THE PROGNOSIS

Even if Medicare-for-all is extremely costly, so is the status quo. 

That may be Sen. Bernie Sanders’s most persuasive argument for his single-payer health plan, in a presidential race where he is continually fending off attacks from opponents on his political right. 

Average spending for each of the 160 million Americans with workplace coverage has reached an all-time high of nearly $6,000 per year. Spending grew more than 18 percent from 2014 to 2018. And this increase is mostly due to the prices for medical services increasing rapidly, not people just using more of them.

That’s per an analysis from the Health Care Cost Institute, which examined medical claims data for roughly 40 million people with Aetna, Humana, Kaiser Permanente or UnitedHealthcare plans provided through their employers. 

The analysis released every year by the nonprofit research firm tells a troubling tale of the U.S. health-care system — one that the Democratic presidential candidates frequently bring up: consumer costs keep rising, making medical care a top financial stressor, even for people fortunate to have coverage provided and subsidized by their employer.

The research also found:

  • Out-of-pocket costs for American workers — including co-pays, coinsurance and deductibles, but not monthly premiums — rose 14.5 percent during the five-year period spanning 2014 to 2018. Average out-of-pocket spending is now $907 per person per year.
  • Average prices for medical services and products grew 2.6 percent in 2018, a little slower than in previous years. But prices still increased 15 percent from 2014 to 2018.
  • During that time period, average health-care spending per person with workplace coverage grew 4.3 percent annually — faster than the 3.4 percent average annual rate of growth in the U.S. per capita gross domestic product.

None of this is expected to reverse any time soon. “We expect spending growth to stay on an upward trajectory in the coming years,” said HCCI president Niall Brennan.

And that’s not to mention other insurance loopholes and fine print, where insured Americans can get massive, unexpected bills if they get care outside their plan’s network. 

“Last Week Tonight” host John Oliver used colorful language to explain the many problems of the U.S. health care system:

But there’s also a political messaging takeaway from this data: It may give Sanders some momentum to sell Medicare-for-all to the American people, by stressing that the alternative of keeping things the way they are is extremely expensive.

He has employed that argument liberally at the many presidential debates.

“The average worker in America, their family makes $60,000 a year. That family is now paying $12,000 a year for health care, 20 percent of their income,” Sanders argued at the December debate.

“Under Medicare-for-all, that family will be paying $1,200 a year, because we’re eliminating the profiteering of the drug companies and the insurance companies and ending this byzantine and complex administration of thousands of separate health care plans,” he said.

Other candidates, including former vice president Joe Biden and former South Bend, Ind., mayor Pete Buttigieg, agree that the current system is unsustainable – even as they attack Sanders on his Medicare-for-all alternative. 

It’s certainly true there are tons of ways a Medicare-for-all system could play out in reality, given the many decisions lawmakers would have to make about what it would cover, how much it would pay providers and how to tax Americans to pay for the whole thing.

Even so, Sanders loves to say he wrote the “damn bill." He frequently touts how Medicare-for-all could free people of out-of-pocket expenses when visiting the doctor or hospital and erase their financial worries should a major illness strike out of the blue.

Over the weekend, he touted a new analysis from a team of epidemiologists published in the medical journal the Lancet, which found Medicare-for-all would save Americans $450 billion and prevent 68,000 unnecessary deaths every year.

AHH, OOF and OUCH

AHH: Health experts have expressed concern that China has not been fully transparent about the extent of the coronavirus outbreak. That may warrant a tougher stance from the United States. 

Yet President Trump has heaped praise on Chinese President Xi Jinping for his handling of the outbreak despite concerns among his advisers, The Post’s Yasmeen Abutaleb and Josh Dawsey report

“Trump has remained uncharacteristically restrained in his public comments about the coronavirus, which has infected more than 70,000 people, the vast majority of whom are in China," they write. "Trump’s praise toward Xi has irked some advisers, who say the compliments are unwarranted as the United States is still working to get a team of experts access to data and Chinese sites to study the virus, aid in the response and secure all the needed information.” 

“Trump has repeatedly told advisers that pushing for a harder line against China could backfire because Xi controls the government ‘totally’ and will not work with the United States if it says anything negative about the country, said one of these senior administration officials."

— Fourteen Americans evacuated from the Diamond Princess cruise ship in Japan tested positive for coronavirus. They, along with more than 300 Americans who disembarked from the cruise liner, have been returned to the United States on two airplanes.

“Their return almost doubles the number of confirmed coronavirus cases in the United States to 29,” our Post colleagues Anna Fifield, Alex Horton and Abha Bhattarai report. 

The State Department and Department of Health and Human Services said the passengers were deemed “fit to fly.” “These individuals were moved in the most expeditious and safe manner to a specialized containment area on the evacuation aircraft to isolate them in accordance with standard protocols,” the departments said in a statement.

Another 44 Americans who were on board the Diamond Princess tested positive for coronavirus but stayed in hospitals in Japan. 

— There's an insufficient supply of masks and gloves, even though manufacturers have warned the U.S. government of a likely shortage should a pandemic ever occur.

That’s because many companies in the United States, including hospitals and pharmaceutical firms, depend on manufacturers in China for products including protective gear like masks and gloves, our Post colleagues Lena H. Sun and Rachel Siegel report.

As coronavirus cases spiked in recent days, Prestige Ameritech, a Texas manufacturer that’s the largest full-line domestic surgical mask manufacturer, was churning out 600,000 masks a day to try to meet demand. Mike Bowen, the company's vice president said he’s been warning for years about this potential scenario, calling on federal agencies and lawmakers to boost U.S. product of medical masks. 

Mike Bowen wrote to President Obama in 2010: “Prestige Ameritech is presently the lone voice warning of the insecure U.S. mask supply… Apathy and inertia are our biggest hurdles.” Three years ago, he wrote to Trump: “The U.S. protective mask supply could — and mostly likely would — be disrupted, confiscated or diverted in the event of a pandemic.”

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OOF: As lawyers work toward settlements in the national opioid litigation, it's possible the payout from drug companies won't be as large as some once thought, the New York Times’s Jan Hoffman reports.

“Lawyers on all sides have been stepping up efforts to reach a national agreement before the start of a New York trial next month,” Jan writes. “But even plaintiff lawyers now believe the payout from dozens of opioid makers, distributors and retailers is likely to be less than half of what the four Big Tobacco companies agreed to pay more than 20 years ago in a landmark settlement with states over costs associated with millions of smoking-related deaths.” 

To compare: The 1998 tobacco settlement was more than $206 billion over a quarter-century, she writes. Yet Eric Percher, a senior analyst following the opioid lawsuits for independent investment research firm Nephron Research, predicts a total opioids settlement between $75 billion and $85 billion. 

OUCH: A decade ago, Mike Bloomberg scoffed at the final Affordable Care Act legislation, saying it would do “absolutely nothing to fix the big health care problems,” CNN’s Andrew Kaczynski and Em Steck report. 

In a July 2010 appearance at Dartmouth College, the former New York City Mayor called the program a “disgrace.” “The President, in all fairness, started out by pointing out what the big problems were, but then turned it over to Congress, which didn't pay any attention to any of those big problems and just created another program that's going to cost a lot of money,” Bloomberg said then.  

A Bloomberg campaign spokeswoman Julie Wood told CNN he supported the bill but “wanted Congress to go further than they did.” “As he references in these comments about Washington dysfunction, Congress failed to enact the public option that he argued for in 2009 and now proposes as part of his Presidential campaign,” Wood said.

Bloomberg remarked several times on the Affordable Care Act in the years following its passage, saying the bill was “really dysfunctional" and did nothing to solve rising health care costs, Andrew and Em write. 

HEALTH ON THE HILL

— Staff for House Speaker Nancy Pelosi (D-Calif.) met with Republican and Democratic House aides to forge ahead on surprise medical billing legislation efforts, but the Hill’s Peter Sullivan reports nothing new came of the meeting. 

The meeting included staffers from the House Energy and Commerce, Ways and Means, and Education and Labor committees, as well as aides to Pelosi and House Minority Leader Kevin McCarthy (R-Calif.). Pelosi wants to reconcile competing measures from the committees and bring a measure to the floor this spring.

“Some observers argue the proposals are not that far apart and could be bridged, but it remains to be seen if politics or tensions between the committees will get in the way,” Peter writes. 

— And here are a few more good reads: 

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DAYBOOK

Coming Up

  • The Supreme Court will discuss whether to hear a case that could settle the fate of the Affordable Care Act at its private conference on Feb. 21.
  • The Washington Post will host a live talk on Feb. 26 on the plight of working families and low-income workers in the United States. Discussions will include topics such as the rising cost of health care.
  • The House Transportation Subcommittee on Water Resources and Environment will hold a hearing on proposals for a Water Resources Development Act of 2020 on Feb. 27.

SUGAR RUSH