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Yale study gives Sanders ammunition to tout Medicare for All

New Haven Register - 2/23/2020

Feb. 23--NEW HAVEN -- Bernie Sanders "wrote the damn bill," but it took scholars from the Yale School of Public Health and two other universities to offer evidence that his Medicare for All Act may be the solution to the nation's health care crisis.

Since professor Alison Galvani of Yale and co-authors from the University of Florida and University of Maryland published their paper in The Lancet medical journal on Feb. 15, Sanders has been touting it as proof that his universal health care plan is the way the country should go.

During Wednesday's Democratic primary debate in Las Vegas, Sanders said Medicare for All "would save $450 billion a year because we are eliminating the absurdity of thousands of separate plans that require hundreds of billions of dollars a year in administration and, by the way, ending the $100 billion a year in profiteering for the drug companies and the insurance companies."

The $450 billion a year in savings he mentioned was straight from the academic paper, "Improving the Prognosis of Health Care in the USA," which also stated that 68,000 lives would be saved annually.

But it's unclear whether having a Yale-led study to back up his plan will help Sanders in the long run.

"It's an academic study that will probably reinforce the support" of Sanders voters, said Gary Rose, chairman of the Department of Government at Sacred Heart University. "As far as expanding beyond his base, I'm afraid not."

Rich Hanley, associate professor of journalism at Quinnipiac University, does see the study helping Sanders, but also sees both supporters and opponents reducing it to a post that pops up on Facebook and Instagram with a short, snappy caption.

"The key will be, how do you transform an academic study into a meme that will resonate with voters and be shared and disseminated by supporters?" Hanley said.

U.S. Sen. Elizabeth Warren, D-Mass., also has a Medicare for All plan, which eliminates premiums, co-payments and private insurance in favor of a government-run payment system paid for by income taxes and taxes on the wealthy. Other Democrats would not go as far, preferring to improve the Affordable Care Act passed under President Barack Obama.

And President Donald Trump would eliminate Obamacare if he could, while attacking Sanders as "communist." Sanders, an independent senator from Vermont, describes himself as a democratic socialist.

"Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care," begins Galvani's paper. "Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services."

Previous estimates of how Medicare for All would change the cost of health care vary from a 16.9 percent increase to a 27 percent decrease, according to the paper. The $458 billion savings calculated by the authors amounts to 13.1 percent in reduced costs. It would also improve health care in a country that, while being the wealthiest in the world, trails in health outcomes, according to the authors.

"Despite higher national healthcare expenditure than any other country, constituting 18% of gross domestic product, the USA ranks below 30 countries for many public health indicators, including preventable deaths, infant survival, maternal mortality, and overall life expectancy," the paper states. "We find that the expected savings from a universal single-payer system would more than compensate for the increased expenditure associated with universal health-care coverage."

"I'm happy that we can help to dispel some misconceptions about Medicare for All," said Galvani. "I think it's paramount for the health-care system to save lives, but it's great when we can save money at the same time."

She said that in the existing system, "the cost of hospital services varies widely," and that if Medicare rates were used for all procedures, "we would save $100 billion a year right there." According to the Lancet paper, childbirth costs an average $2,333 in Spain vs. $14,910 in the United States, while infant mortality here is double that in Spain.

Another problem noted by the authors is that while appendectomies cost anywhere from $9,332 to $33,250, the state with the highest cost, California, has the highest rates of death and perforation.

"Medicare overhead is 2.2 percent compared with more than 12 percent for private insurance," Galvani said. "If we achieve the Medicare overhead rate, that would save the country more than $200 billion a year." Similarly, paying for prescription drugs at the rate paid by the Department of Veterans Affairs -- the only entity legally able to negotiate medication costs -- would lower drug prices by 40 percent, according to the paper.

Galvani said there are other advantages to Medicare for All, such as reducing the time doctors must spend on paperwork, giving them "more time with their patients, which should also improve the quality of care."

Also, "there's this misperception that people will have to give up their providers," she said, when in fact, a Medicare for All plan "will erase in-network and out-of-network barriers, so it will expand choice."

Ending the system of having health insurance as an employee benefit "eliminates the danger of losing health care when it's needed most," Galvani said. "The Americans with Disabilities Act doesn't protect people after an illness becomes burdensome to their employer, so if you get cancer and you miss work ... it's legal to fire you for that reason and you've lost health insurance ... and of course that gravely impacts health outcomes."

In terms of paying for health care, Galvani said employers pay on average 70 percent of health insurance premiums and employees 30 percent. While income taxes would rise, they would not overtake what is spent now and "both the employers and workers would benefit," she said. Income tax increases would not be as large if they were offset by a tax on the wealth of the very rich, as both Sanders and Warren propose.

"On average, the vast majority of Americans are going to be better off," Galvani said. "Middle-class Americans are going to be better off."

Rose said he doesn't believe the study will persuade many who oppose Medicare for All to support it. "It just seems as if it's providing a little more evidence and more data that's generally within the framework of his argument anyway," he said.

On the other hand, the study might serve to harden conservatives' opposition, Rose said. "I think there's an inherent suspicion sometimes of academic studies," he said. "I think people would be somewhat skeptical" of the authors' conclusions.

"I just don't see how this is going to be a game-changer," he said.

Hanley, however, said the "imprimatur of Yale" would help Sanders within the Democratic Party. "I think it will have legs," he said. "Health care is one of the principle issues of the campaign and whether it's Medicare for All or hybrid or a more advanced version of the Affordable Care Act ... any study which will support someone's position will be used in the campaign."

edward.stannard@hearstmediact.com; 203-680-9382

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