Nov 4, 2019

Elizabeth Warren's dream health care world

Illustration: Aïda Amer/Axios

Sen. Elizabeth Warren's Medicare for All plan takes on every major health care industry — insurers, doctors, hospitals and drug companies — in her pursuit of expanding coverage and lowering costs for the middle class.

Why it matters: We've never tried any cost containment measures that are remotely close to being as aggressive as Warren's, and there could be consequences if payment rates are slashed so low.

The big picture: Experts say you can only wring so much money out of the system before it starts to impact the care people receive — and Warren is wringing out a lot.

Private insurance would be eliminated. Warren argues that would save hundreds of billions of dollars in administrative spending, and relieve patients of the hassle of dealing with their insurer.

  • Americans would no longer have to worry about reaching their deductibles or whether their doctors are in their insurance network.
  • They'd pay no premiums and have "virtually no" out-of-pocket costs, according to Warren. They'd have expansive health benefits, including long-term care, audio, visual and dental.
  • They'd also have no choice about any of this.

To pay for all of this, providers would see drastic payment reductions.

  • Doctors would generally be paid at current Medicare rates — which on average are much lower than private insurance rates — although some, like primary care-physicians, would be paid more than they currently are by Medicare and others, like "overpaid" specialty doctors, would be paid less.
  • Hospitals would be paid an average of 110% of Medicare rates, with adjustments for rural and teaching hospitals — still much lower than what private insurance pays.
  • Providers wouldn't have to worry any longer about uninsured patients, nor would they have to negotiate with insurers.
  • "The ultimate question, which we can all guess at but can’t know for sure, is whether enough hospitals and doctors would continue delivering care to a larger number of insured patients. If not, we’d see growing waits for care," said the Kaiser Family Foundation's Larry Levitt.

Drug prices would plummet.

  • The federal government would be allowed to negotiate drug prices, and penalize drug companies that refused to participate with more taxes.
  • Americans would pay no more for a drug than 110% of its average international price.
  • If negotiations don't work, Warren would override a drug's patent — allowing another company to make the drug at a lower price — or have the government manufacture the drug.
  • Warren suggests that no patient will be denied a drug based on its price.
  • Experts have warned that even less aggressive drug pricing plans would come at the cost of less innovation by drug companies, and thus fewer new cures coming to market.

The bottom line: The days of American health care as big business would likely be over. Patients may win financially, but there's no way of knowing at what cost to the quality of their care.

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