Single Payer’s impact on jobs

Reality is, switching to a government-run and administered healthcare system would crush the economy – because millions would lose their jobs.

There are 22 million jobs in the US healthcare and related industries (that includes mine, one of our daughters, and her husband – they are nurses – our other daughter is in the tech business and one of her clients is a large health system; our son is also in tech and his company services medical practices.)

The private health insurance industry alone employs north of a million people. (data on this is spotty; UnitedHealthcare has 300,000, Cigna, Molina, Centene, Aetna and Anthem combined have over 180,000; there are dozens of other healthplans, PBMs, TPAs, and ancillary service providers.

On the provider side, there are over 700,000 management jobs (average salary is $86,000) and several million administrative jobs.

Many large hospitals and healthcare systems need several hundred workers just to handle billing and collections; these jobs would go away under a single payer system.

Let’s add all the college and grad school institutions that employ tens of thousands to educate people on healthcare administration, and the support infrastructure – IT companies, paper form printers, App developers, pundits and commentators, real estate occupied by insurers…you get the idea. The health care industry is at least a fifth of our economy.

If we switched to a true single payer system, millions of administrative, support, and related jobs would disappear. Remember what happened to manufacturing in the rust belt? That happened over 50 years; this would affect a much bigger share of the economy over a much shorter time.

The result would be an economic collapse that would surpass the Great Depression and devastate the economy.

Lest you think this is hyperbole, Taiwan employs a grand total of 300 people to administer a single payer healthcare system for a population of 24 million.

Using Taiwan as a basis, we’d only need 4,125 people to administer a universal single payer system.

All of the people administering Taiwan’s health system work in this one building.

What does this mean for you?

Believing government administered Single Payer can happen anytime soon requires magical thinking.


Single Payer is…what?

(We are reprising several posts about Single Payer; Bernie Sanders’ current status as the sorta-front-runner in the Dem race has folks wondering what this is all about) You’re going to hear a lot about Single Payer over the next few months – mostly from people who a) have an opinion about it BUT b) don’t even know what “Single Payer” is.
Before you get sucked into that discussion/argument, here’s a primer. “Single Payer” – by definition – is government-financed and government-managed health insurance. Beyond that, pretty much every country with Single Payer is unique, each with its own nuances. For example,
  • most don’t have government-employed healthcare providers; in many single payer systems, physicians, therapists, hospitals and other providers are private.
    • The UK is an exception; providers are (mostly) employed by the government
  • many are not government-operated; in many systems private insurers contract with the government to handle administration of health insurance – similar to our Medicare
    • Again the UK is an exception
  • the government sets pricing/reimbursement policy and actual prices – similar to our Medicare
  • funding comes from some combination of employee, employer, and other taxes; in some countries, insureds pay some form of premiums – similar to our Medicare
  • it covers everyone
  • there is little to no paperwork for patients/consumers; all that is handled by the administrative agency
  • there are minimal or no deductibles, copays, or co-insurance requirements
  • people can buy into supplemental insurance through private insurers
What does this mean for you? You are now more knowledgeable than most everyone else about Single Payer.


Single Payer – what’s the real scoop?

(this is an update of a post from last year; given all the attention, it’s timely) It’s the worst kind of government over-reach.

It’s an easy solution to a huge problem that will cost nothing.

And everything in between. Between now and Election Day you are going to hear a lot about Medicare for All and Single Payer, and most of it will be utter nonsense.

Proponents of Single Payer/Medicare for All say it will reduce overall costs and ensure everyone in America has great healthcare; At the other end of the spectrum, it’s fiercest opponents say it will bankrupt the country while giving bureaucrats control over your family’s healthcare.

Reality is, since there is no actual agreed-upon “Medicare for All” or Single Payer legislation, each of us sees what we want to see – MFA as the Holy Grail or a Total Disaster.

Let’s take a step back and think about how voters are affected by the core problem – or rather problems, with healthcare and health insurance.

The focus on voters is critical here – most are covered by employer-based health insurance, and most of the rest are covered by Medicare. For the non-elderly:

  • Health insurance is stupid expensive.
  • For many of us, deductibles are so high “insurance” just protects you from catastrophic injuries or illnesses.
  • Insurance companies control the doctors and hospitals you can use and the care you get.
  • The paperwork is mindboggling, confusing, and adds billions in unnecessary cost.

For workers, healthcare “costs” are a combination of insurance premiums and cost-sharing payments – mostly deductibles and copayments. (While about 75% of premiums are paid by employers, economists argue that most of those premium dollars would be paid in cash wages if health insurance wasn’t provided.)

Today family health insurance premiums are more than $20,000 a year.

Over the last two decades, healthcare costs have eaten up wage increases – one of the main reasons families aren’t getting ahead.

For those who actually have to use their health insurance, it’s worse. Deductibles are so high that many families can’t afford them.


Add this all up, and you understand why healthcare was the top issue for most voters in the mid-terms.

Voters like simple answers to complex questions – and for many, some form of Single Payer sounds great.

The takeaway – voters want healthcare solved and they don’t care much about the details.


What about your pre-existing conditions?

Let’s get real folks.

“Virtually every American has someone with an existing health condition in their family at any given time” 

Dan Mendelson, CEO, Avalere

The Texas lawsuit filed by Republican Attorneys General and supported by the Trump Administration would end the ACA, aka Obamacare.

In so doing, it would end protections for those with pre-existing conditions.

Make no mistake, if Trump et al win the suit and you have to change health insurance plans, you are at real risk of losing coverage  – or having to pay so much you can’t afford it.

Despite President Trump’s assertions, there is No Republican plan to assure those with hypertension, diabetes, a history of heart disease, cancer, anxiety disorder, or any other health condition will be able to afford health insurance.

Not sure if you have a pre-ex?  Here’s a list.

What does this mean for you?

For some, this election is a matter of life and death.


The Healthcare Election

Healthcare is the central issue in the 2020 election.

If Republicans are able to keep healthcare out of the conversation, they win. If Democrats make healthcare THE issue, they win – with one big caveat.

Insurers and hospitals are making record profits, while a family of four has to spend $21,000 before they get any coverage.

Healthcare is unaffordable for middle-income families without subsidies or employer support. In many areas, the cheapest bronze plan is around $13,000 and comes with an $8000 deductible. Before mom dad and the kids get any benefit other than preventive care, they’re out $21,000.

Rural Americans are more likely to have high-deductible plans. And, even if the premiums are subsidized, there’s still their monthly cost plus an $8,000 deductible.

That is, if they can find a provider when they need care.

121 rural hospitals have closed over the last 10 years – 44 in the past three years. with the biggest impact in states in the south and central US where the combination of under-insured patients and no Medicaid expansion has left many small facilities on the brink of bankruptcy – while dozens more have closed.

Meanwhile, back in DC…

There’s been zero meaningful progress on drug prices, an issue of particular concern to seniors. Likewise, all the talk about surprise medical bills has yielded exactly no solutions, as hospital lobbyists have successfully quashed meaningful reforms.

Millions of us have pre-existing conditions; we risk losing coverage – and paying much more – if the Trump-supported Texas lawsuit to overturn Obamacare is successful.

While consumers are getting hammered, hospitals, health systems, and health insurers are raking in the billions.  Near-record profits for insurers, and very strong margins for pharma device manufacturers and hospitals stand in stark contrast to flat wages for most Americans.

Here’s the caveat. Sure, Republicans have no solution to the healthcare coverage and cost crisis. But Americans – at least the ones who vote – don’t want Single Payer.

What does this mean for you?

If Democrats stay focused on healthcare reform and avoid Single Payer, they win.

If not, they lose.


Bloomberg’s betting on healthcare

Mike Bloomberg may be our next President.

If his long-shot bid works, healthcare will be the issue that wins it for him.

I know, Bloomberg??? Riiiiiiiiight…

Up until a week or so ago, I didn’t think the guy had a shot. Here’s why I’ve changed my thinking.

Bloomberg is relentlessly focusing on healthcare – which is THE biggest issue for voters.

He is hitting voters where they are most vulnerable;  fear is the most powerful motivator – and there’s nothing scarier than our screwed up healthcare system. Bloomberg’s massive TV and social media campaign is very effectively messaging around our fear of losing healthcare, fear of bankruptcy due to high bills, fear of no coverage for pre-existing conditions, fear of dying penniless and in pain.

But it issues aren’t important unless you get your messaging right and get it out there.

So far Bloomberg has spent a quarter-billion dollars on his campaign.

That is – literally – nothing to him. The guy is is worth $60.5 billion dollars. He’s the 14th richest person in the world. He can, and will spend whatever it takes.  He could buy every ad in the SuperBowl and have more money in his bank account the next day just collecting interest on his billions.

He will far outspend ALL his Democratic rivals put together.

Oh, and Bloomberg is very, very smart about this internet thing. His digital strategy helped Democrats win both houses in Virginia.  He’s putting together a digital campaign that far outpaces what the Democrats are doing – and will likely be much more sophisticated and effective than Trump’s.

Back to healthcare.  If you’ve seen any of his ads – and I’m betting you’ve seen a lot of them – they focus on protecting your healthcare, reducing your healthcare costs, controlling surprise medical bills, and reducing drug costs.

Not much in the way of an actual plan, but very good messaging.

When you dig deeper you learn he supports a Medicare-based public option – you can buy into a government plan if you don’t like any of the other options – but he’s no Single Payer guy.

What does this mean for you?

Don’t discount Bloomberg. 



Private health insurance has failed.

If you had “government” health insurance for the last decade, your costs would be 20 – 25% lower today.

That’s because private insurers have not controlled spending nearly as well as Medicare and Medicaid have.  This from KFN via Axios.

Doesn’t matter what your economic or political ideology is – that’s a fact.

You and your insurance company pay your doctors and hospital more than twice what Medicare does. Yes, the Feds can exert pricing power – but why can’t United Healthcare, or Aetna, or Blue Cross?

Those healthcare giants should be able to negotiate better deals with providers; they have massive buying power and millions of members to leverage. They should be able to use that power to give you lower insurance costs – but they can’t.

Those private insurers are (theoretically) more nimble, smarter, better run, and more efficient than the government. And they have hundreds of billions of healthcare dollars to leverage.

Yet they’ve failed to outperform a bunch of bureaucrats.

I won’t dive into the “whys” today, because that would take away from the over-arching truth – government has been much more effective than private insurers.

What does this mean for you?

Cutting your health insurance costs by a quarter = more dollars you could have spent on other stuff.

note – happy to hear other thoughts; please use citations to back up any assertions.


Iowans aren’t buying Medicare for All

There’s a big problem with Sen Bernie Sanders’ Single Payer plan. [I think it is Sen Warren’s plan too, but she’s dithering these days.]

Nope, not the cost, not the “gubmint taking over my Medicare”, not the pharma or physician lobbies.

It’s a job killer.

The impact of Single Payer on Iowa’s economy would make the Dust Bowl look like a summer zephyr.

Polling is showing voters’ concerns with Single Payer; here’s the data on the impact on jobs… [Sanders’ version of Medicare for All is pretty much identical to Single Payer]

Somewhere between half a million and 800,000 Americans work for health insurance companies. Most would lose their jobs under Single Payer.

In Iowa, one out of eight workers are in healthcare; a lot of those are clinicians and direct support (med techs, nursing aides etc), most are doing administrative work.

A couple examples of the impact of Bernie Sanders’ Single Payer program on Iowa are helpful.

Wellmark Blue Cross employs 1878 people – adding up the admin costs plus commissions, about $290 million is spent on stuff besides direct healthcare costs – spend that would go away under Single Payer. Sure, some goes to IT, some goes to building maintenance, some goes to paperclips and travel. But much of that $290 million – and 1878 jobs – goes away under Bernie’s plan.

Another 800 folks work for other health insurers;  that’s about $130 million in wages…

Another metric – total healthcare employment. While it’s not possible to tease out the precise number of healthcare administrative jobs – billing clerks, coders, managers, IT support, claim handlers and the like – at least 30,000 Iowans are working in healthcare administration, earning a total of about $1.2 billion.

Some are likely medical billing clerks – the folks who figure out how to bill you and your insurance company for services you receive (these folks); total income for the 5000 Iowans doing billing is just under $200 million.

All this to say there are tens of thousands of Iowans who would lose good-paying, stable jobs if Bernie Sanders’ Single Payer becomes law.  And if they do, those billions in paychecks disappear.

What does this mean for you?

Single Payer is a great idea – if you are starting a healthcare system from scratch. Which we aren’t.


In which I read current research and summarize key takeaways so you don’t have to…

Stress over healthcare costs doesn’t go away when you are on Medicare

HealthAffairs reports that more than half of Medicare recipients with a serious illness reported “serious financial distress” due to medical bills. Drugs are the most common cause, followed by facility bills.

This is important because:

Medicare for All is NOT a panacea; politicians advocating for MFA should understand Medicare needs major improvements before it is “ready for prime time.”

Oh, and a third of all credit card holders are in debt due to medical bills.

Immigration and healthcare

If you or a parent have a healthcare aide, listen up. The bruising battle over immigration and the “Dreamers’ will affect healthcare – particularly for older Americans who rely on home health aides and other lower-level clinical support.

27,000 Dreamers work in healthcare and healthcare support, many providing individual care. The Trump Administration is trying to end this program and force Dreamers to leave the U.S.

The shortage of home health workers is particularly acute in older states such as Maine and the upper midwest. With immigrants filling one of every three home health positions, ending DACA and further restricting immigration would leave thousands of older Americans without care. 

What does this mean for you?

When a politician says something is simple, or their claims just seem to make sense, your alarm bells need to ring.

Medicare will need huge and expensive changes to work for all of us. 

If you don’t want immigrants in the US, then you get to care for your parents without any help.


The most important thing you aren’t paying attention to

Is the ACA case in Texas.

Briefly, Republican Attorneys General have sued to overturn the ACA.  The AGs’ claim the entire law must be thrown out because the individual mandate — a penalty imposed on people who chose to remain uninsured – was killed by Congress in 2017.

You may recall that, in addition to the mandate, the ACA:

  • expanded Medicaid to more low-income families and individuals
  • reduced seniors’ drug costs by closing the “Donut Hole” in Part D plans
  • reduced insurance costs for older Americans
  • increased funding to fight healthcare fraud
  • increased funding for rural healthcare
  • increased tax credits for small businesses providing health insurance
  • provided insurance subsidies for families making less than $88,000
  • required insurers to offer complete insurance coverage to all without discriminating by medical condition, age, or sex

If the Republican Attorneys General prevail, the ACA will be overturned, and health insurers will be allowed to:

  • stop covering pre-existing conditions; 
  • stop covering your adult kids;
  • limit your maximum dollar benefit;
  • exclude different types of medical care
  • medically underwrite small groups; and 
  • subsidies for folks buying health insurance go away.

Meanwhile, there is NO alternative plan if the judge rules in favor of the AGs. While HHS Secretary Seema Verna says there will be a replacement plan, there are no details about this “plan“, and no information whatsoever from the President or Congress.

photo credit Leslie Boorhem-Stephenson for the Texas Tribute,

I don’t understand how the entire law can be overturned because one part of it is no longer in effect – but I’m no attorney and will leave that to those readers who are.

From a political perspective, this doesn’t seem too smart on the part of Republicans.  People hate losing things they already have – much more than they don’t like not getting things they wish they had. And if the ACA is overturned, millions of voters – including millions of seniors – will be really mad.

What does this mean for you?

If you’re a Medicare recipient, parent, make less than $88,000 a year, are a small business owner, have pre-existing condition, and/or need comprehensive insurance coverage…

nothing good.