Healthcare Reform Proposals Under the Biden Administration

Healthcare costs are constraining US households and the national economy, because the amount of government investment and private sector payments are the highest in the world, for results that are no better than the rest of the industrialized countries. This article reviews three different approaches, from the Democrat and Independent political spectrum for healthcare reforms. There is no Republican inclusion because that group has never managed to develop any comprehensive proposal for healthcare reform. To make it easier on those challenged with long text, here is a table summarizing the Medicare X, Biden Public Option Plan, and Bernie’s Medicare for all.

Plan	Medicare X-Kaine/Bennet (Medicare X Choice Act, 2021)	Biden Public Option (Biden Unveils Health Care Plan, 2021)	Bernie Medicare for All Single Payor (Sanders, 2021)
Focus	Emphasizes rural America and could be in the small healthcare market by 2025. Provides healthcare coverage where there is a lack of providers. Uses the same network as Medicare, adds primary care and obstetrics for families.	Offers a public option into the federal employees type plan(luxe) for uninsured people and expands eligibility for those age 55 and up. Also expands subsidies for families within 300% of the FPL for Medicaid. Wants the federal gov to finance 75% of all catastrophic care bills. Throws another billion at EMR. Provides support for 100K more nurses.	Provides a national healthcare plan, based on Medicare expansion for everyone in the US. This plan would be like the Canadian plan, which works well and is less expensive than the US healthcare system.
Financing	Uses the current insurance premium structure and expands tax credits to pay for medical insurance for those within 400% of the FPL.	Finances the entire thing off the general budget allocation-no specific tax hits for targeted groups yet. Would have to increase taxes.	Would require a combination of insurance premiums and higher taxes for employers. Medicare is less expensive than private insurance by far. Restores the marginal tax rate to 52% from the current rich-give-away of 37%. Corporate taxes would increase too from 21% to ?
Benefits	Targets rural communities and offers 125% of Medicare reimbursement rates to entities serving them.	Expansion of healthcare for families is a good idea and the public option may end up being efficacious for the nation.	Providing national healthcare would mean everyone in the nation would have basic healthcare and the opportunity to eliminate wasteful healthcare spending.
Infrastructure changes	Starts a national reinsurance plan which would lower premiums by using the large purchasing power of the US than reinsurers from Lloyds of London.	Would make the federal government responsible for catastrophic healthcare costs over $50,000.	Would make the federal government responsible for healthcare planning, distribution, and resourcing. But Medicare already does this very well.
RX Impact for consumers	Will give the head of Health and Human Services the power to bargain with drug companies	Nothing specific yet, but Biden supports Health and Human Services negotiating with pharma to lower drug prices for public plans.	Will give the head of Health and Human Services the power to bargain with drug companies to lower drug costs and the US gov is the largest customer.
Cost	Supposed to be cost neutral because premiums would pay for it.	Shores up the Affordable Care Act so funded through premiums and fee assessments.	Employees would pay 4% more in a payroll tax, but would no longer have to pay for medical insurance (equal to at least 10% of gross pay now). Employers would no longer have to pay for private insurance, but they would have to pay an additional 7.5% in payroll tax, making that 16.15% if the current SSI and Medicare taxes are in place. Self-employed people would pay 22.8%.

 

Analysis

The Bernie Sanders plan may actually be less expensive (when you consider systemic improvements) than President Biden's and has a clear path to finance the deployment of healthcare to everyone in the US. Every other industrial country in the world has a national healthcare plan and spend a lot less than the US, up to 40% less, which is a lot of money to use for education and infrastructure. The US spends over $10,000 per person on healthcare, which is more than twice what Australia, Canada, France, or the UK spend.

Biden’s plan would make the nation responsible for all medical costs above $50,000 which would be a costly disaster if the current private insurance system is still in place (AKA subsidizing insurance company avaricious behavior and profits). Capping costs above 50K is also too low, based on exhorbitant healthcare costs in the US. The annual cost of Zolgesma, a drug used to treat a motor neuron disorder for those with spinal atrophy is over two million. I don't see any indication of reforming drug approval processes, like the orphan drug rule or applying population health measures to drug company reformulations, which is a ruse to replace drugs whose patents are expiring. Passing this debt on to everyone else is not the answer UNLESS there are meaningful reforms in the drug approval process and the US government finally starts negotiating with big pharma for lower prices, which is what every other nation does. 

The correct response is to REFORM the US healthcare system which would include; cutting waste, curbing unnecessary procedures, using the full power of the massive US government to negotiate contracts and increasing investment in primary care. Bernie Sander's plan would do all of these things, but there would be a significant upfront cost, with savings realized over time. The problem is Americans have the attention span of gnats and Congressmen get elected every four years, which doesn't bode well for patience to see results mature. 

Of these major proposals for healthcare reform, the Kaine/Bennet proposal has the optimal approach, because it addresses the serious shortfall of rural healthcare with a reasonable approach and wouldn’t cost that much. One of the crying problems in US healthcare is the fact health services are very limited in rural areas thanks in large part to the huge hospital groups eliminating “unprofitable facilities from their portfolios.” In other words, they don’t make enough money from serving your needs, which is EXACTLY the reason the government needs to intercede in healthcare, whenever there is a private market failure. By demonstrating that we care about people outside the tech centers and the beltway the nation may just be able to start reforming our healthcare system.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket waivers at hospitals or surgical facilities, do stipulate that for which you consent and for which you don’t. 

 Roberta Winter is the healthpolicymaven and is an independent journalist who has been publishing this column since 2007. The opinions expressed here are her own and are not paid for by any sector of the US healthcare system.  She is the author of a guidebook to the US healthcare system which was published in 2013 by Rowman and Littlefield.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 References

Biden Unveils Health Care Plan. (2021, March 6). Retrieved from Commonwealthfund.org: https://www.commonwealthfund.org/publications/newsletter-article/biden-unveils-health-care-plan

Medicare X Choice Act. (2021, March 6). Retrieved from Bennett.Senate.gov: file:///C:/Users/Roberta%20Winter/Downloads/B62E7A3B8A60C537EB62A11FCC018684.medicare-x-2019-one-pager.pdf

Sanders, B. (2021, March 6). How Does Bernie Pay His Major Plans. Retrieved from Bernie Sanders.com: https://berniesanders.com/issues/how-does-bernie-pay-his-major-plans/