Health Insurance Loss during COVID-19 May Increase Support for Universal Health Coverage.

CONTEXT: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. Millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context. METHODS: Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) and the Affordable Care Act (ACA) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic person who lost employer-sponsored coverage during COVID-19. FINDINGS: We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p < 0.01) with greater M4A support and with more favorable views of extending the ACA (19.3 pp, p < 0.01). Experimental exposure to the vignette increases M4A support by 6 pp (p = 0.05). CONCLUSIONS: In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA.

Costs versus Coverage, Then and Now.

To expand coverage to those without it, Democrats in 2010 sacrificed cost control methods that might have helped those already insured. The law therefore did not offer most Americans what they wanted most. President Obama and those who thought like him convinced themselves the legislation would control costs by reforming how health care is organized, but any such effects have been both weak and unpopular. Now many commentators are accusing Democratic candidates of making the same mistake by prioritizing an ideological vision of "Medicare for All" over voters' worries about out-of-pocket costs. Yet Medicare for All, unlike less "radical" approaches, addresses those concerns directly. Unfortunately, neither elites (outside the industry!) nor voters seem to understand that, and it is politically risky because of the same fears about change, industry opposition, and distrust of government that inhibited more effective action a decade before.

Medicare Expansion Steps Into the Political Limelight.

Democrats think that they've got a winning issue. Sen. Bernie's Sanders Medicare for All bill is gaining backers, but expanding access to coverage by the public payer may be more practicable. Sander's is just one of a bunch of Medicare expansion plans. They all have pros and cons, a major con being how to pay for it.

Medicare for All - If It Were Politically Possible - Would Necessarily Replicate the Defects of Our Current System.

Medicare for All, ideally implemented, could offer powerful advantages over our current health care financial system. Unfortunately, the political obstacles to such a system are formidable and are likely to remain so for decades. More to the point, a politically viable single-payer system would not replace our currently dysfunctional health care politics. It would be a product of that same legislative process and political economy and thus be disfigured by the same interest group politics, path dependence, and fragmentation that Laurence Seidman rightly laments.

The Affordable Care Act versus Medicare for All.

Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All - the extension of Medicare to every age group. Every American would be automatically covered for life. Premiums would be replaced with a set of Medicare taxes. There would be no patient cost sharing. Individuals would have free choice of doctors. Medicare's single-payer bargaining power would slow price increases and reduce medical cost as a percentage of gross domestic product (GDP). Taxes as a percentage of GDP would rise from below average to average for economically advanced nations. Medicare for All would be phased in by age.

The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot.

Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform.

The Future of Work in America: Demise of Employer-Sponsored Insurance and What Should Replace it.

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees. During the pandemic, many workers found that they could work at home remotely. Job losses during the pandemic left many millions uninsured, with many jobs lost indefinitely. Today, many Americans are rethinking how and where they want to be involved in the workplace, while many businesses are considering a future when more people are working from home or being replaced by robots, placing ESI in further jeopardy. This article brings historical perspective to these problems, showing how the private health insurance industry has failed the public interest by being too fragmented and unreliable to be afforded or depended upon. Three major reform alternatives are described, only 1 of which-single-payer improved Medicare for All-can provide stable universal coverage that meets the needs of all Americans while being affordable for patients, families, and taxpayers.

Separated at Birth: The Politics of Pharmacare for All in Canada and Medicare for All in the United States Comment on "Universal Pharmacare in Canada".

Policy decisions about healthcare coverage in Canada and the United States in the 1960s placed two virtually identical systems on different evolutionary paths in the physician and hospital sectors. However, prescription drug coverage remained outside Canada's single-payer model, and employer-based coverage continued to be the norm for the workforce population, as is the case across the broad healthcare system in the United States. As a result the current debate about pharmacare in Canada mirrors in political microcosm the larger debate on universal health insurance among American Democrats. In each case the near-term prospects for a single-payer plan appear slim.

COVID-19 Has Revealed America's Broken Health Care System: What Can We Learn?

The COVID-19 pandemic has exposed long-standing system problems of US health care ranging from access barriers, uncontrolled prices and costs, unacceptable quality, widespread disparities and inequities, and marginalization of public health. All of these have been well documented by international comparisons. Our largely privatized market-based system and medical-industrial complex have been ill equipped to respond effectively to the pandemic. The accompanying economic downturn exacerbates these problems that further reveal the failures of our largely for-profit private health insurance industry, dependent as it is on continued government subsidies while it profiteers on the backs of vulnerable Americans. This article brings historical perspective to these problems, and provides markers of the extent of our unpreparedness and ineffective response to the pandemic. Coherent national health and public health policies are urgently needed based on evidence-based science, not political pressures. Financing reform is necessary, such as through single-payer Medicare for All. Eight takeaway lessons are summarized that can help to inform now best to rebuild US health care and public health, an urgent task for the incoming Biden administration.

Racism, Chronic Disease, and Mental Health: Time to Change Our Racialized System of Second-Class Care.

In this article, we describe how the "weathering hypothesis" and Adverse Childhood Experiences set the stage for higher rates of chronic disease, mental health disorders and maternal mortality seen in African American adults. We illustrate the toll that untreated and overtreated mental health disorders have on Black individuals, who have similar rates of mental health disorders as their white counterparts but have fewer outpatient mental health services and higher rates of hospitalizations. We discuss the history of Medicaid, which, while passed alongside Medicare during the Civil Rights era, was Congress's concession to Southern states unwilling to concede federal oversight and funds to the provision of equal healthcare for poor and Black people. Medicaid, which covers 33% of all Blacks in the US and suffers from chronic underfunding and state efforts to weaken it through demonstration waivers, is a second-class system of healthcare with eligibility criteria that vary by state and year. We propose the adoption of a national, single payer Medicare for All system to cover everyone equally, from conception to death. While this will not erase all structural racism, it will go a long way towards leveling the playing field and achieving greater equity in the US.

Investor-owned Health Care: The Hidden Blight on America's "System".

Investor ownership of US health care has grown exponentially in the past 50 years through ever closer ties with Wall Street corporate interests. More recently, private equity firms have accelerated this process, invariably with harmful impacts on access to affordable care, its quality, and profiteering, with little accountability. These impacts are fueled by several concurrent trends: (1) increasing privatization, (2) consolidation and mergers, (3) increasing bureaucracy and waste, and (4) profiteering that may bleed into outright fraud. This article traces the uncontrolled growth of health care costs and prices in recent decades, together with documented examples across the health care delivery system whereby profit-driven, investor-owned interests have compromised patient care. These include hospitals, emergency care, nursing homes, mental health, and practices of such specialities as obstetrics-gynecology and ophthalmology. These practices have compromised patient care in the midst of a pandemic and economic downturn, as reflected by markers of a system needing reform. A larger role of government is called for, together with the advantages of Medicare for All in establishing health care as a human right, not a privilege based on ability to pay.

A polling experiment on public opinion on the future expansion of Medicare and Medicaid.

OBJECTIVE: To conduct a polling experiment to understand the possible framing effects that drive constituents' views around Medicare For All (MFA) and Medicaid Buy-In (MBI). DATA SOURCES AND STUDY SETTING: Five thousand and fifty-one US adults aged 18 and older were recruited to participate in an online poll conducted between September 12, 2018, and September 26, 2018. STUDY DESIGN: Participants were randomized to receive one of four polls: (a) a poll measuring respondent approval for MFA, with the name of the proposal stated with a description; (b) a poll measuring approval for MFA, with only a description of the proposal; (c) a poll measuring approval for MBI, with the name stated with a description; or (d) a poll measuring approval for MBI, with only a description. PRINCIPAL FINDINGS: Including the names "Medicare For All" and "Medicaid Buy-In" increases approval by 3.4 (from 32.7 percent to 36.1 percent) and 5.0 (from 50.1 percent to 55.1 percent) percentage points, respectively. Support varies by age, where MBI is most strongly supported by Millennials, while Baby Boomers and those older than 65 are more likely to support MFA. CONCLUSIONS: Constituents are more likely to support a proposal when given the names of the proposal. Approval is also higher for health policies that are framed as expansions of existing policies than as new programs.

Challenges To Medicare For All Remain Daunting.

Medicare for All plans have many advantages over the status quo. Yet the challenges facing such plans are immense, reflecting their ambitions to achieve universal coverage through a single federal plan and their disruption to existing insurance and financing arrangements. Medicare for All will not become viable unless it can meet the daunting political, economic, and administrative realities that govern US health care.

Making Single-Payer Reform Work for Behavioral Health Care: Lessons From Canada and the United States.

The claim is often made that the adoption of single-payer health care in the United States would result in dramatic improvement of services for people with mental health and substance use disorders. Evidence from this sector in countries with such frameworks is mixed, however, presenting both positive and negative lessons for an American audience. Focusing on Canada as an example, this article sheds light on this topic by drawing on sources in the professional and academic literature, government reports, news stories and features, and research on-site by the author. A concluding section highlights key policy issues that American single-payer advocates will need to address for meaningful reform of the behavioral health care sector.

The U.S. Health Care Crisis Continues: A Data Snapshot.

Despite implementation of the Affordable Care Act in 2014, the U.S. health care crisis continues. While coverage has been expanded, 28 million people remain uninsured, and tens of millions who have coverage are unable to afford care because of high cost-sharing requirements. Moreover, many with coverage have a sharply restricted choice of physicians and hospitals, and the corporate takeover of medical care in the United States is proceeding rapidly. This article provides a brief précis of recent data on U.S. health policy.