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Issues Spotlight

Our Montana - Issues Spotlight:

Healthcare Reform.

Issue Overview and History

Since the 1940’s Democrats in the United States have advocated some form of universal healthcare plan or another, starting with President Roosevelt.

“President Franklin D. Roosevelt knew that he could not get national health insurance through Congress unless he took the idea to the people first. As World War II came to an end, he flirted with making health care his next great political crusade. His advisers prepared a plan, but Roosevelt died just before the end of the war. The health reform effort then fell to Harry Truman, and every subsequent president." [i]

In fact, universal healthcare via national health insurance was originally intended to be part of the Social Security Act that was ultimately introduced and passed under President Roosevelt. [ii]

Taking up where FDR left off, President Harry Truman introduced his own universal healthcare reform act on November 19, 1945[iii] The legislation was ultimately defeated after being attacked as “communism” as well as falling prey to southern legislators’ fears that national health insurance would force integration of southern healthcare services and facilities, fears that were fueled in part by AMA physicians and hospital associations.

By 1965 President Lyndon Johnson was able to include two forms of national health insurance, Medicaid for the poor and Medicare for the elderly, in his Great Society legislation that aimed squarely at addressing the so-called “war on poverty”. Once again, these reforms ran into the teeth of racial animus that feared “integration” of healthcare services [iv], but despite this opposition both plans prevailed.

Of course Medicaid and Medicare fall short of the goals set by Roosevelt and Truman for a “universal” national health insurance program, so President Bill Clinton made yet another failed attempt in 1993 to legislate a limited type of universal healthcare coverage that included a basic benefit package and reforms to private health insurance plans. This legislation, The Health Security Act, never came to a vote in the Senate where it was introduced and thus defeated, with particularly strong opposition from the private health insurance industry.

On March 23, 2010 President Obama signed the Affordable Care Act (ACA) that took another incremental step toward affordable universal healthcare coverage through a mix of regulatory measures and mandated coverage primarily using the private health insurance industry. And while numerous research studies, including one published by the National Institutes of Health, have found that:

“Overall, research shows that the ACA has substantially decreased the number of uninsured individuals through the dependent coverage provision, Medicaid expansion, health insurance exchanges, availability of subsidies, and other policy changes. Affordability of health insurance continues to be a concern for many people and disparities persist by geography, race/ethnicity, and income.”[v]

There remain many uninsured and healthcare costs, in particular drug prices, remain as a major obstacle for individuals and families across the United States. Thus, by 2019 the United States remains one of the only western developed nations that does not provide a universal system of basic healthcare coverage, despite spending more per capita on healthcare than any other nation.

So the discussion about healthcare reform is nothing new in our nation. it is essentially an ongoing discussion about the best way to provide the best care to those needing healthcare -- which is essentially every single human being in this country. The tension about solutions comes primarily around the “proper mix” of private sector and public sector involvement in the provision of healthcare and paying for healthcare.

Points of Discussion on Healthcare Reform

Picking up the healthcare reform debate in 2019 where we left off in terms of the ACA shortcomings, Democrats are engaged in a wide-ranging debate with numerous proposals for expanding access to and affordability of healthcare in the United States. The following are some of the most prominent healthcare reform proposals being considered as part of the 2020 presidential election debate.

Medicare-for-All with no private health insurance option (single-payer system)

Under this option, best defined in the Medicare-for-AllAct of 2019 (S 1129) introduced into the U.S. Senate on April 10, 2019 bySenator Sanders and 14 senate co-sponsors, an expanded federal Medicare program would provide comprehensive healthcare coverage for all Americans, eliminating private health insurance and workplace-based coverage. By eliminating the need for private health insurance, this proposal essentially pays for itself by converting the insurance premiums currently paid for private health insurance into tax revenue to fund Medicare expansion. Thus people would simply pay for their healthcare coverage through taxes rather than paying through employer-based or private market health insurance. A 2018 study estimates that this proposal would reduce overall healthcare spending by ten percent.
In addition to the bill introduced into theSenate, there is also a single-payer bill that has been introduced in House that provides broader health benefits and a faster transition than the Senate bill(H.R. 1384).

Medicare-for-More that includes a role for private health insurance

The concept under so-called Medicare-for-More is to lower the eligibility age for joining Medicare, which is currently 65, and giving younger individuals the option to buy Medicare coverage rather than a private health insurance policy. This differs from the above proposal in that it does not automatically move everyone into Medicare but rather gives that option to a larger, younger portion of the population. This would maintain the existing private health insurance industry but put Medicare into the role as a competitor to private insurance. One proposal allows individuals to buy Medicare starting at age 55, a second starts at age 50.
Since the private insurance industry would continue, it would be expected that Medicare supplemental insurance options would continue, allowing individuals to purchase insurance to cover additional healthcare procedures that may not be covered by Medicare, including prescription drug plans.

Expanding the ACA by including a government public option health insurance plan

There are currently proposals to create a new federal government insurance plan, similar to Medicare that could be selected by individuals or by employers as part of employer-based insurance coverage. This“public option plan” would compete with private insurance industry plans with the goal of reducing cost and making benefits richer. There was discussion about including a “public option” in the original ACA legislation but under heavy lobbying by the private health insurance industry, this idea was dropped.
There is also a proposal that would allow states to offer Medicaid coverage as an insurance option for both individuals and employers to select and purchase, once again competing with private insurance industry plans and coverage.

Improving the ACA by addressing the quality and cost of private insurance plans being offered

And of course there are a number of ideas to improve aspects of the ACA by making the required benefits richer and more affordable, as proposed by the Urban Health Institute.

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‍And What Are Republicans Proposing to Do About Healthcare

For their part, Republicans have failed to come up with any specific healthcare reform plan since retaking the White House under Donald Trump. Republicans appear to be united in their opposition to using federal or state government resources to create universal healthcare coverage in the United States. Rather, Republicans favor allowing the private health insurance industry and private sector health care providers to address healthcare needs with only minimal government regulation.

Most recently, the Trump administration Justice Department is arguing in favor of a lawsuit that would declare the entire 2010 ACA unconstitutional and roll back all of the reforms and changes of that law, bringing the healthcare market back to where it was a decade ago.

In addition, many state-level Republican elected officials have opposed the expansion of Medicaid programs that provide affordable health coverage to low-income individuals and families.

In Montana, however, a minority caucus of Republicans joined with Democratic legislators and Governor Steve Bullock to continue Montana’s successful Medicaid expansion.

What about “socialism”

None of the historical nor current Democratic proposals for universal healthcare come close to meeting the definition of “socialism” or“socialized medicine,” rather that term continues to be a scare tactic label used primarily by opponents; a tactic that dates back to the original FDR proposals.

Socialism is defined in the Merriam-Webster dictionary as:

1: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

2a: a system of society or group living in which there is no private property

b: a system or condition of society in which the means of production are owned and controlled by the state[vi]

None of the major Democratic healthcare proposals dating back to Roosevelt, including the most progressive Single-Payer/Medicare-for-All plans, call for “government ownership” of the private entities in the healthcare delivery system. These private entities include hospitals, outpatient clinics, physician practices, pharmaceutical companies, etc.

Rather, the Democratic proposals call for the federal and state governments to be either a primary or sole “payer” of the costs to the private sector healthcare providers. This does not meet the definition of socialism or socialized medicine and instead replicates a number of existing government programs that provide the funding to meet basic needs; including Social Security, Medicaid, Medicare, the Veterans Health system, and numerous disaster relief programs.

Nobel-prizewinning economist Joseph Stiglitz reinforces this point in his May 8, 2019 opinion piece in the Washington Post.

What About Cost

Finally, an ongoing point of contention in the healthcare reform debate is the cost question; how would any of these proposals be paid for.

While there are numerous fiscal studies of the above referenced proposals, it is important to keep in mind that Americans already pay more for their healthcare than any other nation, and yet our healthcare outcomes rank well below other countries. So while many of the Democratic proposals would require “tax increases”, for most Americans these new taxes would simply replace the costs they are currently paying through premiums paid directly or through their employer benefit program. Thus, even the most ambitious Medicare-for-All, single payer plans are not projected to require additional funding, rather they simply reallocate existing funds through taxes that are currently paid as premiums, co-pays, deductibles, etc.

In the April 2019 congressional hearing on Rep. Jayapl’s Medicare-for-All Act, even the Republican economic analyst admitted that the most progressive Medicare-for-All bill would not add significant new costs to the healthcare system nor to Americans’ wallets:

A Republican witness, economist Charles Blahous of the conservative Mercatus Center at George Mason University, said his analysis of earlier Medicare-for-all legislation estimated it would add $32 trillion to $39 trillion to federal health-care expenditures. But he agreed with Democrats that most, if not all, of that would be offset by the elimination of private health plans.[vii]

And a document released by sponsors of the Senate’s Medicare-for-all bill points to two research studies, one by a conservative think tank and one by the University of Massachusetts, that both estimate that under the Senate Medicare-for-All bill total healthcare expenditures in the United States are likely to drop!

‍Flathead Democrats Position

At the 2018 County Convention the Flathead Democrats adopted the following plank in the 2018-2020 platform:

Healthcare: We support the state legislative efforts to expand Medicaid coverage across Montana. Our overall goal is a single-payer, Medicare-for-all system that provides universal access to healthcare, including mental health services, in every community. Toward that priority we support an ongoing, incremental decrease in the eligibility age for Medicare coverage until all people are covered by Medicare. We support an individual’s right to make all personal medical and palliative healthcare decisions throughout their life, and we support the expansion and availability of associated healthcare options.

Montana Democrats Position

The Montana Democrats platform adopted July 14, 2018 states:

‍Healthcare: We are dedicated to ensuring quality of life and equality of opportunity for all individuals and all families, regardless of their socio-economic status. Fundamental to such quality and equality is access to the basic necessities of life, including, at a minimum, health care, education, shelter, adequate nutrition, human dignity, and lives free of violence.

We support:

Healthcare as a human right.
Any and all efforts to address Montana’s growing public health crisis of suicide.
Affordable and accessible health care for all Montanans.
Montanans’ right to choose their healthcare providers.
Montanans’ right to keep their personal medical information private.
Patient-centered approaches to prevent and treat chronic disease.
Effective responses to mental illness, substance abuse disorders, and gambling addiction.
Health insurance programs that encourage preventative care, provide coverage parity for mental health services and substance abuse disorders, and preserve adequate coverage for low-income Montanans.
Proactive measures to address the needs of Montana’s aging population.
Efforts to maintain and improve funding for rural health care.
Community-based mental illness and addiction crisis intervention and recovery as the preferred approach.

We oppose:

Laws and other government actions that interfere with the privacy rights of individuals to make their own health decisions, including decisions about contraception, child-bearing, and dying.
Limiting access to legal health care services associated with individuals’ private decisions.
Privatizing Medicare or changing to a voucher system.
Efforts to remove or limit health insurance protections for people with pre-existing conditions.

Additional Reading and Resources

In addition to the various resource links embedded in this update, the following are just some of the many resources available for continued reading and research about healthcare reform in the United States.

Review the Nine Democratic Plans for Healthcare Reform

This article provides a detailed description of healthcare reform proposals being advocated among the 2020 Democratic presidential candidates, other legislators and public interest organizations.

Kaiser Family Foundation compares the 2019 healthcare reform bills.

Similar to the above, this article provides a side-by-side comparison of the various legislative proposals for healthcare reform.

Kaiser Family Foundation: Healthcare Reform Topics

This website provides regular, updated articles and research studies on the various and emerging topics around healthcare reform.

The Economics of Single-Payer/Medicare for All: University of Massachusetts Research Report

This article and the linked research report addresses the likely costs of a comprehensive single-payer, universal healthcare proposal.

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