Tagged Medicare

Democrats Sharpen Health Care Attacks As Primaries Heat Up

The ideal began to get real on Tuesday, as seven of the top contenders for the Democratic presidential nomination sparred over the price tag on health care reform and even revealed similarities on issues like marijuana legalization.

With Democrats in 15 states and American Samoa set to cast their primary votes in the next week, the candidates eagerly seized their chances on the debate stage in Charleston, S.C., to jab Sen. Bernie Sanders of Vermont, the current frontrunner, during the party’s tenth debate.

For all of their interruptions and talking over each other, though, the candidates offered a few thoughtful answers and, seemingly in spite of themselves, agreed on at least decriminalizing marijuana and expunging past, small-scale marijuana possession charges from Americans’ criminal records.

Sanders said he would remove marijuana from the list of controlled substances on the first day of his presidency and added that he would empower black, Latino, and Native American communities to start businesses selling the drug legally, rather than leave corporations to fill what is already a lucrative market.

Mike Bloomberg, the former mayor of New York City, expressed the most skepticism of full legalization because of his concerns about the drug’s effect on the brains of young people. Until we know the science, it’s just nonsensical to push ahead,” he said.

Rural health was also a topic, giving Sen. Amy Klobuchar of Minnesota the opportunity to tout her leadership on bipartisan legislation that would help rural hospitals as well as an immigration bill that would encourage foreign-born doctors trained in the United States to practice in rural areas.

And though the candidates were not asked about abortion rights, the subject came up, briefly and jarringly. Describing how she lost her job as a young teacher when she became pregnant and had no union or legal support to fight back, Sen. Elizabeth Warren of Massachusetts abruptly turned to the allegations of sexual harassment against Bloomberg.

“At least I didn’t have a boss who said to me, ‘Kill it,’ the way that Mayor Bloomberg is alleged to have said to one of his pregnant employees,” Warren said, eliciting gasps.

“I never said that,” Bloomberg said.

Let’s look at what else the candidates claimed.

‘The Incredible Shrinking Price Tag’

Pete Buttigieg, the former mayor of South Bend, Ind., took issue with Sanders’ changing cost estimates for his “Medicare for All” plan.

“Senator Sanders at one point said it was going to be $40 trillion, then 30, then 17. It’s an incredible shrinking price tag,” Buttigieg said. “At some point he said it is unknowable to see what the price tag will be.”

Sanders has indeed cited differing estimates of what Medicare for All would cost.

The $30 to $40 trillion figure alludes to work done by the Urban Institute, a Washington think-tank. It is the only analysis to factor in the price of long-term care — one of the most expensive components of Medicare for All — and finds the program would cost $34 trillion in new federal spending over 10 years. (In terms of national health spending — both public and private dollars, that is — it would result in an increase of just $7 trillion over a decade.) The research makes assumptions that Sanders’ bill leaves open-ended, for instance, estimating what Medicare for All would ultimately pay hospitals and health professionals. Experts note that this is a major hole in Sanders’ plan.

The $17 trillion comes from a paper released this month in the medical journal, The Lancet. The researchers say Medicare for All would save $450 billion annually. That would drop the cost significantly, to just about $17 trillion over 10 years.

This figure is what Sanders relies on in calculating his own plan to finance the single-payer plan. His proposed set of revenues would raise about $17.14 trillion in a decade. (For more information on the Lancet study — whose methodology prompted skepticism from many policy analysts — see our full fact-check.)

Sanders has also said in at least one interview that the price of Medicare for All is “impossible to predict.” This is perhaps the most correct. As analysts repeatedly have told us, the switch to single-payer would represent a shift of unprecedented magnitude in American history. And before you can predict what it would cost, you need to decide what you would pay hospitals and doctors.

Pandemic Specialists: Where Are You Now’?

When the debate turned to the global threat of the new coronavirus, COVID-19, Bloomberg, Klobuchar, and former Vice President Joe Biden used similar talking points: that President Donald Trump cut global health experts from his national security team, leaving the U.S. unprepared to face the virus outbreak either globally or domestically.

“The president fired the pandemic specialists in this country two years ago,” Bloomberg said.

It’s true that, in May 2018, the top White House official who was in charge of the U.S. response to pandemics left the administration. Rear Admiral Timothy Ziemer was the senior director of global health and biodefense on the National Security Council and oversaw global health security issues. That global health team was disbanded after Ziemer’s departure and reorganized as part of a streamlining effort headed by then-National Security Adviser John Bolton.

Ziemer’s position on the NSC has not been filled in the last two years. Tom Bossert, a homeland security adviser who recommended strong defenses against disease and biological warfare, also departed in 2018.  

Last month, Trump announced that Health and Human Services Secretary Alex Azar would be the chair of the coronavirus task force that’s in charge of the U.S. response to the disease. But many are still urging that this position be filled to coordinate the federal response. 

Last week a group of 27 senators sent a letter to current National Security Adviser Robert O’Brien to ask him to appoint a new global health security expert to the NSC.

Preparedness Funding For Global Infections 

Former Vice President Joe Biden said President Donald Trump “cut the funding for CDC.”

Trump has consistently proposed funding cuts to the Centers for Disease Control and Prevention. But Congress has consistently overruled him. 

Because the comment came during a discussion of the United States’ preparedness for emerging global infections like the coronavirus, we looked at the budgets for emerging and zoonotic infectious diseases at CDC, rather than for the CDC as a whole.

The Trump administration’s initial budget proposal has consistently been lower than what was spent the previous year. The administration proposed $61.7 million less in 2018 than 2017; $96.4 million less in 2019 than in 2018; $114.4 million less in 2020 than in 2019; and $85.3 million less in 2021 than 2020.

However, Congress usually treats any president’s budget proposal as an opening volley, with lawmakers reshaping the federal budget as they see fit when they craft final spending bills.

Every year since Trump has been president, lawmakers have passed bills — bills that were eventually signed by the president — that not only exceeded what Trump had asked for on emerging infections but also exceeded what had been spent the previous year.

The next debate, the eleventh of what the Democratic National Committee has said will be 12 presidential primary debates, is scheduled for Sunday, March 15.

PolitiFact’s Louis Jacobson contributed to this story.`

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Bernie Sanders Embraces A New Study That Lowers ‘Medicare For All’s’ Price Tag, But Skepticism Abounds

Defending his signature health plan — a single-payer system known “Medicare for All” that would move all Americans to government-funded coverage  — Vermont Sen. Bernie Sanders argued that the massive health care expansion would actually save the system hundreds of billions of dollars.

Sanders’ figures come from a study published Feb. 15 in The Lancet, a British medical journal.

“It said ‘Medicare for All’ will lower health care costs in this country by $450 billion a year and save the lives of 68,000 people who would otherwise have died,” Sanders said at the Feb. 25 Democratic presidential debate.

The price tag of Medicare for All has been fiercely debated, and some previous analyses have suggested that the proposal would increase health spending, not decrease it. But Sanders is relying on the Lancet paper — which has a cost estimate that is the lowest, in the neighborhood of $17 trillion over 10 years — to argue that the suite of financing mechanisms he has proposed would more than cover the cost of his health bill. (Funding would include taxes on high earners, a new payroll tax, and 4% income premiums for the majority of families.) Most other estimates place the cost between $30 trillion and $40 trillion over a decade, which would make paying for it far more difficult.  So we decided to take a closer look.

We reached out to one of the study’s authors, but never heard back. 

A spokesperson for the Sanders campaign said the paper is “similar to 22 other recent studies that have also shown that moving to a single-payer healthcare system will cost less than our current dysfunctional healthcare system.” (We asked for those 22 other studies but, as of publication, hadn’t received them.)

But independent experts were skeptical of the study’s estimate — arguing it exaggerates potential savings, cherry-picks evidence and downplays some of the potential tradeoffs.

“I don’t think this study, albeit in a prestigious, peer-reviewed journal, should be given any deference in the Medicare for All debate,” said Robert Berenson, a fellow at the Urban Institute who studies hospital pricing.

So, Savings?

Largely, the Lancet paper is more generous in its assumptions than other Medicare for All analysis, noted Jodi Liu, an economist at the RAND Corp., who studies single-payer plans. To the researchers’ credit, she said, they acknowledge that their findings are based on uncertain assumptions.

For instance, the researchers calculate $78.2 billion in savings from providing primary care to uninsured people — $70.4 billion from avoided hospitalizations and $7.8 from avoided emergency room visits. But previous evidence suggests that logic is suspect at best. 

When states expanded Medicaid under the Affordable Care Act, providing new insurance to people who had previously lacked coverage, avoidable hospitalizations and emergency room visits didn’t disappear because people could suddenly use preventive care, noted Ellen Meara, a professor at the Harvard T.H. Chan School of Public Health. That evidence doesn’t appear anywhere in the Lancet paper.

“The notion that we’re going to get rid of all these avoidable visits — that’s not been borne out,” she said. 

The researchers also assume that a Medicare for All system would pay hospitals at a maximum of Medicare rates.

That’s tricky. In 2017, the nonpartisan Medicare Payment Advisory Commission estimated that, on average, a hospital has a -9.9% margin on a patient who is insured through Medicare. (Private pay helps make up that difference.) Some hospitals certainly would be able to swallow this cost. But others would struggle to stay afloat, said Adrianna McIntyre, a health policy researcher at Harvard University 

Given the political influence hospitals in particular carry in Congress — where most members are sensitive to their concerns — passing a plan offering such a low payment rate would be politically challenging.

Sanders’ bill doesn’t actually  specify the rates at which hospitals would be paid.

Beyond the lower payments, the researchers also suggest hospitals would spend less money on overhead, only having to navigate a single insurance plan. That change accounts for $219 billion in their estimated savings.

But again, that ignores some of the reality of how hospitals work. While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals.

The assumptions are unrealistic,” said Gerard Anderson, a health economist at Johns Hopkins University in Baltimore. “You are never going to save that much money from the various providers.” 

The Cost-Sharing Question

Medicare for All would enroll all Americans in coverage far more generous than what most experience now — eliminating virtually all cost-sharing associated with using health care. 

That’s a major change, researchers told us. Previous evidence suggests that such a shift would encourage consumers to use health care more than they currently do. 

The Lancet paper acknowledges that — but only partially. It allows that people who are uninsured or “underinsured” — that is, who have particularly high levels of cost-sharing now — would use more medical care under Sanders’ system than they currently do. It factors that into the price tag. 

But its estimate does not account for people who already have decent or adequate insurance and who would still be moving to a richer benefit, and therefore more likely to use their insurance. 

“It drastically underestimates the utilization increases we would expect to see under Medicare for All,” McIntyre said. “People have different views on whether the increased utilization is good or bad,” she added — it makes the program more expensive, but also means more people are getting treatment.

Other Estimates?

Context is helpful, too. Other estimates — namely, a projection by the Urban Institute — of Medicare for All have suggested it would increase federal health spending by about $34 trillion over 10 years. But elimination of other health spending would make the overall change smaller. 

To implement the Sanders proposal, national health spending — public and private dollars, both — would increase by $7 trillion over a decade, Urban said. And Medicare for All would be bringing new services: more insurance for more people, and more generous coverage for those already covered.

Urban’s estimate of $7 trillion more in spending over 10 years is far removed from the study’s estimate of $450 billion less annually. And, experts said, relying on the latter figure isn’t a good idea.

“I think they need more work to prove” the savings, Meara said. “They’re not being complete, and by not being complete, they’re not being honest.”

It’s also worth noting that the study’s lead author was also an informal unpaid adviser to the Sanders staff in drafting its 2019 version of the Medicare for All bill, according to the paper’s disclosures section.

The “Lives Saved”

Experts agree that expanding access to health insurance would probably reduce early mortality. But the 68,000 figure is another example of cherry-picking, Meara said.

The figure is based on a 2009 paper. It doesn’t acknowledge a body of research that came after, including multiple studies that examined how expanding Medicaid  affected mortality — and maybe offered less dramatic numbers.

“When they so clearly are cherry-picking, when they clearly have all the  information on studies in front of them, it’s concerning,” Meara said. “It’s a situation where you’re going to overpromise and underdeliver.”

Our Ruling

Sanders said a recent study suggested Medicare for All would save $450 billion annually and saves 68,000 lives.

That study does exist. And it cites some evidence. But many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. It cherry-picks data in calculating mortality effects.

This statement has some truth, but ignores context that would create a dramatically different impression. We rate it Mostly False.

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U.S. Medical Panel Thinks Twice About Pushing Cognitive Screening For Dementia

A leading group of medical experts on Tuesday declined to endorse cognitive screening for older adults, fueling a debate that has simmered for years.

The U.S. Preventive Services Task Force said it could neither recommend nor oppose cognitive screening, citing insufficient scientific evidence of the practice’s benefits and harms and calling for further studies.

The task force’s work informs policies set by Medicare and private insurers. Its recommendations, an accompanying scientific statement and two editorials were published Tuesday in the Journal of the American Medical Association.

The task force’s new position comes as concern mounts over a rising tide of older adults with Alzheimer’s disease and other dementias and treatments remain elusive. Nearly 6 million Americans have Alzheimer’s disease; that population is expected to swell to nearly 14 million by 2050.

Because seniors are at higher risk of cognitive impairment, proponents say screening ― testing people without any symptoms — is an important strategy to identify people with unrecognized difficulties and potentially lead to better care.

“This can start a discussion with your doctor: ‘You know, you’re having problems with your cognition, let’s follow this up,’” said Stephen Rao of Cleveland Clinic’s Lou Ruvo Center for Brain Health.

Opponents say the benefits of screening are unproven and the potential for harm is worrisome. “Getting a positive result can make someone wary about their cognition and memory for the rest of their life,” said Benjamin Bensadon, an associate professor of geriatric medicine at the University of Florida College of Medicine.

The task force’s stance is controversial, given how poorly the health care system serves seniors with memory and thinking problems. Physicians routinely overlook cognitive impairment and dementia in older patients, failing to recognize these conditions at least 50% of the time, according to several studies.

When the Alzheimer’s Association surveyed 1,954 seniors in December 2018, 82% said they thought it was important to have their thinking or memory checked. But only 16% said physicians regularly checked their cognition.

What’s more, Medicare policies appear to affirm the value of screening. Since 2011, Medicare has required that physicians assess a patient’s cognition during an annual wellness visit if the patient asks for a checkup of this kind. But only 19% of seniors took advantage of this benefit in 2016, the most recent year for which data is available.

Dr. Ronald Petersen, co-author of an editorial accompanying the recommendations, cautioned that they shouldn’t discourage physicians from evaluating older patients’ memory and thinking.

“There is increased awareness, both on the part of patients and physicians, of the importance of cognitive impairment,” said Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center. “It would be a mistake if physicians didn’t pay more attention to cognition and consider screening on a case-by-case basis.”

Similarly, seniors shouldn’t avoid addressing worrisome symptoms.

“If someone has concerns or a family member has concerns about their memory or cognitive abilities, they should certainly discuss that with their clinician,” said Dr. Douglas Owens, chair of the task force and a professor at Stanford University School of Medicine.

In more than a dozen interviews, experts teased out complexities surrounding this topic. Here’s what they told me:

Screening basics. Cognitive screening involves administering short tests (usually five minutes or less) to people without any symptoms of cognitive decline. It’s an effort to bring to light problems with thinking and memory that otherwise might escape attention.

Depending on the test, people may be asked to recall words, draw a clock face, name the date, spell a word backward, relate a recent news event or sort items into different categories, among other tasks. Common tests include the Mini-Cog, the Memory Impairment Screen, the General Practitioner Assessment of Cognition and the Mini-Mental Status Examination.

The task force’s evaluation focuses on “universal screening”: whether all adults age 65 and older without symptoms should be given tests to assess their cognition. It found a lack of high-quality scientific evidence that this practice would improve older adults’ quality of life, ensure that they get better care or positively affect other outcomes such as caregivers’ efficacy and well-being.

A disappointing study. High hopes had rested on a study by researchers at Indiana University, published in December. In that trial, 1,723 older adults were screened for cognitive impairment, while 1,693 were not.

A year later, seniors in the screening group were not more depressed or anxious — important evidence of the lack of harm from the assessment. But the study failed to find evidence that people screened had a better health-related quality of life or lower rates of hospitalizations or emergency department visits.

Two-thirds of seniors who tested positive for cognitive impairment in her study declined to undergo further evaluation. That’s consistent with findings from other studies, and it testifies to “how many people are terrified of dementia,” said Dr. Timothy Holden, an assistant professor at Washington University School of Medicine in St. Louis.

“What seems clear is that screening in and of itself doesn’t yield benefits unless it’s accompanied by appropriate diagnostic follow-up and care,” said Nicole Foster, associate director of the Center for Aging Research at Indiana University’s Regenstrief Institute.

Selective screening. “Selective screening” for cognitive impairment is an alternative to universal screening and has gained support.

In a statement published last fall, the American Academy of Neurology recommended that all patients 65 and older seen by neurologists get yearly cognitive health assessments. Also, the American Diabetes Association  recommends that all adults with diabetes age 65 and older be screened for cognitive impairment at an initial visit and annually thereafter “as appropriate.” And the American College of Surgeons now recommends screening older adults for cognitive impairment before surgery.

Why test select groups? Many patients with diabetes or neurological conditions have overlapping cognitive symptoms and “it’s important to know if a patient is having trouble remembering what the doctor said,” said Dr. Norman Foster, chair of the workgroup that developed the neurology statement and a professor of neurology at the University of Utah.

Physicians may need to alter treatment regimens for older adults with cognitive impairment or work more closely with family members. “If someone needs to manage their own care, it’s important to know if they can do that reliably,” Foster said.

With surgery, older patients who have preexisting cognitive impairments are at higher risk of developing delirium, an acute, sudden-onset brain disorder. Identifying these patients can alert medical staff to this risk, which can be prevented or mitigated with appropriate medical attention.

Also, people who learn they have early-stage cognitive impairment can be connected with community resources and take steps to plan for their future, medically and financially. The hope is that, one day, medical treatments will be able to halt or slow the progression of dementia. But treatments currently available don’t fulfill that promise.

Steps after screening. Screening shouldn’t be confused with diagnosis: All these short tests can do is signal potential problems.

If results indicate reason for concern, a physician should ask knowledgeable family members or friends what’s going on with an older patient. “Are they depressed? Having problems taking care of themselves? Asking the same question repeatedly?” said Dr. David Reuben, chief of geriatrics at UCLA’s David Geffen School of Medicine and director of UCLA’s Alzheimer’s and Dementia Care program.

A comprehensive history and physical examination should then be undertaken to rule out potential reversible causes of cognitive difficulties, implicated in about 10% of cases. These include sleep apnea, depression, hearing or vision loss, vitamin B12 or folic acid deficiencies, alcohol abuse and side effects from anticholinergic drugs or other medications, among other conditions.

Once other causes are ruled out, neuropsychological tests can help establish a diagnosis.

“If I detect mild cognitive impairment, the first thing I’ll do is tell a patient I don’t have any drugs for that but I can help you compensate for deficits,” Reuben said. The good news, he said: A substantial number of patients with MCI ― about 50% — don’t develop dementia within five years of being diagnosed.

The bottom line. “If you’re concerned about your memory or thinking, ask your physician for an assessment,” said Dr. David Knopman, a neurologist at the Mayo Clinic. If that test indicates reason for concern, make sure you get appropriate follow-up.

That’s easier said than done if you want to see a dementia specialist, noted Dr. Soo Borson, a professor emerita of psychiatry at the University of Washington. “Everyone I know who’s doing clinical dementia care says they have wait lists of four to six months,” she said.

With shortages of geriatric psychiatrists, geriatricians, neuropsychologists and neurologists, there aren’t enough specialists to handle demands that would arise if universal screening for cognitive impairment were implemented, Borson warned.

If you’re a family member of an older adult who’s resisting getting tested, “reach out privately to your primary care physician and express your concerns,” said Holden of Washington University. “And let your doctor know if the person isn’t seeing these changes or is resistant to talk about it.”

This happens frequently because people with cognitive impairments are often unaware of their problems. “But there are ways that we, as physicians, can work around that,” Holden said. “If a physician handles the situation with sensitivity and takes things one step at a time, you can build trust and that can make things much easier.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

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Scalpels Out: Democrats Make Slashing Attacks On Health Care Plans

Top contenders for the Democratic presidential nomination torched one another’s proposals to reform the health care system Wednesday, as the contest to unify behind a single candidate to defeat President Donald Trump took a bitterly divisive turn.

Minutes after Tom Perez, the chairman of the Democratic National Committee, warmed up the debate audience in Las Vegas by describing the party as a spirited but unified family, most of the candidates abruptly shifted into attack mode — and not just against Mike Bloomberg, the billionaire businessman and former New York City mayor making his first, belated appearance in the ninth debate.

Fighting to regain momentum after weak performances in the Iowa caucuses and New Hampshire primary, Sen. Elizabeth Warren of Massachusetts dispatched with her opponents’ plans in brutally rapid succession.

Pete Buttigieg, the former South Bend, Ind., mayor, has offered “not a plan” but “a PowerPoint” that she claimed would leave millions uninsured, she said. Sen. Amy Klobuchar of Minnesota has a proposal that is “like a Post-It note: Insert plan here,” she quipped. And Sen. Bernie Sanders of Vermont, whose “Medicare for All” plan she initially adopted as her own, “has a good start,” but his campaign cannot stop attacking those who question how it would work, she said.

“Health care is a crisis in this country,” Warren concluded. “My approach to this is, we need as much help for as many people as quickly as possible.”

It wasn’t the only tense moment.

Sanders Angers The Culinary Workers Union

How Sanders’ Medicare for All proposal would affect unions in particular isn’t a new question. But despite strong support for the proposal from some national unions, it emerged as a flashpoint in the run-up to Nevada’s caucus on Saturday, turning the state’s prominent Culinary Workers Union against Sanders, the current frontrunner, in the 11th hour.

The union did not endorse a candidate but warned members that Sanders’ proposal could eliminate the health care coverage they have gained through years of collective bargaining, replacing it with a system that is untested and unknown.  The union then put out a statement last week saying its members had been “viciously attacked” by Sanders’ supporters over the organization’s opposition . Sanders responded by saying that, though there were some bad actors on social media, it was “not thinkable” that his supporters would attack union workers.

“Let me be very clear for my good friends in the Culinary Workers union, a great union: I will never sign a bill that will reduce the health care benefits they have,” Sanders said. “We will only expand it for them, for every union in America and for the working class.”

Klobuchar defended the “hard-working” culinary workers “who have health care plans that have been negotiated over time, sweat, and blood,” she said. “And that is the truth for so many Americans right now.”

Last summer Sanders tweaked his proposal to try to alleviate concerns from unions. Under a Medicare for All system, he said, the National Labor Relations Board would supervise unions in renegotiating contracts with employers, so that they could acquire “wrap-around services and other coverage not duplicative of the benefits established under Medicare-for-all.”

The idea, Sanders’ aides said then, was so that any savings a switch to single-payer achieved could still be passed on to workers, as increased benefits or wages.

But members of the Culinary Workers Union — and some other groups — still worry about losing the coverage they have, in exchange for something unknown.

Would that happen? Technically, yes, the health plan Nevada’s culinary workers get through their union would no longer exist. Under Medicare for All, private health plans could not sell coverage that duplicates what the government program offers.

But it’s worth noting that, in this world, culinary workers would still have generous health insurance. Sanders’ envisioned health plan is robust – he says it would cover virtually all practicing physicians and medically necessary services, with virtually no cost-sharing.

Of course, that would also depend on whether a President Sanders could muster support for his plan among skeptical members of Congress.

$100 Billion In Profits

Sanders brought up one favorite talking point twice Wednesday — his claim that the health care industry makes $100 billion a year in profits. We previously checked this claim and rated it True. The number comes from adding the net revenues in 2018 from 10 pharmaceutical companies and 10 health insurance companies. We recalculated the numbers, and they added up. Experts said it was even likely that the figure was an underestimate. 

Big Pharma Is Giving Money To Buttigieg And Others 

In another biting moment, Sanders charged that drug companies are donating to Buttigieg and other campaigns as the pharmaceutical industry profits off the current system.

We previously checked Sanders’ claim that Buttigieg was a “favorite of the health care industry” and rated it Half True. This is in part because it is actually Sanders who has received the most donations of any Democratic candidate from the entire health care sector, which includes pharmaceutical companies, health insurance industry, hospitals/nursing homes and health professionals.

But, while checking this claim we also found that Buttigieg has received donations from employees and executives of pharmaceutical and health insurance companies such as AbbVie, Aetna, Anthem, Eli Lilly and Co., Merck & Co. and Pfizer. We did not check into donations for other candidates from pharmaceutical executives. 

Do People ‘Love’ Their Insurance?

You don’t start out by saying, I have 160 million people, I’m going to take away the insurance plan that they love,” Bloomberg said just minutes into the debate, pointing out the shortcomings of Sanders’ Medicare for All plan.

It is true that Sanders’ signature health proposal would eliminate private health insurance, replacing it with a single public plan that covers everybody. That would include the roughly 160 million Americans who get employer-sponsored insurance

But Bloomberg’s argument here — that those people “love” their plans — is complicated.

When we previously checked a similar claim — that 160 million people “like their health insurance” — we rated it Half-True. Cursory polling suggests people with that coverage are mostly satisfied. 

But most isn’t all. And, experts pointed out to us then, once Americans try to use that coverage, many find it lacking. In a Kaiser Family Foundation/ L.A. Times poll, for instance, 40% of people with employer-sponsored insurance still reported having trouble paying for medical bills, premiums or out-of-pocket costs. In that same poll, about half said they skipped or delayed health care because — even with coverage — they couldn’t afford it. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

And More About Warren’s Attach On  Klobuchar’s Health Plan

“Amy, I looked online at your (health care) plan. It’s two paragraphs.” Warren said.

This is highly misleading.

Warren’s campaign told PolitiFact that she was referring specifically to Klobuchar’s plan for “universal health care.” It pointed to the two paragraphs at the end of this Klobuchar campaign web page, which come under the heading “Propose legislation to get us to universal health care.” 

But that ignores most of Klobuchar’s health care plan, which she outlines in quite a bit of detail on four different web pages — a main health care policy page, a more detailed sub-page, a sub-page on prescription drugs and a sub-page on mental health.

We did a word count on the text from those four web pages, and it exceeded 6,000 words — and a lot more than two paragraphs.

PolitiFact’s Louis Jacobson contributed. 

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Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No.

During the Feb. 7 Democratic presidential debate, former Vice President Joe Biden once again questioned the price tag of “Medicare for All,” the single-payer health care proposal championed by one of his key rivals, Sen. Bernie Sanders of Vermont.

Biden argued that the plan was fiscally irresponsible and would require raising middle-class taxes. Specifically, he claimed, the plan “would cost more than the entire federal budget that we spend now.”

Medicare for All’s price — and whether it’s worth it — is a subject of fierce discussion among Democratic presidential candidates. But we had never heard this figure before. It caught our attention, so we decided to dig in.

Biden’s campaign directed us to the 2018 federal budget, which totaled $4.1 trillion. It compared that amount with the estimated cost of Sanders’ single-payer proposal: between $30 trillion and $40 trillion over a decade. The math, they said, shows Medicare for All would cost more than the national budget.

But it turns out, based on the numbers and interviews with independent experts, Biden’s comparison of Medicare for All’s price to total federal spending misses the mark because the calculation is flawed.

The Numbers

Sanders has said publicly that economists estimate Medicare for All would cost somewhere between $30 trillion and $40 trillion over 10 years. Research by the nonpartisan Urban Institute, a Washington, D.C., think tank, puts the figure in the $32 trillion to $34 trillion range.

We pointed out to Biden’s campaign that comparing 10-year spending estimates to one-year budgets is like comparing apples to oranges. The campaign suggested that if you take 10 times the current federal budget, you get a figure smaller than the estimated cost of Medicare for All over that 10-year window.

That calculation would lead you to multiply $4.1 trillion by 10 to get $41.1 trillion. That result is close to the high mark Sanders set for his program’s cost but well above the $34 trillion that Urban researchers projected.

Still, that’s not the correct way to formulate a comparison, experts say. “That’s not good math,” said Marc Goldwein, the senior vice president and senior policy director at the Committee for a Responsible Federal Budget. “That’s taking a 2018 number and multiplying it by 10, whereas the $34 trillion is a 10-year number that assumes a lot of growth.”

What you would need to do is add up the Congressional Budget Office’s projected budget outlays from 2020 to 2029, and compare the sum to the Medicare for All spending figure.

So we spoke to Linda Blumberg, an institute fellow at Urban’s Health Policy Center, who arrived at the $34 trillion estimate. She ran the CBO’s numbers: The next 10 years of on-budget outlay, the government office projects, add up to $44.8 trillion.

To be clear, $34 trillion (34 followed by 12 zeros) is no small sum. It accounts for about 75% of that nearly $45 trillion budget estimate and would represent a bigger single increase to the federal budget than we’ve ever experienced, Blumberg said.

That raises one point on which Biden may have some ground. Goldwein argued that you would indeed need significant tax increases to finance the Sanders proposal.

But its price tag still would be less than the projected budget.

“If he said [Medicare for All] was as big as the current federal budget, that would be incorrect,” Blumberg said.

Goldwein looked at the numbers another way: Including interest, he found, the federal budget would consume about $55 trillion between now and 2030. Again, that’s more than what Medicare for All would cost during the same period.

Big picture: No matter how you slice Biden’s math, his numbers are off.

“If what he said was Medicare for All will cost as much as the entire rest of the budget, that would be fair,” Goldwein said. But that’s not the same thing.

Our Ruling

Biden argued that Medicare for All “would cost more than the entire federal budget that we spend now.”

This relies on faulty math. Medicare for All would certainly represent a substantial increase to the federal budget. But it would neither match nor dwarf current federal spending overall. We rate this claim False.

Related Topics

Elections Health Care Costs Insurance Medicare