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Why don't we debate how to reach Universal Healthcare here?

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In front of the first Democratic Debates I saw an add regarding how single payer is bad policy. I expect there to be many more throughout the primaries and I would expect these adds to ramp up quite a bit if a progressive Democrat gets elected. 

 

But the question is, are these adds factual?

 

The one add they had the other night focused on long wait times for any type of important healthcare offering. While there are many studies that have been done regarding the total cost as well as the possible outcome of single payer, I will admit I have only read one. I'm quite sure there are a few, and some of them show very negative results, it's impossible to know for sure what kind of weight this would register on the economy, and how it would result in quality care for all.

BTW,

The one I read was positive and I thought extremely well thought out. I'm talking about the one performed by PERI, by the University of Massachusetts at Amherst https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all

 

One problem in going to single payer is that we have millions who already have decent healthcare from their employer. Even though the amount employees contribute to their employer plan has increased quite a bit over the years, people feel satisfied with what they have and they are afraid of losing what they feel is good healthcare. Basically it cost a lot now, but if you break the current system

the outcome is scary, especially because all the unknowns, and there are quite a few.

 

If you add to this misinformation, it really becomes hard to get people motivated enough to go forward with single payer. 

 

If you have single payer this might mean - longer wait times. This would be because more people who did not have quality healthcare before would immediately. This would mean there just is not enough hospitals to deal with the all the new patients. And as they say, this would mean longer wait times for care.

 

 

 

I think it is a gigantic task, but that doesn't mean we should not go for it. 

The PERI paper I read notes that a lot of Americans already get their healthcare through a public option, this includes medicare, medicaid, the VA, and federal employees. 

It also notes the huge administration costs that private hospitals deal with through working with private insurance companies. It also notes that the US pays quite a bit more than other countries

per person, and they do this while still having for the most part universal quality care for all of their citizens. And they have healthcare quality that is as good or better than the US provides.

 

We also need to discuss the high cost of pharmaceuticals. We want the best, but we also want to know the best way to pay for the best. What we want is the most efficient system for quality healthcare for all, that leaves no one out. 

 

What are the cons?

wait times, for sure. at least up front. 

Just like public school, grades K-12, where some richer neighborhoods can afford better schools through donations by rich folks who live in those neighborhoods. You could say some single payer hospitals are better where they have wealthy donors, while those in the downtrodden neighborhoods are left with much less. You know, the same old story - the rich don't allow their families to get less, and it cost more to live there, they don't want no poor people moving in next door.

 

It could be really frustrating, it could be scary to go down that road of uncertainty. A lot of voters would get turned off by all this when the rail hits the road. Remember the huge outcry when they tried to pass off the ACA? Remember the ACA, akin to, "remember the Alamo", outcry. We would see all kinds of adds, millions, even billions spent on adds to make sure single-payer never happens.

And yes, this would have a large impact.

 

 

Anyway, to me, it could be done and we would all be better for it. A lot better off. To me it's the same thing regarding doing something about climate change. 

If there is a strong will there is a way. 

 

How can we have universal healthcare that allows for excellent quality for all? How can this be accomplished in an efficient way where taxpayers pay up front for research, expensive equipment, transition of workers from private health insurance to public insurance, etc ...

 

Or maybe not. Maybe we should go in a different direction all together? 

 

What do you think? 

 

 

 

 

 

 

 

 

 

 

 

 

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People support universal healthcare but not at the expense of their own healthcare.

 

The private system grants those with means access to immediate treatment for relatively minor ailments. Those without means go without treatment for life threatening conditions.  A public-only system might increase wait times for non life threatening conditions because healthcare resource allocation will be based on need, not money. That will be a tough sell for those who currently perceive the healthcare system as working for them. 

 

Perhaps the public/private compromise is the only achievable goal in the near term. The public-only solution may need to wait a term or two.

 

——

 

Negotiation of pharmaceutical prices seems like a no brainer. The government protects the pharmaceutical industry with monopolistic patents on specific chemicals and drugs. It therefore becomes the government’s responsibility to prevent pharmaceutical companies from taking advantage of their government supported  monopolies with predatory pricing practices..

 

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Maybe we should get a few hundred Medicare recipients to do commercials about their experiences.

 

I spent one night in the hospital, at two different times, while in my 60s. Similar diagnosis.

One covered by private insurance.

One covered by Medicare after I became eligible.

The one covered by the private insurance required a three quarter inch high stack of paper, and a lot of my additional money.

The one covered by Medicare required a single sheet of paper.

 

I remember sending the same private insurance form to three different offices.

In my opinion, much of the excessive cost of private insurance comes from their gross inefficiency.

After experiencing Medicare, I wouldn't wish private insurance on my worst enemy.

Well, maybe on a "conservative".

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2 hours ago, peter45 said:

Maybe we should get a few hundred Medicare recipients to do commercials about their experiences.

 

I spent one night in the hospital, at two different times, while in my 60s. Similar diagnosis.

One covered by private insurance.

One covered by Medicare after I became eligible.

The one covered by the private insurance required a three quarter inch high stack of paper, and a lot of my additional money.

The one covered by Medicare required a single sheet of paper.

 

I remember sending the same private insurance form to three different offices.

In my opinion, much of the excessive cost of private insurance comes from their gross inefficiency.

After experiencing Medicare, I wouldn't wish private insurance on my worst enemy.

Well, maybe on a "conservative".

 

I rarely hear anything negative about Medicare. I can especially vouch for the quality of services they provide to elderly in-home hospice care, and help for the disabled / handicapped. This system includes many, many private companies that provide the actual services. Regulations are imposed on the cost, and quality of these services, but the private companies are still profitable, and employ a very large number of people where I live. There can be no doubt that some of these companies overcharge Medicare for their generous services, but even private insurance companies have built fraud into their cost model.

 

Many critics of Medicare for All will indeed sign up for Medicare when they qualify…

So they don’t really have a problem with the “Medicare” part.

It seems they have a problem only with the “for All” part.

 

Maybe “Medicare for Me, but not for you”???

 

Just like ACA, Democrats aren't doing a good job explaining the details, or emphasizing the benefits to consumers of their plans. 

Like no premiums, no cost sharing, no co-pays, etc

 

It seems to me that the most efficient insurance systems for consumers would be to have the largest pool of people possible. Like near 100%.

This admittedly monopolistic system can enforce cost, and quality, and at the same time spread the risk across the largest number of people.

If you are young, and healthy, this may not be lowest cost solution, but the young and healthy do not seem to be the ones opposed to it.

 

Monopoly's are efficient, but dangerous. Adding even a little profit motive to the equation dilutes it's efficiency, and would lead to windfall profits.

It's better that the profits go into the Treasury, than private equity accounts, IMHO.

 

I’m no expert, but my ‘plan’ would simply be to drop the Medicare requirement age down gradually over the next few decades.  A choice would be given, (like it is now) to go public, or go private.

 

 

 

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I will only speak for idaho but I have a feeling it sorta like this across the whole midwest

 

the green is where Idaho has poor health care  or no healthcare

 

purple is where we have the best healthcare

 

 so you can have triple platinum black diamond insurance but if you live in the middle of Idaho odds are good you died early cause there was no healthcare

 

the only way privet will build viable healthcare in the green is if there is a profit to be made

 

25% of the population makes to 65 in the dark green and our Government forced them to buy health insurance 

 

insurance is easier to find than healthcare in some places 

 

 

 

 

 

 

 

 

 

population-over-age-65-county.jpg

 

 

 

 

 

 

 

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4 hours ago, rrober49 said:

I will only speak for idaho but I have a feeling it sorta like this across the whole midwest

 

the green is where Idaho has poor health care  or no healthcare

 

purple is where we have the best healthcare

 

 so you can have triple platinum black diamond insurance but if you live in the middle of Idaho odds are good you died early cause there was no healthcare

 

the only way privet will build viable healthcare in the green is if there is a profit to be made

 

25% of the population makes to 65 in the dark green and our Government forced them to buy health insurance 

 

insurance is easier to find than healthcare in some places 

 

 

 

 

 

 

 

 

 

population-over-age-65-county.jpg

 

 

 

 

 

 

 

interesting map regarding population age. The best healthcare is where people don't need it as much possibly. Young people under 50 use it for the basics. Reproduction and stuff. If you have children you need it for kids getting sick, or having a broken bone or a minor abrasion - for the most part. If you have a child with real need you really really need it big time. 

Older people need it more percentage wise, but a lot of older Americans are also in good health - knock on wood.

 

If you need it and you don't have it - that is big time bad, and I think really wrong, I don't care who you are or at what age. 

 

I do think the Democrats need to talk about this much more. Use the Congressional Oversight that they have now to hold many hearings describing what is needed and how to pay for it. 

Like dealing with climate change, I think it is imperative that this country fights the good fight and finds a way to cover all! Make universal healthcare the goal - no two ways about it.

 

Peace!

 

 

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6 hours ago, ExPDXer said:

 

 

Maybe “Medicare for Me, but not for you”???

 

Just like ACA, Democrats aren't doing a good job explaining the details, or emphasizing the benefits to consumers of their plans. 

Like no premiums, no cost sharing, no co-pays, etc

 

It seems to me that the most efficient insurance systems for consumers would be to have the largest pool of people possible. Like near 100%.

This admittedly monopolistic system can enforce cost, and quality, and at the same time spread the risk across the largest number of people.

If you are young, and healthy, this may not be lowest cost solution, but the young and healthy do not seem to be the ones opposed to it.

 

Monopoly's are efficient, but dangerous. Adding even a little profit motive to the equation dilutes it's efficiency, and would lead to windfall profits.

It's better that the profits go into the Treasury, than private equity accounts, IMHO.

 

I’m no expert, but my ‘plan’ would simply be to drop the Medicare requirement age down gradually over the next few decades.  A choice would be given, (like it is now) to go public, or go private.

 

 

 

This is true. I just have known people who have gone without while needing it. It kind of makes you sick thinking about it. Knowing that someone, a friend or possibly family member has an illness that needs to be treated and could be much better off if they only could see a doctor and not go completely broke for doing so. For this, the ACA has been a godsend. I have helped step in to help pay for insurance for someone I knew, and was glad to do so. If it were not for the ACA that would have been impossible.

 

Peace!

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4 hours ago, rrober49 said:

I will only speak for idaho but I have a feeling it sorta like this across the whole midwest

 

Fair enough. I'm with you.

 

4 hours ago, rrober49 said:

the green is where Idaho has poor health care  or no healthcare

 

purple is where we have the best healthcare

 

I agree fully.

 

4 hours ago, rrober49 said:

the only way privet will build viable healthcare in the green is if there is a profit to be made

 

This is also true, but I would say the only way to build private healthcare anywhere (green or purple) is if there is a profit to be made.

Public healthcare theoretically could build viable healthcare without the profit motive. Think of VA hospitals, for instance.

 

4 hours ago, rrober49 said:

25% of the population makes to 65 in the dark green and our Government forced them to buy health insurance  

 

Really? Only 25% make it to 65 in rural areas? That's sounds like a real health problem

Or, 75% of the population retires to purple areas like Arizona, Florida, where, as you said 'we have the best healthcare'.

Many of the 65+ er's in very purple areas relocated from the green areas for a variety of reasons, including healthcare.

I can't explain the purple dot in South Jersey, however.

 

4 hours ago, rrober49 said:

insurance is easier to find than healthcare in some places 

 

I agree with this as well, but this is a population density problem. The same thing happened with Internet access, and telephone access before that, and Interstate access before that, and Post office access before that. I suspect most critical cases are flown by helicopter to the nearest purple dot on your map.

 

The economics of placing a hospital every 50 sq miles, to serve a couple dozen people just does not add up. When your next door neighbor is 25 miles away, and the nearest town is 200 miles away, most services are hard to find.

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44 minutes ago, ExPDXer said:

 

The economics of placing a hospital every 50 sq miles, to serve a couple dozen people just does not add up. When your next door neighbor is 25 miles away, and the nearest town is 200 miles away, most services are hard to find.

This is a really important issue!

 

Peace!

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maybe we could discount  the cost of medicare Idea based upon location of services ?

 

I agree universal would be the best chance at adding more services in the remote regions and we could increase the cost as we add them

 

making people feel like the things that would create long wait times are being addressed as the system goes live would be a great selling point 

 

lack of institutions creates wait times  wait times being the bigger issue to people 

 

 

 

 

 

 

 

 

 

 

 

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1 hour ago, rrober49 said:

maybe we could discount  the cost of medicare Idea based upon location of services ?

Or, add more institutions to these areas.

 

1 hour ago, rrober49 said:

making people feel like the things that would create long wait times are being addressed as the system goes live would be a great selling point 

 

lack of institutions creates wait times  wait times being the bigger issue to people 

It's all in the number of patients per hospital equation. Too many hospitals, with too few patients produce no wait time,  but also negative profits.

Too many patients, with too few hospitals, or medical services produces long wait times, and coincidentally produce higher profit margin.

Kinda like the number of passengers per airplane equation.

 

International airline hubs like NYC, LA, Miami feed smaller hubs like Denver, Chicago, and Dallas. These major hubs feed even smaller regional hubs that serve rural districts. Federal Air Traffic controllers impose very strict regulations on for-profit airlines, which affects how much profit they can squeeze out of compromising safety.

 

Hospitals could build smaller, mini-hospitals that utilize technology to connect to medical resources available at larger medical centers across the nation. This is entirely possible. Whether it is profitable enough to entice private investment may be another question.

 

Contrary to popular opinion, this is the kind of thing that where public funding has outperformed venture capitalism. Some things that are critical to the public, are not profitable to private enterprise. Development of new antibiotics is another example with a low profit motive, but the ‘public need’ may become apparent, soon.

 

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a result. Hospital acquired infections, and antibiotic resistance is now a major threat to public health.

 

But there is no economic incentive for making new antibiotics. Large drug makers have abandoned their antibiotic development programs in recent years in favor of more lucrative drugs. Compared with medicines for chronic conditions, which patients may have to take for many years, antibiotics are used for a short period of time. This means that pharmaceutical companies don't get a significant return on their investment in new antibiotics.

 

I understand that private enterprise exists only to serve shareholders. Some problems can't, (or shouldn't) be solved by corporations.

But they are still problems that need to be solved, regardless of whether it is profitable.

 

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54 minutes ago, ExPDXer said:

Hospitals could build smaller, mini-hospitals that utilize technology to connect to medical resources available at larger medical centers across the nation. This is entirely possible. Whether it is profitable enough to entice private investment may be another question.

 

 

wellness centers to help filter out who needs to go to the center hub

 

maybe leave private pay  for expanded prescription and short term care and universal for long term care ?

 

money allows invention to happen it does not make invention happen

 

inventors just need funding to find a cure

corporate wants a profit to find a cure

 

corporate would work harder for our money if we funded more  from our government 

 

 

 

 

 

 

 

 

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I do like the idea of lowering the qualifying age for Medicare/Medicaid periodically, I think it would obviously lower premiums for private insured and also help older employees retain employment till retirement age. Maybe that could help avoid the full impact of long wait times while seeing how the system reacts for both single payer and private.

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On 7/4/2019 at 11:22 AM, ExPDXer said:

Or, add more institutions to these areas.

 

It's all in the number of patients per hospital equation. Too many hospitals, with too few patients produce no wait time,  but also negative profits.

Too many patients, with too few hospitals, or medical services produces long wait times, and coincidentally produce higher profit margin.

Kinda like the number of passengers per airplane equation.

 

International airline hubs like NYC, LA, Miami feed smaller hubs like Denver, Chicago, and Dallas. These major hubs feed even smaller regional hubs that serve rural districts. Federal Air Traffic controllers impose very strict regulations on for-profit airlines, which affects how much profit they can squeeze out of compromising safety.

 

Hospitals could build smaller, mini-hospitals that utilize technology to connect to medical resources available at larger medical centers across the nation. This is entirely possible. Whether it is profitable enough to entice private investment may be another question.

 

Contrary to popular opinion, this is the kind of thing that where public funding has outperformed venture capitalism. Some things that are critical to the public, are not profitable to private enterprise. Development of new antibiotics is another example with a low profit motive, but the ‘public need’ may become apparent, soon.

 

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a result. Hospital acquired infections, and antibiotic resistance is now a major threat to public health.

 

But there is no economic incentive for making new antibiotics. Large drug makers have abandoned their antibiotic development programs in recent years in favor of more lucrative drugs. Compared with medicines for chronic conditions, which patients may have to take for many years, antibiotics are used for a short period of time. This means that pharmaceutical companies don't get a significant return on their investment in new antibiotics.

 

I understand that private enterprise exists only to serve shareholders. Some problems can't, (or shouldn't) be solved by corporations.

But they are still problems that need to be solved, regardless of whether it is profitable.

 

This is why a lot of people propose doubling or tripling the amount spent at the NIH for drug discovery - no patents, and sharing of knowledge is I think a great selling point. Of course there could also be Federal subsidizing that went to private companies who can do some of the development. I like the idea of subsidizing mini hospitals as well. Actually in a lot of largely populated areas we could do better by having smaller facilities that take care of a lot of

urgent care needs. 

 

Long ago I heard that the Soviets had made some solid improvements in healthcare by creating facilities that focused on only one type of care, like treating heart conditions, or cancer.

Privately many hospitals have gone to large groups who purchase all of their medical supply, sort of like the auto industry, where it needs to maintain a stock load of parts. The trick is to maintain low overhead, and low inventories, yet still maintain efficiency. 

 

I envision the need for private corporations in healthcare, while at the same time going to a single payer health insurance payout. How this is implemented is what needs to be determined. It may take a few decades to become fully implemented. We might start off with say a public option, and possibly lowering the age for medicare - for those who choose it.

The government could spend money to subsidize for costly equipment, such as MRI equipment, especially in rural areas.

 

Private hospitals today have to deal with huge administration costs regarding dealing with insurance companies. Single payer would reduce that cost drastically. I would suppose there is a lot of waste in healthcare spending today in other areas as well. The free market has its place in healthcare where it has the incentive to reduce waste for profits sake, but without

sacrificing good care.

 

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Well I just wish the Democratic Party would have at least one serious debate dedicated solely to healthcare in America. 

I would like it to begin with some excellent piece of journalism. I picked this one from the American Prospect regarding the high price of Insulin because it points to a huge problem 

we have with pharmaceutical prices while explaining why. 

I think it would be a smart move. It would educate all people watching the debate and each politician would then need to describe what measures they think the American people should take. They could put the article below into a documentary form and play it prior to letting the candidates come out for the debate. If they did, I really think they'd get some traction. 

 

https://prospect.org/article/insulin-racket

 

Peace!

 

 

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There is widespread support for universal coverage but not for the elimination of private health insurance. An insistence on the elimination of private insurance may well cost Democrats the 2020 election.

 

 

hillharrisx-1_feb7.png

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On 7/4/2019 at 9:34 AM, rrober49 said:

maybe we could discount  the cost of medicare Idea based upon location of services ?

 

I agree universal would be the best chance at adding more services in the remote regions and we could increase the cost as we add them

 

making people feel like the things that would create long wait times are being addressed as the system goes live would be a great selling point 

 

lack of institutions creates wait times  wait times being the bigger issue to people 

 

 

 

 

 

 

 

 

 

 

 

I think that where there is small areas of service you need primary care big time. Other more complex issues would need to be handled a bit farther away. In smaller populated areas you need efficiency, and efficacy to suite the smaller population. Then, you need regional hubs that are more suited to deal with a whole host of more difficult healthcare needs.

It's not perfect, but you need a plan to address this issue. One that makes the most sense. 

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The PERI research team / University of Mass at Amherst of Pollin, James Heintz, Peter Arno, Jeannette Wicks-Lim and Michael Ash, found that Medicare for All would reduce annual health care spending to $2.93 trillion from the current level of $3.24 trillion. Public health care revenue sources that presently provide about 60 percent of all U.S. health care financing, including funding for Medicare and Medicaid, would provide $1.88 trillion of financing for the new system. Removing the other costs attributed with the current system would leave a gap of $1.05 trillion, which the economists suggest could be raised with a set of four proposals that will generate enough revenue to create a surplus of 1 percent for the system.

The researchers propose:

  • Continuing business health care premiums, but with a cut of 8 percent relative to existing spending per worker. Businesses that have been providing coverage for their employees would thereby see their health care costs fall by between about 8-13 percent. ($623 billion)
     
  • A 3.75 percent sales tax on non-necessities, which includes exemptions for spending on necessities such as food and beverages consumed at home, housing and utilities, education and non-profits. The researchers include a 3.75 percent income tax credit for families currently insured by Medicaid. ($196 billion)
     
  • A net worth tax of 0.38 percent, with an exemption for the first $1 million in net worth. The researchers state that this tax would therefore apply to only the wealthiest 12 percent of U.S. households. ($193 billion)
     
  • Taxing long-term capital gains as ordinary income. ($69 billion)

Under these recommendations, the researchers find that the net costs of health care for middle-income families would fall by between 2.6 and 14 percent of income. For high-income families health care costs will rise, but only to an average of 3.7 percent of income for those in the top 20 percent income group, and to 4.7 percent of income for the top 5 percent.

The researchers also find that based on 2017 U.S. health care expenditure figures, the cumulative savings for the first decade operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality and net job creation through lower operating costs for small- and medium-sized businesses.

“Medicare for All will produce large cost savings for both businesses and households,” says co-author Jeannette Wicks-Lim, associate research professor at PERI. “Under our proposal, all businesses that now provide health care coverage for their employees will receive an across-the-board 8 percent cut in premiums. For families, our results show that Medicare for All will promote both lower average costs and greater equity. For example, middle-income families who now purchase private insurance on the individual market would see their health care costs fall by an average of 14 percent under Medicare for All.”

“This study is the most comprehensive, detailed, authoritative study ever undertaken of Medicare for All, and it points powerfully and unassailably in support of MFA,” said economist and public policy expert Jeffrey Sachs, University Professor at Columbia University, in reviewing the researchers’ analysis. “Medicare for All promises a system that is fairer, more efficient, and vastly less expensive than America’s bloated, monopolized, over-priced and under-performing private health insurance system. America spends far more on health care and gets far less for its money than any other high-income country. This study explains why, and shows how Medicare for All offers a proven and wholly workable way forward.”

In his review of the report, William Hsiao, K.T. Li Professor of Economics at the Harvard University T.H. Chan School of Public Health, said the study “presents an objective, unbiased, comprehensive and thorough economic analysis of Medicare for All. Professor Pollin and his co-authors have set a new high standard for transparency and clarity in presenting their analyses, estimations, and conclusions. The research methods they used to estimate both the cost increases and savings are sound. The assumptions they used to generate cost estimations are based on the latest empirical evidence. Consequently, the conclusions of this study on the overall costs and savings of Medicare for All are reasonable and scientifically sound.”

“This stellar economic analysis of a single-payer, universal health care system for the U.S. is the first to sufficiently document each step of the calculations, enabling reproducibility of the findings. It is also the first study that thoroughly addresses the transition to and financing of a universal health care system for the U.S.,” said Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis and Burnett and Stender Families’ Professor of Epidemiology at Yale University, in her review of the report. “Underlying the analysis is an interdisciplinary evidence base that has been compiled from literature spanning economics, health policy and clinical care both within the US and internationally. The methodology is sound and the assumptions are conservative with regard to their conclusions. Specifically, lower-end figures from the expert literature are used in the calculation of savings, whereas anticipated expenditures are based on the higher end of empirical distributions. Despite stacking the deck against Medicare for All, this analysis convincingly demonstrates the substantial improvements in cost efficiency that could be achieved by Medicare for All. I am confident that the Pollin et al. study will become recognized as the seminal analysis of a single-payer universal health care system for the U.S.”

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