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Bernie Sanders and Elizabeth Warren Are Wrong About Trump's Medicare Cuts

Meanwhile, both support single-payer, which would radically cut payments to health care providers.

Over the last few days, both Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.)—both of whom are currently vying for the Democratic presidential nomination—have attacked President Trump for proposing Medicare cuts in his latest budget.

You might get the impression from these tweets that Trump is proposing to slash Medicare's benefits. For the most part, that's not true. As Trump's acting budget director said when the budget plan was released, the president is "not cutting Medicare," and "there are no structural changes for Medicare." Too bad.

Rick Friedman/Polaris/NewscomRick Friedman/Polaris/NewscomInstead, the cuts, such that they are, are focused on eliminating that conveniently vague Washington standby—"waste, fraud, and abuse." Trump's budget, like previous presidential budgets, won't become law, so this is in some sense an argument about vague cuts that almost certainly won't happen.

In this case, the proposed cuts mostly take the form of payment reductions to health providers, like hospitals. (In the world of health care policy, you can usually tell whose payments are on the chopping block by which industry group issues the loudest objection.) About 11 percent of the reductions would hit Medicare Part D, the prescription drug program, and could affect how much seniors pay out of pocket.

There are a few things to note about these reductions.

The first is that the total reduction is not the $845 billion Sanders claims. Instead, it's $515 billion. As the Committee for a Responsible Federal Budget (CRFB) noted in a recent analysis, the $845 billion figure includes money that is being moved out of Medicare and into other parts of the budget for the Department of Health and Human Services, which oversees Medicare. These aren't really cuts; they're organizational reclassifications.

The second is that these Medicare cuts are quite similar to the provider reimbursements backed by the Obama administration, which cut Medicare payments by about $800 billion as part of Obamacare. As an Axios report notes, President Obama defended those reductions by saying they wouldn't affect seniors' benefits. According to the CRFB analysis, many of the cuts included in Trump's budget "closely resemble or build upon proposals made in President Obama's budgets."

At the time, Republicans criticized those payment reductions, implying they would hurt seniors. In reality, the main effect would be to make obvious hypocrites out of everyone involved. Obama responded to GOP criticism by portraying those payment reductions as necessary to "strengthen and preserve" Medicare. If that's what Obama was doing then, then that's what Trump is doing now.

Perhaps Sanders and Warren believe that reimbursement cuts would force providers to reduce service: Pay doctors less, and you'll get less from them.

If so, it's worth recalling that both are backers of Medicare for All—single-payer plans that would scrap today's private health insurance coverage as well as today's Medicare program for seniors and replace them with a new, government-run program covering all Americans. Sanders' single-payer plan is premised on paying health care providers far less than they are paid right now, with some estimates putting the reduction around 11 to 13 percent, and others putting it closer to 40 percent. In any case, doctors and other health care providers would, overall, be paid quite a bit less than they are today.

The transition to single-payer would be fairly rapid, with the Sanders plan calling for full-scale implementation in just four years, and another plan recently introduced by House Democrats calling for a two-year timeline, meaning doctors would face a sudden payment cliff.

There is a reasonable debate to be had about exactly how provider rates affect service, and what sort of payment reductions and reimbursement tweaks doctors and hospitals can absorb. Americans tend to pay higher prices for health care services than in other countries, and health care workers at all stations are often paid more as well. Trump's budget would cut existing Medicare rates; single payer would reduce payments from today's mix of private and public payers. Too much of the health care industry lacks any meaningful price signals, and even payers and providers themselves don't always fully understand the various reimbursement systems they interact with. It's complicated.

But it is hard to imagine that a rapid transition to a nationwide government-run system of health care financing that dramatically reduces provider payments would not significantly impact the quality or quantity of health care delivery in the United States. Yet by supporting Medicare for All, that is what Sanders and Warren are saying they want for every American.

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  • loveconstitution1789||

    If the US economy does not implode under the weight of these welfare programs, how can we possibly expect people to be on board with the Socialist revolution?

  • TrickyVic (old school)||

    I believe socialized medicine has a paradox for the left. They are generally against tort reform. I don't think you can sue for medical malpractice in socialized medicine the way you can here. If a government doctor screws up, a government doctor with be tasked with repairing it. Depending on how bad they messed up, you might get a better placement in line.

  • BYODB||

    What could possibly go wrong with nationalizing medical services while telling people they have a right to the fruits of someone else's labor? I mean, besides the obvious reduction in suppliers of said service...and the inevitable rationing. Ask yourself if you want to rely on a public defender if you're on death row...

  • Sevo||

    "But it is hard to imagine that a rapid transition to a nationwide government-run system of health care financing that dramatically reduces provider payments would not significantly impact the quality or quantity of health care delivery in the United States."

    In fact, I'm pretty sure you meant "impossible"; the New Soviet Man never was and never will be.

  • BYODB||

    I'm sure that magically no potential future doctor's will become petroleum engineers, as an example, rather than become a low paid public sector worker. That is unpossible. After all, brilliant altruists are super common.

  • Enjoy Every Sandwich||

    Bernie, looking at clipboard: "You, comrade, will become a doctor."
    Comrade: "But I don't want to become a doctor."
    Bernie: "Funny, I don't remember asking you what you wanted."

  • BYODB||

    Amusingly, that is exactly what socialist nations did. They gave medical licenses to people with virtually no training, called them Doctors, and claimed victory.

    The best case scenario if medical ends up nationalized is that you won't ever see a doctor again, but you'll have all the access to barely trained LVN's you can survive.

  • TrickyVic (old school)||

    It will be all robots by then.

  • TJJ2000||

    And where's my rocket suite, hoover car, and Easy button I was promised in the 80s by the year 2000?

  • Ordinary Person||

    Single payer is like getting your groceries from Costco. What we have now is like buying them at Circle K.

  • loveconstitution1789||

    No its not.

    We are taxed outrageously on what we buy at Costco but we can pay with cash.

  • Sevo||

    Ordinary Person|3.13.19 @ 3:00PM|#
    "Single payer is like getting your groceries from Costco."

    Read that at Huffpo?
    Hint: You can shop at places other than Costco, you idiot.

  • Kevin Smith||

    Single payer is like getting your groceries from Costco.

    This actually may be a good analogy:

    There are only about 500 Costco stores in the US, leaving millions of people very far from a location
    You have to pay a fee just to walk in the door
    Most people would prefer to get their groceries somewhere else when given the option

    What we have now is like buying them at Circle K.

    Or Whole Foods, or Albertsons, or Publix, or Aldi, or Kroger, or Walmart, or even Costco. What we have now are choices

  • TJJ2000||

    Funny; I thought Costco was a capitalist business.
    Perhaps you meant...
    Single payer is like getting healthcare in Venezuela.

  • Ordinary Person||

    There's nothing to innovate in the health insurance business. It's basically just number crunching and that service would be superfluous under single payer. Instead it be much like the way Walmart uses its buying power to negotiate lower prices and we need to put downward pressure on health care prices to an extent. They're out of control. It's just smart business for Americans to pool together to negotiate the prices.

  • Rockabilly||

    Ordinary Person, I refuse to pool with anyone else.

    How will you force me? At the point of your finger?

  • loveconstitution1789||

    Poor Ordinary. They dont want people to pay cash for minor medical stuff and have catastrophic health insurance for major medical stuff; lower rates and costs for those; and lower taxes because we dont have ObamaCare, Medicare, or Medicaid anymore.

  • Sevo||

    Ordinary Person|3.13.19 @ 3:15PM|#
    "There's nothing to innovate in the health insurance business."

    You made the claim; prove it.
    What a fucking ignoramus, here daily to show there are as yet new depths of stupidity and dishonesty yet to be plumbed.

  • Nardz||

    "It's basically just number crunching and that service would be superfluous under single payer."

    Da.
    United Socialist States of America will have no use for math.

  • Colossal Douchebag||

    Fuck off slaver

  • TJJ2000||

    Walmart is Capitalism TOO! Yep, healthcare is "out of control" and Yep, healthcare is government regulated to the bone.

    Stupid -- Doing more of the same over and over again and expecting a different result.
    Point n Case -- The "Affordable" Care Act

    https://www.youtube.com/watch?v=fFoXyFmmGBQ
    https://mises.org/wire/how- government-regulations-made- healthcare-so-expensive

  • SimpleRules||

    Kind of like the way we all get together and negotiate with the IRS by electing congressmen. Instead, how about breaking the monolith down so individuals can send personalized economic signals and decide for themselves what they want.

    I suspect Ordinary Person is just stirring trouble and doesn't believe what's being spouted but I could resist the opportunity

  • TrickyVic (old school)||

    "" It's basically just number crunching and that service would be superfluous under single payer. ""

    I don't think the HEDIS requests I get for patients from MCOs are number crunching. It falls under care management.

    ""They're out of control. It's just smart business for Americans to pool together to negotiate the prices.""

    The citizens are not part of the price negotiations under socialized medicine.

    U.S. Health care providers are burning out due to rules government has places on them. Meaningful Use rules the government has laid out for EHRs, Population Health reporting criteria, and such have a lot of the blame. If we want to avoid a major doctor shortage, we should move to remove the burden placed on the providers to alleviate burnout. Doctors want to return to practicing medicine instead of being data monkeys for the government. Government has made it worse, not better. Why empower them more?

  • Nardz||

    Also,
    F the AMA.
    No more residency caps

  • DrZ||

    Politicians lying? Who woodhavthunk?

  • Colossal Douchebag||

    Your headline has too many words.

  • TJJ2000||

    Bernie, "Make no mistake about it: Trump's budget is a massive CUT to the transfer of wealth from the working class to the wealthiest POLITCIANS and most profitable REGULATIONS in America."

    Elizabeth Warrent, "The Trump administration wants to cut hundreds of billions of dollars from the SOCIALIST budget, all while giving billionaires and giant working citizens THEIR PROFITS BACK. This is immoral"

  • TJJ2000||

    Listen up lefty's -- "Power" does NOT create "Wealth". The best it can do is STEAL "Wealth" that someone has already created by adding VALUE to society.

    VALUE=WEALTH
    POWER=JUSTICE
    FREEDOM = LIBERTY

    ... NOT ....
    POWER = WEALTH
    SYMPATHETIC THEFT = JUSTICE
    SOCIALIST UNIFORMITY = LIBERTY

    Check your "moral" compass; It's been severely broken by evil propaganda.

  • gaoxiaen||

    Single payer works very well here in Taiwan. Health care is a human right here. Americans are being extorted by the crony-capitalist cartel comprised of the AMA/insurance company/big pharma/government cartel. A free market in health care would be best, but it ain't gonna happen. Free market or regulation as a public utility.

  • gaoxiaen||

    Damn your 50 character limit. I would have provided a link, but I'm busy cooking dinner.

  • TJJ2000||

    Taiwan Top-End Taxes - 45% Individual Income, 25% Profit-Seeking Enterprise, 5% VAT, 15% Real Estate sales, 9% Social Security.

    So for a Top-End earner in a Real-Estate Enterprise = 99% Tax rate.

    CA has a population of 39.5M; Taiwan has a population of 23M.
    If CA wants a human right to Health Care - They're are more than welcome to try it; But they have no authoritarian right to force it upon the entire nation.

  • TJJ2000||

    AMA (Gov Instituted)
    Insurance Company mandating (Gov Obamacare)
    Big Pharma (Gov FDA)

    Yes, ALL wrapped into the phrase, "governmental cartels" - IS socialistic governing practice creating monopolies.

    Its NOT and never was "crony-capitalism" it is CRONY-SOCIALISM.

    The only difference between CA implementing a "right" to Healthcare and Free-Market Healthcare is the 'Power' (i.e. Forcing) of people to buy said service.

    The main 'goal' is to take away Individual Freedom and responsibility and replace it with a dictatorship. The American Dream is all about individual freedom (or at least it was once upon a time).

  • Civility Please||

    "the total reduction is not the $845 billion Sanders claims. Instead, it's $515 billion."

    Oh, well if it's only cutting 515 BILLION $... How many people can $350 billion save anyway?

    "... the $845 billion figure includes money that is being moved out of Medicare and into other parts of the budget for the Department of Health and Human Services, which oversees Medicare. These aren't really cuts; they're organizational reclassifications."

    Oh jeezus. Are you f'n kidding me? Is this "new speak"? Cuts are cuts, no matter where the money goes

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