THE PROGNOSIS

While doctors and hospitals would take a financial hit under Medicare-for-all, the outlook is even bleaker for the private health insurance industry, whose extensive workforce could be wiped out.

Health economists say that might not be such a bad thing, however.

Nearly 386,000 people were employed by health insurance carriers last year, according to federal labor data. The workforce is even larger if one counts jobs that exist because of health insurance, like administrators in doctor’s offices and hospitals who negotiate prices. Economists have projected as many as 2 million jobs could be lost under a Medicare-for-all system that eliminated all private coverage.

Democratic presidential candidate Elizabeth Warren — who backs Sen. Bernie Sanders’s Medicare-for-all legislation and on Friday proposed a way to pay for implementing it — acknowledged this much in an interview last week, when New Hampshire Public Radio reporter Casey McDermott pointed to job loss projections from University of Massachusetts Amherst researchers.

“Even supporters of that approach within the health policy world have said that would likely mean lost jobs in some form,” McDermott told the Massachusetts senator.

“So I agree,” Warren responded. “I think this is part of the cost issue and should be part of a cost plan.”

A single, generous public plan replacing private insurance from companies like UnitedHealth Group, Anthem and Cigna would undoubtedly amount to a massive reshaping of the country’s health-care system and a significant loss of jobs throughout the health-care sector. America’s Health Insurance Plans (AHIP), insurers’ powerful trade association, calculates the jobs of around 1.5 million workers in the industry would be jeopardized. 

But defenders of Medicare-for-all argue — and economists agree, to some extent — that a reduction in health-care jobs is an upside, not a downside. Over the past few decades, the sprawling health-care complex has partly grown out of huge administrative burdens, as insurers and providers constantly haggle in a complex and wasteful payment system.

Merely trying to protect those jobs is at odds if the goal is to reform the U.S. health-care system to offer better-quality, high-value care, said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy.

She stresses that the debate over whether Medicare-for-all is good policy shouldn’t be driven by considerations of how many people would lose their jobs.

“It’s just the wrong metric for evaluating health policy,” Baicker told me. “There are lots of things that warrant really important consideration in these health reform plans, but the argument for or against can’t hinge in jobs.”

Baicker and other economists use innovations in agriculture as an example. Back in 1870, nearly 70 percent of the U.S. workforce consisted of farmworkers. By 2000, only 2 percent of Americans worked in agriculture. Just as that industry morphed to reflect innovations, so too should today’s health-care industry transform into a sector that better serves patients, they argue.

“Now we are able to produce so much more food with so many fewer people,” Baicker said. “That’s a good thing. It means more people have more food and food is more affordable.”

As a general rule, economies do tend adjust over the long run, and those who were laid off are able to find employment elsewhere. Such industry expansions and contractions are natural.

But that doesn’t mean the short-term job loss from Medicare-for-all would be inconsequential, warned Michael Chernew, a professor of health-care policy at Harvard University. Some people would be absorbed into other sectors, but there would also be real dislocations and transitions played out over many years, he said.

A prime example: the decline of manufacturing jobs in the United States, which led to higher levels of unemployment in formerly thriving Rust Belt cities such as Detroit and Cleveland.

“It is a mistake to assume everyone who loses their job in the insurance industry is going to be unemployed,” Chernew said. “But it is also a mistake to assume everyone in the insurance industry who become unemployed is going to be employed in another industry in a reasonable amount of time.”

AHIP, which is part of an industry coalition fighting Medicare-for-all, makes an argument along those lines and takes it further: that the hundreds of thousands of people to be laid off would hardly be assured of easily finding other health-care-related employment, given that the Medicare-for-all framework proposes cutting payments across the sector.

“Who is going to have the extra dollars to spend on hiring them, given the caps on spending?” said AHIP spokeswoman Kristine Grow. “To just assume the jobs will disappear here and reappear somewhere else just doesn’t hold water.”

AHH, OOF and OUCH

AHH: Georgia Gov. Brian Kemp (R) has proposed a limited expansion of Medicaid that would require that beneficiaries work, volunteer or job train for 80 hours a month to qualify for coverage.

The proposal from Kemp could cover tens of thousands of low-income Georgians, but it falls short of a full expansion of Medicaid under the Affordable Care Act, the Atlanta Journal-Constitution’s Ariel Hart and Greg Bluestein report.

Kemp has called full expansion a “risky one-size-fits-all that costs too much.” "Kemp’s alternative, known as an 1115 waiver, takes aim at some of the state’s poorest residents: the 408,000 or so adult Georgians who make less than the federal poverty level — about $12,000 a year for an individual — but do not qualify for Medicaid," they add. "Kemp’s aides estimate a fraction of those — about 50,000 people — will be enrolled under this plan." 

“The governor and his aides say that extending Medicaid eligibility to those who have jobs, are enrolled in school or are engaged in specific types of community service will encourage more of the state’s poor to lift themselves out of poverty through job training and education,” Ariel and Greg report. Still, the plan will face criticism from Democrats and health care advocates who argue that “nothing short of a full Medicaid expansion will cover hundreds of thousands of uninsured Georgians, boost the state’s economy and shore up the flagging network of rural hospitals.”

OOF: The Oklahoma Supreme Court ruled 6 to 2 to temporarily block a law banning a controversial but common abortion procedure.

The state law that bans dilation and evacuation abortions after 14 weeks of pregnancy was passed in 2015, but legal challenges have kept it from going into effect.

"The high court acted Monday after an Oklahoma abortion clinic appealed a lower court judge’s decision to uphold a ban on a second-trimester abortion procedure," the Associated Press reports. "The Tulsa Women’s Reproductive Clinic requested the temporary injunction to put the law on hold, telling justices that the law would be detrimental for women." 

 In a statement, Autumn Katz, senior counsel at the Center for Reproductive Rights, said the ruling “means Oklahomans can continue receiving high-quality, evidence-based abortion care. Under this law, doctors would be subject to criminal penalties for providing abortions consistent with the standard of care."

OUCH: Last September, Lauren Bard gave birth to her daughter, Sadie, at just 26 weeks. Her baby was born three months prematurely and weighed less than a pound and a half. This month, she opened a bill for $898,984 for Sadie’s care.

Bard told ProPublica’s Marshall Allen that she knew the costs would be high, but she thought her employer, Dignity Health, which owned the hospital where she worked, would cover most of the costs.

Her health plan, administered through Anthem Blue Cross, required employees to enroll newborns within 31 days or else they wouldn't be covered. Bard missed the deadline, and she wrote two appeals that were rejected.

“As health care costs continue to rise, employers are shifting the expense to their workers — cutting back on what they’ll cover or pumping up premiums and out-of-pocket costs,” Marshall reports. “But a premature baby, delivered with gaspingly high medical claims, creates a sort of benefits bomb, the kind an employer — especially one funding its own benefits — might look for a way to dodge altogether.”

After ProPublica reached out to Dignity while reporting on the story, “Bard got a call from the senior vice president of operations for Dignity Southern California, who apologized and said she’d heard about the situation from the organization’s media team and would help. Two days later, Dignity added Sadie to the plan, retroactive to her birth date. It would cover the bills.”

HEALTH ON THE HILL

— Pete Buttigieg is pitching himself as the middle ground candidate between liberal Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) and the more moderate former vice president Joe Biden.

On health care specifically, he has recently sharpened attacks against Warren on Medicare-for-all, running ads that the proposals for single-payer health care would eliminate choices for Americans. Instead, the South Bend, Ind. mayor has pithed himself as a “Midwestern pragmatist who offers ‘real solutions, not more polarization,’ our Post colleagues Holly Bailey and Amy B Wang report.

“In television interviews and at the last debate, he attacked Warren for supporting a ‘my way or the highway’ approach to health care. (He favors maintaining the private insurance market but allowing Americans to buy into Medicare if they wish.),” Holly and Amy write. “He initially criticized Warren for not having a plan to pay for Medicare-for-all. After she released a proposal last week, Buttigieg called the math ‘controversial.’ More broadly, he has accused Warren of inviting ‘infinite partisan combat’ with her proposals of sweeping structural change.”

“There’s very little fear that he’s going to win the nomination. But he seems very happy to do a ton of damage in the meantime,” Adam Jentleson, who was a top aide to former Senate Democratic leader Harry M. Reid (Nev.) and is close to Warren’s campaign, told our colleagues.

AGENCY ALERT

— In a letter to Health and Human Services Secretary Alex Azar, government accountability advocacy group Restore Public Trust urged him to intervene in the decision by Teva Pharmaceuticals to stop producing cancer treatment Vincristine.

In the letter, the group’s director, Lizzy Price, writes the drug company decided to discontinue the drug despite being one of two suppliers. “Now, doctors are sounding the alarm to say that time is running out to stop a true shortage crisis. As the head of the Department of Health and Human Services, we implore you to intervene to help save the lives of thousands of children who depend on this important drug,” Price writes. “… Medications that literally save children’s lives should not be cost-prohibitive in the United States. That means we need your department to stand up to the drug giants attempting to raise profit margins at the expense of some of our youngest, most vulnerable citizens.”

The Food and Drug Administration said the company made a “business decision” to discontinue the medication. Pfizer, now the sole supplier of the medication, told ABC News last month it was “expediting additional shipments of this critical product over the next few weeks to support three to four times our typical production output.”

— And here are a few more good reads: 

MEDICAL MISSIVES

Investigations
Pockets of resistance to the events are cropping up across the country as mass shootings become more frequent and more deadly.
Beth Reinhard and Neena Satija
The number of US adolescents admitted to emergency rooms for injuries related to sexual abuse more than doubled between 2010 and 2016, according to a new study. For kids ages 12 to 17, the number increased from 2,280 in 2010 to 5,058 in 2016.
CNN
Politics
Carter, at 95 the oldest former president in U.S. history, was hospitalized after suffering a pelvic fracture at home on Oct. 21.
Katie Mettler
The army says Congolese radio host Papy Mumbere Mahamba was killed at home by unidentified men.
BBC News

INDUSTRY RX

Health
Increased demand — along with the time it takes to manufacture the lifesaving immune globulin medicine — has led to limited supplies.
Holly Rosenkrantz
States without personal belief exemptions are four times more likely to have children claiming religious exemptions than states that offer both options.
Stat

REPRODUCTIVE WARS

In Virginia and Kentucky, activists on both sides of the abortion debate are working to elect candidates at the state level with the power to affect abortion policy.
NPR

DAYBOOK

Coming Up

  • The Senate Special Committee on Aging holds a hearing to examine “veteran scams, focusing on protecting those who protected us” on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the response to lung illnesses and youth e-cigarette use on Nov. 13. 

SUGAR RUSH