than they would under current law. CBO estimates that the premium for enrolling in the FFS program under the second-lowest bid option in 2024 would be about twice as much, on average, as the current law Part B premium projected for that year. Under the average-bid option, the premium would be 57 percent more, on average, than the projected current law Part B premium.”
After passing a massive tax cut for the wealthy and corporations that will cost $1.9 trillion dollars between 2018 and 2027, Womack and his buddies have the audacity to use the national debt as the reason to cut entitlement programs such as Medicare and Medicaid. The CBPP offers this comparison of tax cuts and the House budget plan’s program cuts:
• Between 2019 and 2028 (the period covered by the House budget plan) the tax cuts will cost roughly $1.6 trillion, according to CBO. Over that same period, the budget proposes to cut $1.5 trillion from Medicaid and Affordable Care Act tax credits, health programs that serve only low-and moderate-income households.
• Similarly, the tax law’s net corporate tax cuts, including the sharp cut in the corporate rate from 35 to 21 percent, will cost about $320 billion between 2019 and 2028. The budget would cut SNAP, Pell Grants, and student loans by roughly $370 billion over that period.
The Tax Policy Center recently found that nearly all households in the bottom 60 percent (those with income below $86,100) would end up losing more from the program cuts than they would gain from the tax cuts. It should also be noted that both The National Committee to Preserve Social Security and Medicare and the AARP are strongly opposed to Womack’s budget.
Josh Mahony, Womack’s Democratic challenger, summed up Womack’s act of duplicity: “Congressman Womack recently voted for a tax cut that adds $1 trillion to our national debt, and then when he released the GOP House Budget he decided the best way to reduce the debt he created was by cutting Social Security, Medicare and Medicaid. To pay for his tax cut for the wealthy, they are cutting programs that are essential to the other 99 percent of Americans. Steve Womack blew up the deficit and now he’s trying to fix it by sticking it to the people who can afford it the least.” Womack should be asked, who gets to share in his Brighter American Future?