Entrepreneur Andrew Yang, who's mounting a long-shot bid to become the Democratic nominee for president in 2020, released a healthcare plan this week that is at odds with more drastic plans being proposed by some of his more liberal opponents, including Senators Bernie Sanders and Elizabeth Warren.
Sanders and Warren have proposed plans that embrace Medicare For All, which would expand the government-run program to include all Americans regardless of age -- a move that would likely eliminate the private insurance agency.
Such plans have divided the Democratic candidates on the healthcare issue, and have also drawn some concern from voters -- who, according to an October HealthPrep Data Service report, would be more likely to support Medicare For All if it were optional rather than mandatory.
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Yang's proposal eschews Medicare For All in favor of a plan that focuses more on lowering costs and expanding coverage. To do so, he introduced a six-prong approach.
The six prongs: lowering prescription drug prices; investing in technology; expanding healthcare in rural areas; expanding access to mental health; offering flexibility to providers; and diminishing the influence of lobbyists.
To address mental health, Yang favors integrating mental health checkups into primary care. On the prescription drug front, his plan is to authorize his administration to negotiate drug prices, and pressure pharmaceutical companies by using standard international price reference points.
Yang also addressed the increasing shortage of healthcare providers in rural areas, suggesting that existing technologies, such as telehealth, should be the focus of more investment so it can help to fill the provider gap -- especially in so-called "primary care deserts," or rural pockets in which access to physicians is limited or nonexistent.
In a bid to reduce the influence of lobbyists, Yang's plan is to raise the salaries of government officials, and bar them from transitioning into the private sectors they once regulated.
WHAT'S THE IMPACT
Yang's healthcare plan positions him as more of a moderate compared to many of his Democraic contemporaries. Sanders' plan would do away with private insurance companies, offering Medicare coverage for all Americans -- regardless of legal status -- while eliminating out-of-pocket costs for consumers, save for prescription drugs.
Warren's plan is similar, but would entail a longer transition, beginning with a Medicare public option that would automatically cover all children and low-income Americans. Others could opt into the program or stay with their private insurance. Medicare For All would officially get off the ground during the third year of her presidency, with an estimated cost of $20 trillion.
Mayor Pete Buttigieg has offered a kind of middle ground by proposing a Medicare public option that would compete with private insurance companies, and would cap premiums at 8.5% of a person's income. For those opting into Medicare, he would also cap out-of-pocket drug spending at $250 per month, or $200 for seniors.
Former Vice President Joe Biden, still widely considered the front-runner in the Democratic field, would avoid Medicare for All and instead favors tacking a public health insurance option onto the existing Affordable Care Act, funded primarily through higher taxes on capital gains. Consumers could stay on their employer-based coverage or independently buy into a private plan.
THE LARGER TREND
To date, Yang is the only candidate to address the healthcare industry's transition to value-based care on the debate stage. Traditional Medicare is fee-for-service, which is at odds with the value-based care paradigm being promoted by the Centers for Medicare and Medicaid Services, in which reimbursement is tied more to care quality than to volume.
His plan may also have some resonance among voters, whose support for a Medicare For All plan is largely dependent on its rollout. In the HealthPrep Data Service report, a Medicare for All option -- such as the one proposed by Buttigieg -- enjoys a 2:1 preference against mandatory programs proposed by Warren and Sanders. Voting age Americans would prefer no change at all to the current private health system over mandatory Medicare for All.
Optional Medicare for All was the most popular policy among respondents to the poll, at 45.4%. Keeping the current private system intact came in second at 33.3%, while a mandatory Medicare for All system garnered the least support at 21.2%.
This suggests that, while there's public support for a shift to some form of universal healthcare, voting age Americans are wary of a complete break from the current system.