Thread by @DickJackman1

I asked the Yale PhD Professor author of the Medicare For All Savings Report reasonable and logical in depth questions... and then I got BLOCKED.

Here's what happened. Here are my questions. Here's where they are WRONG.

February 25th debate in South Carolina, Bernie Sanders is asked the Never Gets Old question... How are you going to pay for it?

He responds as he always does about everything... it'll pay for itself. He then backs up this claim by referencing a recent Yale study.

The study makes claim that as a result of a few tax plans, reductions in reimbursement amounts and a few other triggers... Medicare for All would save $455B per year and around $5.3T over the first decade (2020-2030).

One problem. $455B x 10 = $4.55T, w/ 2% inflation = $4.982T.

Now let's dive into the facts that were kept out of or hidden from the report as well as those which are true.

1. Reduced Fees for Hospital and clinical (Provider, your Dr. visits) services by using current Medicare fee schedules.

Ok, yes, this is a true statement. However,...

... this presents a problem right off the bat because it is that fee schedule that Hospital, provider and insurance loses money on. An example here is the ACA (Obamacare). From a financial perspective, this was initially a loss almost across the board which is what created...

... issues because more and more insurance companies just bowed out because they couldn't take on the losses. Those who did stay in, had to pull on levers elsewhere to make up the difference (employer plans). Then when the competition was scarce enough, the ACA open exchange...

... saw issues because without competition those still in were able to adjust to break even or small profit from it.

2. Hospital/Provider fees to private insurers are higher in some areas (ex. California) than others for the same care.

Again, true. But that is due to other...

... factors such as cost of land, taxes, union foothold, talent cost, local law/policy, etc. Additionally it compares cost of care in US vs other countries but doesn't take into account what a Dr. makes in the U.S. vs that other the other country. So this leads to a key point...

... what kind of salary reduction will be necessary in the U.S. to help with this? Income of today is factored into these people's lives and a Dr. making $300K today will need to make massive cuts to get down to $100K, $150K or $200K.

Rpt est.s 5.5%-7.4% reduction ($100B) in...

... savings. Which moves us into 3.

3. Billing & Admin ("B&A") Reductions. The report estimates $768B in B&A costs for Providers. Where to start... the $768B seems to originate from a report they used from 2017 (below1) which got it's numbers from one in 1999 (below2-3).

But also in that 1999 report is a critical stat. How many people work in this segment of the healthcare industry. I'd say at least 30% safely based on their data. But also key is the footnote: "exclude(s) insurance-industry personnel." So, that's around 3.6M in healthcare...

...and using 15% of the insurance sector around 80K. So 3.7M or so jobs on the line. This also doesn't include B&A Call Center domestic and abroad. Maybe another 100K or so? The report says $284B can be saved. Bc this function would be streamlined... it's now an automated...

... function. So software/tech "employed."

4. Elimination of unpaid bills. The rpt states $35B could be found because hospitals wouldn't write off billing screwups due to "physician burnout" but one can argue that there are negatives here if they just willy nilly submit for...

... services leading to overbilling as we see today in Medicare/Medicaid Fraud cases. So true, Dr's would have more time with patients, but potentially at a cost, not a savings. Plus, with B&A all but gone (who likely do the coding today) it might actually INCREASE the Dr work.

To no surprise, the noted proponents of this aspect are Bernie's big money group National Nurses United and also the Physicians for a National Health Program. Two groups that clearly believe the policy would not affect their employment status.

5. B&A w/in Insurance. Glad the...

...report touches on it and states by absorbing insurance companies into M4A it would save $219B. Again, this is due to job losses. But, it's lies from where in part. "...top-heavy salary"

6. Salaries for execs saying they would cap at $211K instead of up to $20M. OK. That...

... would save a bundle of millions, sure. Let's say $90M.

7. Fraud prevention. This was a big one for me. Huge. They cite that Taiwan elim 8% health costs by enacting single-payer. So my question there would be did they have a robust system of fraud detection before, or...

...only after? In other words, was it a basket of ripe low hanging fruit for them to pluck? Or did it really just come from Single Payer? Also, the healthcare industry and government have been increasingly finding and prosecuting fraud over the last 10-15 years so I don't see...

... too much there. The report however uses 4% healthcare cost savings. $102B.

8. Drug Prices. Ah yes. Big Pharma. First off... this IS a problem. But it's a self-created one. When you create a drug, it's wildly expensive. Tens or Hundreds of millions of dollars go into the...

... end to end process. Then, when it is over, that money can only be recouped depending on the demand and pop size who needs it. If you create an amazing drug that affects 10,000 people that costs $500M to get it on market... that presents an issue. Well, over a long period...

... you can recoup it right? In theory, yes. But our governmental system has restrictions on the timetable that your patent stays active before someone can just use the formula and recreate for pennies on the dollar, driving you out of the market. So the rational play is to...

... price it to recoup and profit within the window. Hence outrageous costs for drugs. Also, a similar but different drug can be essentially copied in a relatively short time causing a similar issue (but not as defining as patent expiration). The solution is simple. Expand the...

...patent timeframe and cap the profit AFTER investment is recouped. Win-Win-Win. But the report doesn't even talk about that, instead claiming all savings would be based on buying power leverage based negotiations. But that would crush innovation (even though they say it...

... wouldn't) because imagine making the drug and investing in all that process only to have to negotiate with the only buyer in town? Govt: we will pay , take it or find another country to sell in. Report: $180B in savings. But they use $219B (40%) in their calcs.

END PART 1

So... we've debunked or AT LEAST asked the questions which require answers about the "savings" that Medicare For All would yield. But now we must look deeper into...

PART II: How Do We Pay For It?

#1. The Income Tax. This is the one that says that any household that makes over $29K gets a 4% (5% in this report though) tax rate to partially fund M4A. But here is the crazy part... today we pay 1.45% of our paycheck to fund Medicare... 1.45% from employer, but put that aside.

So wow, a great deal as an Employee right? A little over double what we pay today and eliminate the costly insurance! We go from 1.45% + $300-600/month to 4%. Let's take an example.

Salary $100K
Today: $1,450 + $6,000 ($500/mo.)
Total: $7,450

Vs.

M4A: $4,000 total.

But...

... now that shortfall ($3,450) has to be paid elsewhere. After their reported savings, $3K or so.

So lets look at Employers. Today they pay $536B on $4.5T salaries. 12%ish. Employers under M4A would pay 10%, $450B.

Employees (4%) $180B.

M4A: $630B

Today: $536B (employers) +$700B (employees - health)+ $65.3B = $1.3T.

So Medicare For All... Will Be Paid... by reducing the employee and employer contributions and costs by half... despite the report saying that overall cost of healthcare will reduce by only 13%.

But wait...

... there's more.

Let's not forget about the savings I questioned. I pointed out the massive job losses and federal spending on providing those people 5 years of displacement salary. In other words, there will be even less income tax and salary tax. On top of that, there...

... are salary caps in industries being changed. Remember the millions in CEO/exec salaries that would be eliminated with the $212K/yr max cap? If those positions are reduced from say $100M to $5M, that's $9.88M less M4A funding under tax policy proposed.

But wait...

... here is the BIG ONE.

The report claims that Employers currently pay $10,466 per employee ($536B/yr.).

Now read the tweet from Bernie. They will save 90%. But above even in this flawed report, they'd save 50%.

I could keep going but it has honestly fallen so apart it's gotten too hard to keep track of who is lying about what anymore... and this is just one of the pillars.

One thing is clear... the Bernie camp really needed Andrew Yang... they clearly have a VERY hard time with MATH.