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Universal health care can be funded by eliminating profits 

Dr. David Ray is chairman of the Capital District Alliance for Universal Health Care, August 9, 2020, Commentary: Universal health care system will save money and lives, https://www.timesunion.com/opinion/article/Commentary-Universal-health-care-system-will-15470977.php

Data published in The New York Times revealed that, even accounting for differences in underlying health conditions and age, poor people living in communities with underfunded safety-net hospitals in New York City were up to three times more likely to die from their coronavirus infections than patients in hospitals managed by the same large corporations in wealthier parts of the city. It’s likely that this inequity held true in many socioeconomically and racially segregated cities from coast to coast as the pandemic spread. And yet, both for-profit and nonprofit hospital systems have poured our health care dollars into capital improvements and continue to do so even during the pandemic, a direct result of the perverse incentives built into our health care system. When patients become customers, and health care is marketed as an exclusive luxury, public health concerns and stewardship of health care dollars fall by the wayside. While the continuing efforts of President Donald Trump and his Republican apologists to dismantle the Affordable Care Act are reprehensible and shameful, it is also now quite evident that the accomplishments of that law were sharply limited by the concessions made to the insurance companies and other middlemen who contribute little value to our citizens’ health needs. I hope that the energy produced by the groundswell of indignation and outrage will not be wasted trying to shore up the ACA. We need a national health program that offers the same access and quality of care to every human being in America. The money saved by eliminating the health care profiteering of the pharmaceutical and insurance industries would amount to nearly $1 trillion annually. This is one-third of the country’s total health care expenditures, and would easily cover the cost of extending coverage to 100 percent of Americans, with money left over to improve and expand what Medicare already guarantees. The possibility of coverage for home care through the end of life would reduce the warehousing of our elderly in nursing homes, some of which became coronavirus death traps. Essential services like mental health care, dental and vision care should be universally available. Multiple studies have shown that a nationwide Medicare for All program would reduce the total cost of health care for over 90 percent of Americans, with any increase in taxes for the majority more than offset by lower out-of-pocket expenditures, the end of co-pays and constantly rising insurance premiums.  The health insurance industry has its knee on our necks. As surely as unregulated policing is a danger to the health of the most vulnerable among us (and by association, all of us), so unregulated profiteering in health care is making us sicker — as individuals and as a society. We must tell our elected officials to let us inspire equality, fairness, and hope for our own, our children’s and our grandchildren’s health by creating a system of equitable health care for all.

Turn — Universal care encourages prevention, increasing cost savings

Paul Olson, 2012, PhD, MDiv, Moral Arguments for Universal Health Care, Kindle edition, page number at end of card

This observation does not abrogate individual responsibility, but it tempers a judgmental attitude that would lead to denial of their rights as citizens to medically necessary care. Acknowledging the shared responsibility leads to a recommendation of prevention as a goal and task for individuals, and as an essential element of public policy. Both prevention through public health initiatives and primary health care in our health care system would reduce   overall costs substantially by limiting misuse and overuse of medical services. Unfortunately, in the present pluralistic market of payers and plans, there is a disincentive to emphasize prevention and health promotion because employers and their employees change health plans, hence the long term cost savings implemented by one health plan may end up benefitting another competitor (Power, 2011).  “R. Paul Olson Ph.D. MDiv.”. Moral Arguments for Universal Health Care: A Vision for Health Care Reform (Kindle Locations 6378-6381). AuthorHouse. Kindle Edition. Based on the major standards of justice—treating people fairly, ensuring civil, natural, and moral rights, and distributive justice—the inescapable conclusion is that the U.S. health care system is unjust (Adler, 1981, pp. 186f, esp. p. 189). Its denial of the human right to medically necessary care also makes the American health care system harmful,   immoral, and inhumane. I have discussed three concepts of justice that support universal health care: A utilitarian theory (chapter six), fairness-based justice (chapter seven), and rights-based justice in this chapter. The latter has been discussed in terms of both civil rights, natural (human) rights and moral rights, including the rights to social insurance and to a decent minimum of medically necessary health care. An implicit premise of all three types of arguments is that we have a duty to be just.  “R. Paul Olson Ph.D. MDiv.”. Moral Arguments for Universal Health Care: A Vision for Health Care Reform (Kindle Locations 6384-6389). AuthorHouse. Kindle Edition.

Medicare for All means overall economic gain

Sally Pipes, 2020, False Promise: The Disastrous Reality of Medicare for All, Pipes is the President & CEO, Pacific Research Institute .

As of 2017, U.S. Health Consumption Expenditures are equal to 17.2 percent of GDP. The comparable ratio for eight other large industrial economies ranges between 8.9 percent of GDP for Italy and 11.3 percent of GDP for Germany. In addition, health care spending as a share of the U.S. economy has risen dramatically over time. In 1970, U.S. Health Consumption Expenditures equaled 6.2 percent of GDP. The Centers for Medicare and Medicaid Services (CMS) projects that the ratio will reach 18.8 percent by 2026. Following from our estimates, Health Consumption Expenditures would fall to 15.8 percent of GDP under Medicare for All, as of the 2017 economy. This would represent a dramatic decline in health care spending as a share of GDP for the U.S., but would still be substantially higher than the figures for all other large advanced economies. We conclude that further incremental improvements in service delivery under Medicare for All should enable U.S. health care costs to stabilize at around 15.8 percent of GDP, even after taking account of the rising cost pressures resulting from an aging population. Based on these results, we can then develop a 10-year forecast of Health Consumption Expenditures under Medicare for All, and compare this forecast with the projection by CMS of Health Consumption Expenditures assuming that the U.S. continues operating under its existing health care system. We find that, over the decade 2017 – 2026, the cumulative savings through operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP. There would also be broader macroeconomic benefits through operating the U.S. health care system under Medicare for All. Among these are that improved health outcomes will raise productivity; Medicare for All will support greater income equality; and that Medicare for All should support net job creation, especially through lowering operating costs for small- and mediumsized businesses.

Turn — Strong growth key to tax revenues and deficit reduction

Alice Rivlin, March 13, 2013, https://www.brookings.edu/testimonies/growing-the-economy-and-stabilizing-the-debt/, Alice M. Rivlin was a senior fellow for Economic Studies at Brookings, where she was a cherished colleague for more than sixty years.

Weak economic growth—or worse, sliding back into recession—will reduce revenues and make it much harder to reduce or even stabilize the ratio of debt to GDP.

Medicare for All saves money over the long-term

Diane Archer is a senior adviser at Social Security Works, February 24, 2020, 22 studies agree: ‘Medicare for All’ saves money, https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money

The evidence abounds: A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money. Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S. [Every study] All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage. Medicare for All is far less costly than our current system largely because it reduces administrative costs. With one public plan negotiating rates with health care providers, billing becomes quite simple. We do away with three-quarters of the estimated $812 billion the U.S. now spends on health care administration.Administrative costs are so high because thousands of insurance companies individually negotiate benefit rules and rates with thousands of hospitals and doctors. On top of that, they rely on different billing procedures — and this puts a costly burden on providers. Administrative savings from Medicare for All would be about $600 billion [dollars] a year. Savings on prescription[s] drugs would be between $200 billion and $300 billion [dollars] a year, if we paid about the same price as other wealthy countries pay for their drugs. A Medicare for All system would save still more with implementation of global health care spending budgets.[and] Even more savings are possible in a Medicare for All system because, like every other wealthy country, we would have a uniform electronic health records system. Such a system generates additional savings because system problems would be easier to detect and correct. A uniform claims data system helps reduce health care spending for fraudulent services. In 2018, total U.S. health care costs were $3.6 trillion, representing 17.7 percent of GDP.Savings are in part a function of the benefits Medicare for All covers. The Mercatus report and others projected savings, even with the elimination of deductibles and out-of-pocket costs. Under both Sen. Bernie Sanders’s (I-Vt.) Medicare for All bill and Rep. Pramila Jayapal’s (D-Wash.) Medicare for All bill, patients would not pay deductibles or coinsurance when they receive medical care. Their bills also provide for vision, hearing and dental care, as well as long-term services and supports, such as home care and nursing home care. No matter how you design a single-payer public health insurance system, it would have lower overall health care costs, so long as for-profit private health insurers no longer exist to drive up health care costs. Yes, it’s true that some other wealthy countries rely on “private insurers” to provide benefits and spend far less than we do on care. But, these insurers do not operate in any way like health insurers in the U.S. Other wealthy countries dictate virtually every element of the health insurance people receive, including what’s covered, what’s paid, and people’s out-of-pocket costs — all identical for everyone. The insurers operate like claims processors or bill payers.

Administrative costs constitute 30% of all health care expenditures. M4A gets rid of these costs

Crowley et. al 20 [Crowley, Ryan; Daniel, Hilary; Cooney, Thomas. 01-21-2020. “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care.” Animals of Internal Medicine. https://www.acpjournals.org/doi/full/10.7326/M19-2415] /// CP

In large part owing to its pluralistic financing system, the United States spends more on administration of health care than peer countries. One study estimated that in 2012, the United States spent $471 billion on billing and insurance-related costs—$375 billion (80%) more than in a “simplified financing system,” such as Canada’s single-payer model (23). Another study concluded that administrative costs were 31% of total U.S. health care expenditures, nearly double those of Canada (24). In 2010–2012, administrative costs varied with type of insurance market: 20% in nongroup and 11% in large-group markets (25). Average administrative costs for private insurers are around 12.4%, substantially higher than Medicare administrative spending, which accounts for around 2% of total program costs (26, 27). Physicians and hospitals in the United States spend much more than their counterparts elsewhere on administrative activities. Physician practices in the United States spend $61 000 more per physician per year dealing with insurers than their Canadian counterparts (28). Hospital administrative costs make up 25% of total U.S. hospital spending, compared with 20% in the Netherlands, 16% in England, and 12% in Canada (29). Insurance premiums reflect high administrative costs. Analysts project that administrative costs account for 30%, or roughly $5700, of the approximately $19 000 annual premium for an average employer-sponsored health family insurance plan (30), slightly less than the average annual amount that workers pay toward insurance ($6015) (31).

We have consensus on our side

Ryan Cooper, February 21, 2020, The Week, https://theweek.com/articles/896455/how-much-medicareforall-save-americans-lot.

hey conducted a meta-analysis of Medicare-for-all research — that is, they surveyed a bunch of papers on the topic, picked out the best 22, and aggregated the results. (These papers were not all directly about the specific Sanders bill, but they were a lot closer than the Urban Institute paper.) They found that 19 of the analyses “predicted net savings … in the first year of program operation and 20 … predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans.”

Single payer saves costs through reduction in administrative costs—specifically cutting back bulk buying and reducing malpractice premiums

Weisbart 12 [Weisbart, Ed. November 2012. “A Single-Payer System Would Reduce U.S. Health Care Costs.” AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/single-payer-system-would-reduce-us-health-care-costs/2012-11] /// CP

Profound administrative excesses divert resources into activities that do not improve health outcomes. They often represent the entire careers of countless highly skilled and compassionate people who could be spending their time delivering health care rather than impeding it. Insurance companies have balked at the ACA’s requiring them to spend at least 80-85 percent of their revenue on delivery of health care. (In contrast, more than 98 percent of Medicare’s expenditures are clinical [16].) Estimates vary, but one-quarter to one-third of our current costs are driven by insurance company overhead, profits, and the administrative costs embedded in clinical settings. Roughly half of these costs would be recovered under single-payer and could be reallocated to the delivery of meaningful health care services [17, 18]. A single-payer model would eliminate the inefficiencies of fragmentation by converting public programs such as Medicare, Medicaid, and CHIP into a single administratively efficient financing system. Streamlined billing under single payer would save physicians vast amounts in overhead [19]. In addition to reduced billing expenses, physicians would also enjoy a meaningful drop in their malpractice premiums. Roughly half of all malpractice awards are for present and future medical costs [20], so if malpractice settlements no longer need to include them, premiums would fall dramatically. Use bulk purchasing to negotiate lower costs. We spend more but use less of most services [21] than other member nations of the Organization for Economic Cooperation and Development. In other words, our prices are much higher [22]. As health care economist Uwe Reinhardt noted, prices for identical products or services in the U.S. tend to be, on average, twice or more than the prices of the same products and services paid in other countries…. Prices are high here because the payment side of the health system is so fragmented that few payers have sufficient market power to bargain for lower prices from an increasingly consolidated supply side [23]. Drug formularies vary widely among health plans. The medical evidence behind the formulary selections is the same in Florida and Alaska, yet the drug lists are sometimes as different as the geography. Although pharmacy benefit managers work within the boundaries of medical evidence, they also consider the prices they have negotiated and the local drug market shares on their formulary selections. Any industry’s power to negotiate prices depends upon its purchasing volume. Only a single-payer system enables the kind of bulk purchasing of drugs and medical devices that would give the buyer power. A model for this structure exists today in the United States: the Department of Veterans Affairs. Due to governmental authority to negotiate drug prices for the VA, it pays roughly half of the retail price of drugs [24]. Negotiations with clinicians should ensure adequate reimbursement of expenses plus fair profits, while ensuring value for taxpayers. A recent careful analysis found that this model is effective and does not lead to a loss in physician income [25].

Universal care encourages prevention, increasing cost savings

Paul Olson, 2012, PhD, MDiv, Moral Arguments for Universal Health Care, Kindle edition, page number at end of card

This observation does not abrogate individual responsibility, but it tempers a judgmental attitude that would lead to denial of their rights as citizens to medically necessary care. Acknowledging the shared responsibility leads to a recommendation of prevention as a goal and task for individuals, and as an essential element of public policy. Both prevention through public health initiatives and primary health care in our health care system would reduce   overall costs substantially by limiting misuse and overuse of medical services. Unfortunately, in the present pluralistic market of payers and plans, there is a disincentive to emphasize prevention and health promotion because employers and their employees change health plans, hence the long term cost savings implemented by one health plan may end up benefitting another competitor (Power, 2011).  “R. Paul Olson Ph.D. MDiv.”. Moral Arguments for Universal Health Care: A Vision for Health Care Reform (Kindle Locations 6378-6381). AuthorHouse. Kindle Edition. Based on the major standards of justice—treating people fairly, ensuring civil, natural, and moral rights, and distributive justice—the inescapable conclusion is that the U.S. health care system is unjust (Adler, 1981, pp. 186f, esp. p. 189). Its denial of the human right to medically necessary care also makes the American health care system harmful,   immoral, and inhumane. I have discussed three concepts of justice that support universal health care: A utilitarian theory (chapter six), fairness-based justice (chapter seven), and rights-based justice in this chapter. The latter has been discussed in terms of both civil rights, natural (human) rights and moral rights, including the rights to social insurance and to a decent minimum of medically necessary health care. An implicit premise of all three types of arguments is that we have a duty to be just.  “R. Paul Olson Ph.D. MDiv.”. Moral Arguments for Universal Health Care: A Vision for Health Care Reform (Kindle Locations 6384-6389). AuthorHouse. Kindle Edition.

Any increased costs morally required

Paul Olson, 2012, PhD, MDiv, Moral Arguments for Universal Health Care, Kindle edition, page number at end of card

This rule of double effect could help to resolve dilemmas created by conflicting goals of health care policies. Ideally a health care   system would provide the good effect of universal access without incurring a bad effect of increased cost. Administrative costs resulting from duplications of underwriting, billing, claims processing services and excess marketing and lobbying by hundreds of private health plans and insurance companies; (f) excluding for-profit corporations from involvement in the health sector; or (g) limiting extravagant executive   compensation and/or inflationary increases in providers’ fees and hospital prices. All of these strategies could save billions of dollars sufficient to pay for the expansion of health insurance to cover all Americans. There have been several estimates of substantial savings in administrative costs alone that would result from a national single-payer system compared to the present private-public system in the United States (Himmelstein, Woolhandler, & Hellander, 2001; U.S. GAO, 1991a, 1991b; Woolhander, Campbell, & Himmelstein, 2003; Woolhandler & Himmelstein, 1991, 1997, 2002). Opponents of universal health care challenge the estimates of cost savings, and they project substantial increases in costs of health care particularly under a publicly   financed, single-payer plan. Nevertheless, according to the rule of double effect, if increased costs of a universal health care policy were foreseen, these cost increases could be permitted, though not intended because (a) the policy itself is good (providing universal access to health care is beneficent, utilitarian, and fair); (b) universal coverage is the good effect intended, not increased cost; (c) the increased cost is not the means to universal health care, but the effect of the above mentioned cost saving strategies; and (d) the good effect (universal health care) outweighs the bad effect (if costs increase). This line of reasoning is an example of applying the ethical rule of double effect. Of course, to be responsible one must estimate the cost increase associated with such  ” a health policy, plan how to pay for the additional costs, and estimate whether these costs can be contained over time so the program of universal health care is fiscally sustainable. Moreover, given a limited budget, the opportunity costs of policies must be considered. That is, one must assess what other social goods might be limited by increased health care expenditures (e.g., education, police, fire, and environmental protections, safe bridges and roads, employment, investments in economic growth, etc.)  “R. Paul Olson Ph.D. MDiv.”. Moral Arguments for Universal Health Care: A Vision for Health Care Reform (Kindle Locations 3434-3438). AuthorHouse. Kindle Edition.

Turn — Medicare for All reduces health care costs

Pollin, 2018, Robert Pollin is Distinguished University Professor of Economics and Co-Director of the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst. He is also the founder and President of PEAR (Pollin Energy and Retrofits), an Amherst, MA-based green energy company operating throughout the United States, Economic Analysis of Medicare for All, file:///Users/stefanbauschard/Downloads/Medicare_For_All_12.5.18%20(1).pdf

Medicare for All has the potential to achieve major cost savings in its operations relative to the existing U.S. health care system. We estimate that, through implementation of Medicare for All, overall U.S. health care costs could fall by about 19 percent relative to the existing system. The most significant sources of cost saving will be in the areas of: 1) administration (9.0 percent savings in total system costs); 2) pharmaceutical pricing (5.9 percent savings in system costs); and 3) establishing uniform Medicare rates for hospitals, physicians, and clinics (2.8 percent savings in system costs). An additional, more modest source of cost savings, at least in the initial years under Medicare for All, would be to reduce the high levels of waste and fraud that currently prevail in service provision. As a low-end figure, we assume that achievable cost savings in these areas would be about 1.5 percent of total system costs in the first year of full operations. We also assume that further gains in waste reduction and fraud control are achievable in later years, at a rate of about 1 percent per year for roughly a decade. As of 2017, the U.S. is spending $3.24 trillion on Health Consumption Expenditures (other than public health programs). With Medicare for All generating both increased overall demand in the range of 12.0 percent and cost savings of about 19.2 percent, total Health Consumption Expenditures would fall to $2.93 trillion. We therefore estimate that Medicare for All could reduce U.S. Health Consumption Expenditures by about 9.6 percent while also providing decent health care coverage for all U.S. residents.

Taxes won’t hurt the economy because the $ would have otherwise been spent on health care

Pollin, 2018, Robert Pollin is Distinguished University Professor of Economics and Co-Director of the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst. He is also the founder and President of PEAR (Pollin Energy and Retrofits), an Amherst, MA-based green energy company operating throughout the United States, Economic Analysis of Medicare for All, file:///Users/stefanbauschard/Downloads/Medicare_For_All_12.5.18%20(1).pdf

Overall then, as Table 18 shows, our bottom-line figure for all existing public funding sources available to finance Medicare for All is $1.88 trillion (rounded down from $1.884 trillion). This figure includes, again, 1) all available public insurance funds; 2) funds now provided for other public third-party payers; and 3) federal tax subsidies as well as health insurance spending on federal government employees. Given our estimate that the costs of providing universal coverage under Medicare for All would be $2.93 trillion in 2017, we can then conclude that, for the U.S. economy as of 2017, we would need to raise an additional $1.05 trillion in new taxes to fully fund Medicare for All. We show our simple derivation of this figure in Table 19. Of course, these new tax revenues would not constitute a net additional cost or spending burden on the U.S. economy. These funds would rather be serving to substitute for the loss of revenue into the U.S. health care system that presently come from existing private revenue sources— i.e. primarily private health insurance and out-of-pocket expenditures. These private revenue sources would no longer operate. We explore the net effects of this shift in spending sources later in this chapter. First, however, we consider measures for raising $1.05 trillion in revenues within the U.S. economy as of 2017.