THE PROGNOSIS

Sen. Bernie Sanders (I-Vt.) insists most Americans would ultimately pay less for their health care if the country transitioned to a Medicare-for-all system.

That’s an argument worth considering. But it’s unlikely to happen under the hugely generous plan suggested by Sanders, who is seeking the 2020 Democratic presidential nomination.

Sanders offered this argument in a widely viewed Fox News town hall on Monday evening, where the hosts quizzed him on how he’d pay for the latest version of his Medicare-for-all plan. The original version of the bill would cost an estimated $32 trillion over a decade, many times more than the Affordable Care Act. And this latest version adds on even more benefits (as The Health 202 detailed here).

“Health care costs money,” Sanders acknowledged to Fox anchor Martha MacCallum. “But at the end of the day, the overwhelming majority of people will end up paying less for health-care because they’re not paying premiums, co-payments or deductibles.”

The town hall – in which the audience appeared surprisingly enthusiastic when asked whether they’d like to trade in their commercial health coverage for a Medicare-for-all system – caught the eye of President Trump, who appeared to knock the conservative network for giving “Crazy Bernie” a platform.

Fox News anchor Bret Baier replied to an earlier Tuesday tweet from the president:

But then again last night:

It’s not surprising Sanders struck a chord when he talked about the burden of health-care costs for the typical American family. Americans spend a substantial portion of their income on health care, according to this calculator from the Kaiser Family Foundation, and health care constitutes about 18 percent of U.S.  gross domestic product – more than in any nation.

According to the calculator, someone who makes $50,000 annually can expect health-care costs to consume roughly 11 percent of their income under employer-sponsored coverage and about 20 percent of their income if they purchase insurance on their own. A family in good health earning $100,000 spends an average of 12 percent of their income on health-care under a workplace plan.

Sanders argues that under his proposal, all that spending would be replaced with some taxes to pay for a single-payer plan made available to everyone. He believes people would be willing to pay more to the government if that meant they didn’t have to purchase private health coverage and deal with a complicated, multilayered health-care system that results in hundreds of billions of dollars in waste every year.

Under the senator's plan, people could obtain everything from emergency surgery to eye care to mental health without any co-payments. The only time they’d be charged out of pocket costs would be minimal sums when purchasing prescription drugs, an amount that couldn’t exceed $200 per year. The coverage Sanders has proposed is more generous than what's offered under current Medicare system: now, seniors foot 20 percent of the bill for doctor visits. And certainly more generous than commercial plans, which typically include deductibles of $1,000 or more.

Consumers would indeed save a considerable sum of money if they didn’t have to buy private health plans. But Sanders may be off the mark when he claims those savings would more than offset higher taxes to pay for his Medicare-for-all plan. Here's why: It depends heavily on how much the government would pay doctors and hospitals. 

Pay medical providers too much, and the government faces outrageous bills. Pay them too little, and consumers struggle to access care as providers facing financial losses exit the system.

There have been several analyses of Sanders’s Medicare-for-all ideas, and they make different assumptions about how much the government would pay medical providers. But those assumptions are critical because they determine whether Medicare-for-all would increase – or decrease – national health-care spending compared to current levels.

Under the current system, private plans pay providers at much higher rates than the Medicare and especially the Medicaid programs. Those higher payments help providers make up the losses incurred from caring for seniors and the low-income.

In its analysis of Sanders's first Medicare-for-all proposal, the Urban Institute assumed doctors would be paid at Medicare rates but hospitals would be paid at rates equal to hospital costs, which is more than what they’re getting from Medicare and Medicaid currently. Because of those relatively generous assumptions, Urban analysts estimated Sanders’s plan would result in a 16.6 percent increase in national health expenditures, or $6.6 trillion more over a decade.

“Sanders is right that a good chunk of this money is in the system now,” Urban’s John Holahan told me. “But it’s not all in the system.”

But the Mercatus Center, a conservative research organization housed at George Mason University, assumed in one of its Medicare-for-all projections that providers would all be paid at Medicare rates, costing the government somewhat less. As a result, it estimated total health spending would actually fall by $2 trillion over a decade.

And then there's the question of the how many more health services people may seek under Sanders’s comprehensive, no-copays plan. That’s a big unknown, but it's fair to assume people would visit doctors or check into the emergency room more often if there was no out-of-pocket cost to them. That could also make Medicare-for-all more expensive compared to current national health-care spending.

Urban estimated modest increases in the use of services "based on actuarial standards and the heatlh economics literature," noting that health-care use for seniors increased substantially after the Medicare program was set in motion back in 1965.

The bottom line: Moving the U.S. away from its current patchwork system of public and private health insurance to a single-payer system would save some money. But it ultimately could end up costing the government more depending on how much providers would be paid and how demand for medical services would change. It also seems pretty clear that some people would pay more in taxes to support the whole Medicare-for-all system than they're paying for their own health insurance now.

“We should always be suspect of any public policy – especially when it comes to something as complicated as health-care – when anybody tells us everybody is going to get more and pay less for it,” said Linda Blumberg, a health policy expert at Urban. “It’s really not possible.”

AHH, OOF and OUCH

AHH: The Food and Drug Administration has ordered manufacturers to halt the sales of certain surgical mesh used in some pelvic operations, citing an increase in “adverse events” involved in the devices, our Post colleague Laurie McGinley reports.

The surgical mesh is used for a transvaginal repair for pelvic organ prolapse, a condition which occurs happens when muscles and tissue supporting the uterus, bladder or rectum becomes loose or weak.

The FDA said the manufacturers, Boston Scientific and Coloplast, have not demonstrated “reasonable assurance” of safety and effectiveness. In a statement, Boston Scientific said it was “deeply disappointed” by the FDA’s order, adding “patient safety is always our highest priority.”

It’s the latest step from the agency to address safety concerns for women related to the mesh. Thousands of women have sued, alleging they have been injured by the device. Three years ago, the agency reclassified the products as high-risk and mandated that manufacturers gain approval to market them.

OOF: This week former Health and Human Services Secretary Tom Price lamented the failure to replace the Affordable Care Act during his time in the Trump administration.

He said that Republicans were not able to replace the health-care law while the party had control of Congress “is one of my great sadnesses from my time up in D.C.,” the Atlanta Journal-Constitution’s Ariel Hart reports. He was speaking to the Franklin Roundtable, a group of conservatives in Cobb County in Georgia.

“You can’t beat something with nothing,” Price added.

Democrats flipped the House in the 2018 midterm elections -- including seizing the Georgia 6th Congressional District seat formerly occupied for a dozen years by Price -- after largely prioritizing a health-care message, especially regarding protections for preexisting conditions. 

OUCH: The World Health Organization says the number of cases of measles worldwide spiked 300 percent in the first three months of this year, compared with the same time last year, an increase that “follows consecutive increases over the past two years.”

“While this data is provisional and not yet complete, it indicates a clear trend,” WHO said in a statement. “Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases.”

The sharp rise globally comes as the United States is grappling with numerous measles outbreaks that have reached 555 cases, the highest number in the past five years.

The rate of vaccinations, which can prevent measles, has declined, our Post colleague Emily Tamkin writes. Worldwide, the decline can in part be blamed on issues with supply.

“But increasing accessibility and adding requirements won’t necessarily solve the problem of measles outbreaks,” she adds. “According to the World Health Organization, understanding of vaccinations needs to increase if the number of measles cases is to decrease.”

“Responding to measles requires a range of approaches to ensure all children get their vaccines e on time, with particular attention to access, quality and affordability of primary care service," the WHO statement said.

— Even as the worst measles outbreak in two decades continues, Republicans are rejecting efforts by Democrats in numerous states to pass measures that would make it more difficult for parents to avoid vaccinating their children, Politico’s Arthur Allen reports.

In Arizona, Colorado, Maine, New Jersey, New York and Washington, Republicans have opposed bills pushed by Democrats to tighten such immunization laws. In West Virginia and Mississippi, Republicans have instead sought to expand vaccine exemptions.

“Democrats present bills tightening the loopholes as science-based and necessary to fight disease, while sometimes demeaning their foes as misguided or selfish ‘anti-vaxxers,’” Arthur writes. “Republicans portray themselves as equally enthusiastic about the life-saving virtues of vaccines, but many are loath to diminish the right of parental control over their children’s bodies, and yield that power to the government.”

HEALTH ON THE HILL

— Sen. Kirsten Gillibrand (D-N.Y.) is endorsing a Democratic challenger to Rep. Daniel Lipinski (D-Ill.), who is one of three Democratic lawmakers who regularly supports antiabortion legislation, our Post colleague David Weigel reports.

Gillibrand endorsed liberal activist Marie Newman at an event in Chicago. Lipinski, who has faced primary challenges in three of his eight elections, narrowly won against Newman in 2018.

“Newman, who had never run for office before 2018, gave Lipinski the toughest challenge of his career,” David writes. “She secured endorsements from two of the congressman’s Illinois colleagues, Reps. Jan Schakowsky (D) and Luis Gutierrez (D), and was backed by a coalition of abortion rights and gay rights groups, which had clashed with Lipinski.”

— House Energy and Commerce Chairman Frank Pallone (D-N.J.) and Rep. Donna Shalala (D-Fla.) have introduced a bill that seeks to raise the minimum age for buying tobacco products to 21 and make it illegal for companies to market cigarette and e-cigarette products to anyone under 21.

The bill is the latest effort from federal lawmakers to curb the rising rate of youth tobacco and e-cigarette use. The Reversing the Youth Tobacco Epidemic Act would also demand tobacco companies have “graphic health warnings” on their ads and product packages, The Hill’s Juliegrace Brufke reports.

“The Reversing the Youth Tobacco Epidemic Act makes clear that we will not tolerate the proliferation of slick new products purposefully designed to appeal to young people to get them addicted to nicotine and tobacco,” Pallone said in a statement.  “Congress must act to reduce youth nicotine addiction by making it clear that selling tobacco products to kids is illegal.”

— There’s a record number of congresswoman who are mothers and they recently formed what they’re calling the “Moms in the House” caucus.

Rep. Debbie Wasserman Schultz (D-Fla.), who came to DC in 2005 as the mother of twin 5-year-olds and a 1-year-old, formed the group and invited to join the 25 mothers of school-aged children in the House, which includes 21 Democrats and four Republicans. It’s the first such caucus in congressional history, as our Post colleague Caitlin Gibson writes.

“We are doing these jobs differently than the majority of Congress,” Wasserman Schultz told a group of women at a recent breakfast. “I want this to be a vehicle, not only to be supportive of one another but also to help each other be successful, to use it as a way for us to advance an agenda and collect our power, to move things forward.”

“So far, only Democrats have attended the monthly Moms in the House events, which began in January, though Wasserman Schultz says Republican members have expressed interest,” Caitlin writes. “There is also an active text group, she says, in which members frequently turn to one another for advice: Should the whole family move to Washington? What are the best summer camps in D.C.? What to do with visiting kids when Mom has to be on the House floor to vote?”

INDUSTRY RX

— CVS Health has agreed to pay a fine of $535,000 following allegations that its pharmacies filled dozens of forged prescriptions for the painkiller Percocet, which contains acetaminophen and the opioid oxycodone.

The Drug Enforcement Administration’s New England office and the U.S. attorney for Rhode Island announced the fine, which followed allegations from federal officials that several Rhode Island locations filled forged prescriptions between September 2015 and June 2017, the Associated Press reports.

CVS denied the claims but said it “agreed to this settlement to avoid the delay, uncertainty and expense of litigation.”

— And here are a few more good reads: 

The U.S.’s biggest health insurer sharply criticized the “Medicare for All” proposals being debated by Democrats, wading into a heated Washington political debate that’s likely to dominate the 2020 presidential race and the conversation about the future of private health plans in America.
Bloomberg
MEDICAL MISSIVES
National
USDA said it “disagrees with the underlying assumption that meat and poultry products bearing the mark of inspection are likely to be contaminated with feces.”
Kimberly Kindy
Supporters of the technique say it could help certain women who are carriers of serious genetic diseases have healthy, biologically related children.
Stat
STATE SCAN
Local
The sick person is a “household contact” of the first person infected, according to the health department.
Justin Wm. Moyer
Michigan women would not be prosecuted for obtaining an abortion if Roe v. Wade is overturned.
MLive.com
REPRODUCTIVE WARS
The nation’s largest reproductive health services provider is in the midst of a high-stakes effort to showcase what it considers its vital role in providing community health care.
Kaiser Health News
DAYBOOK

Coming Up

  • The Heritage Foundation hosts an event with the Institute for Behavior and Health and Smart Approaches to Marijuana, “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence,” on Thursday.
  • The Kaiser Family Foundation holds a forum on the Trump administration’s HIV initiative on April 22.
SUGAR RUSH

From The Fact Checker: The Trump and Harris campaigns' misleading boasts about small-dollar contributions: