Under the rules of the House of Representatives, the majority and minority party leaders each have the privilege of assigning the first ten numbered bills of each Congress to their top legislative priorities.1 For the 116th Congress, Speaker Nancy Pelosi (D-CA) designated as H.R. 1—her top priority—a bill called the “For the People Act.” Passed by the House of Representatives on March 8, 2019, the bill claims to “reduce the influence of big money in politics, and strengthen ethics rules for public servants.”2
Conservatives have numerous concerns about the legislation’s provisions, for attempting to stifle the First Amendment rights of individuals and organizations in the name of “ethics reform.” But over and above philosophical objections to the measure, supporters of the ethics legislation fail to comprehend that single-payer health care would undermine most, if not all, of the supposed “reforms” in H.R. 1.
Single payer would invest the federal government with enormous power, even compared to its current sizable influence. The legislation would incorporate trillions of dollars of new spending into the federal sphere, and give unelected bureaucrats the power to write new rules affecting every corner of the health-care market. With health care currently comprising 17.9% of the economy, and rising, single payer would give federal officials command and control over a vast swath of our society.3
Almost by definition, this new federal authority presents an invitation to corruption of all kinds. Fraudsters would seek to make a quick buck by submitting claims for improperly provided goods and services, as they do regularly in the current Medicare and Medicaid programs.
Under single payer, every doctor, hospital, drug manufacturer, and other medical provider would have an even greater incentive to hire lobbyists to increase their reimbursements from the government, which would represent most providers’ largest source of income, if not their only source of income. Rather than draining “the swamp” in Washington, single payer would only make the federal cesspool worse.
Democrats in Congress need not look far to find the corrupting effects of such government power on the political process. The sordid tale of their colleague Sen. Robert Menendez (D-NJ), tried for corruption to his links with physician and convicted fraudster Salomon Melgen, provides a clear example of how federal involvement in health care foments improper influence-peddling. These trends would only accelerate under a single-payer system, no matter how many “ethics reform” bills Congress may pass.
Single payer’s entire premise focuses on consolidating power within government. The House and Senate bills contain numerous specific provisions giving the federal government—specifically bureaucrats working on the federal government’s behalf—tremendous authority. Examining some of its most egregious provisions demonstrates how single payer will take authority from patients—and doctors and hospitals—and hand it to unelected officials in Washington.
Requiring Doctors to Provide Abortions: Section 104 of the House and Senate single-payer bills includes provisions prohibiting discrimination—a laudable goal, in theory. However, the text of the bill could have far more troubling implications for medical providers:
No person shall, on the basis of race, color, national origin, age, disability, marital status, citizenship status, or…sex, including…pregnancy and related conditions (including termination of pregnancy), be excluded from participation in or be denied the benefits of the program…or be subject to any reduction of benefits or other discrimination by any participating provider.4
This language would effectively define doctors who refuse to perform abortions as engaging in discrimination, for “den[ying] the benefits of the program” on the basis of “pregnancy and related conditions (including termination of pregnancy).” Under the bill, the more than 600 Catholic hospitals nationwide—who treat more than one in seven American patients—could face severe penalties, or even termination from the program, for refusing to provide taxpayer-funded abortion-on-demand.5
Obamacare contains similar non-discrimination provisions that have resulted in legal controversy.6 After the Obama administration interpreted the provisions to include gender identity, religiously affiliated employers sued. A federal district court judge struck down the provision, although appeals, and an attempt by the Trump administration to rewrite the relevant regulations, remain ongoing.7
Despite its controversial non-discrimination language, Obamacare contained a provision stating that nothing in the law would “be construed to have any effect” on existing federal law securing conscience protections.8 That federal law, in the form of a prohibition attached to Congress’s annual spending bills, prohibits any government entity from “subject[ing] any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.”9
However, the single-payer bills provide an entirely separate and new source of funds for the new government-run health system. As a result, most existing conscience protections for medical providers would not apply.10 Under single payer, doctors and hospitals would be forced to provide abortions and other services that violate their deeply held religious beliefs.
Ethics Requirements Run Amok: Section 301 of the House bill states that board members, executives, and administrators of providers like hospitals or nursing homes may not “receive compensation from, own stock or [have] other financial investments in, or serve as a board member of any entity that contracts with or provides items and services, including pharmaceutical products and medical devices or equipment, to such provider.”11 While this provision intends to combat conflicts of interest, its broad language would likely encompass otherwise-innocuous behavior.
For instance, a strict reading of this provision in the House bill would prohibit any hospital executive or board member from holding stock in pharmaceutical or other health-care companies. In some cases, individuals might not even know that their mutual funds hold stock in health-care-related entities, but could get ensnared by this provision regardless.
Massive Government Database: Section 401 of the House and Senate bills requires the secretary of Health and Human Services to create “an adequate national database” containing information related to:
The House bill contains more specific language on what information participating providers will have to give the federal government to compile this database, in addition to the data they are already providing under existing federal requirements:
The breathtaking scope contemplated for this database poses several questions, including whether it would even work. Recall that not too many years ago, the federal government spent more than $2 billion building a website to facilitate enrollment in Obamacare, and that website famously crashed and burned on its launch.14 Given that catastrophic failure, who should believe this even-more-ambitious venture in government technology would lead to a different outcome?
The privacy of this “adequate national database” raises another obvious issue. The House and Senate bills both include language about releasing outcome measures and other information from the database “without compromising patient privacy.”15
But even though the House bill contains detailed requirements for reporting on employees—including job titles, wages, and hours worked—it includes not a word about employees’ privacy. The nonchalant way the legislation disregards any possible privacy concerns about millions of health-care employees suggests the federal government would disregard patients’ privacy in a similar manner, notwithstanding the nods to patient privacy included in the bill. The federal government already disregards privacy concerns in many of the databases it oversees.16
Most importantly, however, this database implies that the federal government can, and should, supervise and oversee thousands of hospitals, and hundreds of thousands of other medical providers, nationwide. Over and above whether such micro-management would work in practice, few doctors, let alone patients, would welcome the idea that federal bureaucrats—the proverbial “Doctor Sam”—are constantly looking over their shoulders, in ways that intrude upon the doctor-patient relationship.
The ongoing debacle over health information technology speaks to the ultimately harmful, however well-intentioned, efforts of government bureaucrats to interfere in the practice of medicine.17 As a 2019 Fortune magazine exposé noted, doctors now spend more time per day interacting with screens, in the form of electronic health records, than they do with actual patients.18 Tens of billions of dollars of government spending, as part of the 2009 economic “stimulus,” forced hospitals to buy health IT systems that weren’t ready for prime time, just to meet government requirements.
While proponents of the government spending spree claimed that electronic health records would save money and time, they have done the opposite. One study concluded that an emergency room doctor makes an average of 4,000 mouse clicks in the course of a single shift, a sum that virtually guarantees human errors by turning highly trained physicians into button-pushing automatons.19
Electronic health records have caused at least 101 deaths from various forms of “alert fatigue,” and likely many more not officially documented.20 This failed experiment speaks volumes about projects like the “adequate national database” proposed in single-payer legislation, and its questionable chance of success. Moreover, as the electronic health records debacle demonstrates, sometimes even when projects “succeed”—most doctors and hospitals now do use electronic health records, because the federal government forces them to—unintended consequences can nevertheless create a massive failure.
Allocating Trillions of Dollars: Section 601 of the House bill directs the secretary of Health and Human Services to allocate the national health budget thusly:
(3) ALLOCATION AMONG COMPONENTS.—The Secretary shall allocate the funds received for purposes of carrying out this Act among the components described in paragraph (2) in a manner that ensures—
(A) that the operating budget allows for every participating provider in the Medicare for All Program to meet the needs of their respective patient populations;
(B) that the special projects budget is sufficient to meet the health care needs within areas described in paragraph (2)(C) through the construction, renovation, and staffing of health care facilities in a reasonable timeframe;
(C) a fair allocation for quality assessment activities; and
(D) that the health professional education expenditure component is sufficient to provide for the amount of health professional education expenditures sufficient to meet the need for covered health care services.21
In 2018, Americans spent more than $3.6 trillion—that’s $3,600,000,000,000—on health care.22 A single-payer system would bring virtually all that spending onto the federal government’s already grossly unbalanced books. Only the 128 words outlined above would provide guidance to HHS on where, and how, to spend that money. And the House bill seems practically verbose in comparison to the Senate legislation, which includes a mere 58 words directing HHS on how to spend trillions of dollars.23
Other provisions within the legislation give HHS similarly broad authority to determine spending allocations. The House bill directs the secretary to “provide each regional office with an allotment the Secretary determines appropriate” to carry out the program—giving one individual the unilateral, and virtually limitless, authority to set spending levels for the various regional health systems.24 Likewise, when determining payment amounts for hospitals, the House bill also gives the secretary the authority to consider “any other factor determined appropriate.”25
These virtually unchecked grants of authority to a single individual, or a group of unelected bureaucrats, give HHS carte blanche to remake the health system however its unelected leadership likes. Particularly given the ways liberals have criticized President Trump for his implementation of Obamacare, one would question why this legislation provides even more authority to the executive branch, and therefore more opportunities for such supposed “sabotage.”26
Allowing the Executive to Legislate: Section 701 of the House legislation contains provisions regarding the new single-payer system’s funding. After establishing the level of appropriations for the program’s first year, the bill includes the following about future years’ spending levels:
(B) SUBSEQUENT YEARS.—Notwithstanding any other provision of law, there is appropriated to the trust fund for the fiscal year containing January 1 of the second year following the date of the enactment of this Act, and for each fiscal year thereafter, an amount equal to the amount appropriated to the Trust Fund for the previous year, adjusted for reductions in costs resulting from the implementation of this Act, changes in the consumer price index for all urban consumers for the fiscal year involved, and other factors determined appropriate by the Secretary. [Emphasis added.]27
The Constitution specifically states that “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”28 In fact, House Democrats objected to President Trump’s border emergency declaration for precisely this reason. House Speaker Nancy Pelosi wrote that the border declaration “undermines the separation of powers and Congress’s power of the purse, a power exclusively reserved by the text of the Constitution to the first branch of government, the legislative branch, a branch co-equal to the executive.”29
But Section 701 of the House’s single-payer bill would effectively grant the secretary of HHS the authority—authority Pelosi rightly notes belongs in the hands of Congress—to appropriate funds. By creating whatever “adjustments” he or she finds “appropriate,” the secretary can thereby set appropriations levels—a “power of the purse” that the Constitution reserves to Congress. Whereas President Trump’s emergency declaration resulted in a transfer of approximately $6.6 billion toward border security, the grant of spending authority the bill would give to the secretary of Health and Human Services will affect trillions of dollars in federal spending.30
Stifling First Amendment Rights: Section 614 of the House bill includes language prohibiting payments to providers from taking into account, or being used for, “any agreement or arrangement described in Section 203(a)(4) of the Labor-Management Reporting and Disclosure Act of 1959.”31 That section of law describes “any agreement or arrangement with a labor relations consultant” who “undertakes such activities where an object thereof, directly or indirectly, is to persuade employees to exercise or not to exercise…the right to organize and bargain collectively.”32 By prohibiting doctors and hospitals from using funds to educate employees about the pros and cons of unionization, the House bill attempts to stifle medical providers’ First Amendment rights to free speech.
Seizing Intellectual Property: Section 616 of the House bill states that the secretary of Health and Human Services shall “negotiate” pharmaceutical prices with drug manufacturers. However, if “the Secretary is unable to successfully negotiate an appropriate price” with a manufacturer—the term “appropriate” defined by the secretary, of course—he or she must override any government patents or exclusivities the manufacturer holds, and grant a license to other companies to produce the drug for the government health program.33 The bill requires those other companies to provide “reasonable” compensation to the original manufacturer holding the patents, but leaves the secretary to define that “reasonable compensation.”34
One study found that drug manufacturers spend an average of nearly $1.4 billion out of pocket to bring a new pharmaceutical to market.35 After factoring in opportunity costs, meaning the money that companies might have earned had they invested that $1.4 billion elsewhere, the total cost of developing a new drug approaches $2.6 billion.36 If companies believe they will not have an opportunity to recover those costs, or if that opportunity will depend upon the whims of what an HHS secretary considers “reasonable compensation,” they will never invest time and resources to develop new, and potentially lifesaving, drugs in the first place.
This proposal will leave behind the millions of Americans—for instance, cancer patients fighting that deadly disease—whose quality of life and sometimes whole lives depend on medical innovation. While this provision in the House bill theoretically gives government bureaucrats tremendous power over drug manufacturers, in practice it may simply destroy the sector instead.
With apologies to Coolio, a new single-payer system could represent a dream come true for individuals wishing to pursue a career in fraud. Existing government health programs already face myriad problems with improper payments; expanding government-run health care to all Americans would only turbocharge the incentives for criminals to bilk taxpayers out of even more dollars.
In 2009, the television news magazine 60 Minutes looked into what has become a $60 billion-per-year industry: Medicare fraud.37 The report revealed shocking details about how fraud went from a cottage industry to big business for criminals:
Lest anyone think much has changed within the Medicare program in the decade since that report, the spring of 2019 saw not one but two separate billion-dollar fraud schemes exposed. In one, federal authorities obtained the conviction of Philip Esformes for orchestrating a $1.3 billion fraud scheme in which he referred patients to nursing facilities so the facilities could bill Medicare and Medicaid for treatments the patients didn’t need or never received.39 In the second, federal authorities arrested and charged more than two dozen individuals with billing Medicare for $1.2 billion in orthopedic braces that recipients didn’t need—just two days after Esformes’s conviction.40
Since 60 Minutes reported on Medicare fraud ten years ago, the program remains on the Government Accountability Office (GAO) “high-risk” list of programs susceptible to waste, fraud, and abuse, and has been since the list’s creation in 1990.
Over the past two years, improper payments in Medicare—representing payments made incorrectly, or fraudulent payments that should not have been made at all—declined by 1 percentage point across the program.41 However, Medicare has yet to implement 80 separate recommendations government auditors suggested to reduce fraud, and improper payments still totaled $48.5 billion during fiscal year 2018.42
While Medicare contains the largest share of federal government improper payments, another federal health program—Medicaid—ranks in second place. In fiscal year 2018, the two programs combined for more than half (56.3%) of all improper payments within the federal government.43 Like Medicare, Medicaid remains on GAO’s “high-risk” list, where it has remained since 2003.
In fiscal year 2018, improper payments totaled $36.2 billion—nearly one in ten (9.8%) federal dollars spent on the program.44 Yet despite the high rate of fraudulent and improper payments, more than one-quarter of recommendations by government auditors to improve Medicaid integrity remain unfulfilled.45 Why would we expand programs that are this susceptible to fraud and impervious to improvement?
Single-payer advocates believe that creating a government-run health system would lead to administrative cost savings, both because of greater efficiency—doctors could use a single billing system and so forth—and elimination of the profit motive. But consider that the nation’s largest health insurers made $21.7 billion in net profits in 2018, according to Fortune magazine.46
By comparison, Medicare and Medicaid—where government programs pay claims quickly, then try to chase fraudsters after the fact—incurred a total of $84.7 billion in improper or fraudulent payments, $48.5 billion from Medicare and $36.2 billion from Medicaid. Viewed from this prism, the $21.7 billion in insurer profits seems like a comparative bargain, particularly if private insurers do a better job not just of detecting fraud, but preventing it before crooks can get their hands on reimbursement checks.
Creating a single-payer system would invite a further explosion of health care fraud. In fiscal year 2018, the traditional Medicare fee-for-service program had an improper payment rate of 8.12%, while the Medicaid program had an improper payment rate of 9.8%.47
In 2018, Americans spent nearly $3.65 trillion on health care.48 If a single-payer system in control of all that health spending maintains an improper payment rate equal to the current fee-for-service Medicare program, that would imply approximately $296.1 billion in spending on fraudulent or improper payments every year ($3.65 trillion multiplied by 8.12%). Conversely, if the single-payer system leads to an improper payment rate equal to the current Medicaid program, that would imply approximately $357.3 billion in spending on fraudulent or improper payments every year ($3.65 trillion multiplied by 9.8%).
By comparison, in 2018 the gross domestic product of Denmark totaled approximately $350.9 billion, while the GDP of Finland totaled $275.3 billion.49 That improper health-care payments alone under an American single-payer system could exceed the entire economies of major developed countries, both of whom happen to have their own single-payer systems, speaks to the rampant problems in our existing government-run health programs. Yet neither the House nor Senate single-payer bill includes any major new provisions or ideas to crack down on health-care fraud, virtually ensuring that it will continue, and likely increase, under a new, larger, system.
Over and above explicit fraud, single payer would also lead to an increase in crony capitalism and special-interest lobbying. Under single payer, medical providers would have even more reason to hire lobbyists and plead for special treatment from the government-run system—likely most doctors’ and hospitals’ only source of revenue.
Consider the case of Sen. Bob Menendez. In 2015, federal prosecutors indicted the senator for a series of charges relating to bribery, fraud, and making false statements. In laying out their case against Menendez, prosecutors argued that he had become the “personal senator” to Salomon Melgen, a friend and ophthalmologist. 50 Menendez helped Melgen in his dealings with the federal government while receiving nearly $1 million in gifts and favors, none of which he revealed on his required financial disclosure forms:
Some of the trial centered on Menendez’s efforts to procure a port security contract for Melgen’s company and obtain visas for his girlfriends. But health care, specifically Medicare, consumed a large portion of the case. Medicare officials sought nearly $9 million in repayments from Melgen, charging that he had overbilled the government program for the macular degeneration drug Lucentis.52
Menendez’s corruption trial revealed the ways the senator personally intervened with Medicare officials, including the secretary of Health and Human Services, to help his friend Melgen. One Medicare official, recounting a 2009 phone call with the senator, said Menendez “was so angry that [he] wasn’t giving him the answers he wanted on his friend’s Medicare billing dispute that he hung up on him.”53
The official testified: “I was very curious why the senator was focused on this case and asked the staff several times. The senator is from New Jersey. The physician is based in Florida. I pressed our staff several times on the connection between the senator and Dr. Melgen.”54
Three years later, Menendez was still trying to help his friend and contributor Melgen—this time with Obama’s secretary of Health and Human Services, Kathleen Sebelius. Sebelius testified at Menendez’s trial that she had attended a meeting in 2012 where Menendez again pressed the same issue he had three years earlier—the Medicare billing dispute about Melgen’s use of the drug Lucentis. Sebelius testified about the unusual nature of the meeting—it came at the behest of Senate Majority Leader Harry Reid (D-NV), and it involved billing disputes normally handled by lower-ranking staff members.55
In the end, the jury deadlocked on whether to convict Menendez of the charges against him. Prosecutors ended up dropping the case entirely, in part due to the difficulty of proving an explicit quid pro quo in bribery and corruption cases.56 But that does not mean the characters involved in the case acted appropriately—to the contrary, in fact. The Senate Ethics Committee “severely admonished” Menendez for his behavior, and a federal jury convicted Melgen of defrauding the Medicare program out of $90 million.57
That a U.S. senator accepted nearly $1 million in gifts from a physician convicted of 67 separate counts of defrauding Medicare says much about the incestuous relationship between money and corruption already present in official Washington. Increasing Washington’s authority, by making the federal government virtually omnipotent over health care, would only increase this kind of potential for corruption, and make that corruption worse.
More than two centuries ago, James Madison famously wrote in The Federalist Papers that “If men were angels, no government would be necessary.”58 He continued, articulating one of the many problems with a single-payer system:
In framing a government which is to be administered by men over men, the great difficulty lies in this: You must first enable the government to control the governed; and in the next place oblige it to control itself.59
In advocating for a system of checks and balances, Madison hoped that, as he put it, personal ambition would counteract personal ambition, resulting in something approaching equilibrium among the various branches of government. Distributing power among many interests and people would help keep them all naturally accountable.
But single-payer legislation gives virtually unchecked power to one branch of government—and unelected bureaucrats at that. This large grant of power will lead to bureaucrats intervening in the doctor-patient relationship, to be sure. But it will also encourage two distinct types of corruption: Fraudulent schemes, whereby criminals steal directly from the government, and influence peddling, where special interests use lobbying and political “grease” to increase their share of taxpayer largesse.
The left believes that, after having made government omnipotent over vast stretches of society, it can impose enough constraints on the people administering that government to ensure its honest functioning. But Madison’s theory, to say nothing of the practical history of rampant Medicare and Medicaid fraud, demonstrates otherwise.
Human experience shows that only making centralized government smaller and less powerful can control the inherent threat of corruption. Conversely, a single-payer health system would only make that threat worse.
1 Section 103(e) of H.Res. 6, Adopting the Rules of the House of Representatives for the 116th Congress, as passed by the House on January 3, 2019.
2 H.R. 1, as passed by the House of Representatives on March 8, 2019; House Roll Call Vote 118 of 2019, http://clerk.house.gov/evs/2019/roll118.xml.
3 Centers for Medicare and Medicaid Services Office of the Actuary, “National Health Expenditure Projections 2018-2027: Forecast Summary,” February 20, 2019, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf.
4 Section 104(a) of H.R. 1384 and S. 1129, the Medicare for All Act of 2019.
5 Catholic Health Association, “U.S. Catholic Health Care 2019,” https://www.chausa.org/docs/default-source/default-document-library/cha_2019_miniprofile.pdf?sfvrsn=0.
6 Section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-148, codified at 42 U.S.C. 18116.
7 Anna Gorman, “Obamacare Now Pays for Gender Reassignment,” Daily Beast, August 25, 2014, https://www.thedailybeast.com/obamacare-now-pays-for-gender-reassignment; Katie Keith, “ACA Litigation Round-Up: Take Care, Contraceptive Mandate, Section 1557, and HIT,” Health Affairs blog, March 22, 2019, https://www.healthaffairs.org/do/10.1377/hblog20190322.945198/full/.
8 Section 1303(c)(2) of PPACA, codified at 42 U.S.C. 18023(c)(2).
9 See for instance Section 507(d)(1) of Division B of the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019, P.L. 115-245.
10 Beyond the annual appropriations rider, known as the Weldon Amendment, a separate conscience provision exists in permanent federal law. This provision, known as the Church Amendment, is codified at 42 U.S.C. 300a-7. The Church Amendment prohibits grant recipients under three statutes—the Public Health Service Act, the Community Mental Health Centers Act, and the Developmental Disabilities Services and Facilities Construction Act—from taking actions against employees who refuse to perform abortion or sterilization procedures. A further provision of the Church Amendment applies similar restrictions to any biomedical or behavioral research grant administered by HHS. While these conscience provisions may appear robust at first glance, they apply to a comparatively small amount of federal funding, making their ultimate applicability limited. Moreover, if the grants funded under these programs get subsumed into the single-payer system, as the program’s adherents undoubtedly hope, even these limited conscience protections will no longer apply.
11 Section 301(b)(1)(I) of H.R. 1384. See also Section 301(b)(2)(C).
12 Section 401(b)(1)(A) of H.R. 1384 and S. 1129.
13 Section 401(b)(1)(B)(ii) of H.R. 1384.
14 Alex Wayne, “Obamacare Website Costs Exceed $2 Billion, Study Finds,” Bloomberg, September 24, 2014, https://www.bloomberg.com/news/articles/2014-09-24/obamacare-website-costs-exceed-2-billion-study-finds.
15 Section 401(b)(1)(C) of H.R. 1384.
16 Jane Robbins, Joy Pullmann, and Emmett McGroarty, “Cogs in the Machine: Big Data, Common Core, and National Testing,” Pioneer Institute White Paper No. 114, May 2014, http://pioneerinstitute.org/wp-content/uploads/dlm_uploads/Cogs-inthe-Machine_new.pdf.
17 Chris Jacobs, “How Electronic Health Records Became an Absolute Fiasco,” The Federalist, April 30, 2019, https://thefederalist.com/2019/04/30/electronic-health-records-became-absolute-fiasco/.
18 Erika Fry and Fred Schulte, “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong,” Fortune, March 18, 2019, http://fortune.com/longform/medical-records/.
19 Ibid.
20 Ibid.
21 Section 601(a)(3) of H.R. 1384.
22 Centers for Medicare and Medicaid Services Office of the Actuary, “National Health Expenditure Projections 2018-2027: ,” https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2018Tables.zip, Table 2, National Health Expenditure Amounts and Annual Percent Change by Type of Expenditure: Calendar Years 2011-2027.
23 Section 601(a)(3) of S. 1129.
24 Section 601(a)(5) of H.R. 1384.
25 Section 611(b)(2)(H) of H.R. 1384.
26 Andy Slavitt, “Going on Offense to Save Obamacare from Trump Sabotage: It’s Illegal and Unconstitutional,” USA Today, August 2, 2018, https://www.usatoday.com/story/opinion/2018/08/02/lawsuit-trump-obamacare-sabotage-illegal-and-unconstitutional-column/873306002/.
27 Section 701(b)(2)(B) of H.R. 1384.
28 Article I, Section 9, Clause 7 of the United States Constitution.
29 Rep. Nancy Pelosi, “Dear Colleague: All Members Encouraged to Co-sponsor Congressman Castro’s Privileged Resolution to Terminate President Trump’s Emergency Declaration,” February 21, 2019, https://www.speaker.gov/newsroom/22119/.
30 The White House, “President Donald J. Trump’s Border Security Victory,” February 15, 2019, https://www.whitehouse.gov/briefings-statements/president-donald-j-trumps-border-security-victory/.
31 Section 614(b)(4) of H.R. 1384.
32 Section 203(a)(4) of the Labor and Management Reporting and Disclosure Act, codified at 29 U.S.C. 433(a)(4).
33 Section 616(3)(A) of H.R. 1384.
34 Ibid.
35 Joseph DiMasi, Henry Grabowski, and Ronald Hansen, “Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs,” Journal of Health Economics, May 2016, https://www.sciencedirect.com/science/article/abs/pii/S0167629616000291?via%3Dihub.
36 Ibid.
37 Steve Kroft, “Medicare Fraud: A $60 Billion Crime,” 60 Minutes, October 23, 2009, https://www.cbsnews.com/news/medicare-fraud-a-60-billion-crime-23-10-2009/.
38 Ibid.
39 Charisse Jones, “South Florida Businessman Convicted in $1.3 Billion Medicare and Medicaid Scheme,” USA Today, April 7, 2019, https://www.usatoday.com/story/money/2019/04/07/businessman-found-guilty-1-3-billion-medicare-and-medicaid-scheme/3393975002/.
40 Ricardo Alonso-Zaldivar, “Feds Charge Two Dozen in Billion Dollar Medicare Brace Scam,” U.S. News & World Report, April 9, 2019, https://www.usnews.com/news/business/articles/2019-04-09/feds-say-12b-medicare-back-brace-scam-busted.
41 Government Accountability Office, “High-Risk Series: Substantial Efforts Needed to Achieve Greater Progress on High-Risk Areas,” Report GAO-19-157SP, March 6, 2019, https://www.gao.gov/assets/700/697245.pdf, p. 33.
42 Ibid., pp. 33-34.
43 Ibid., Figure 7, Improper Payment Estimates Were Concentrated in These Areas in Fiscal Year 2018, p. 64.
44 Ibid., p. 250.
45 Ibid., p. 250.
46 Total includes profits by UnitedHealthGroup ($10.558 billion), Anthem ($3.843 billion), Aetna ($1.904 billion), Humana ($2.448 billion), Centene ($828 million), Cigna ($2.237 billion), Molina Health Care (loss of $512 million), and WellCare Health Plans ($374 million). See “Fortune 500,” Fortune, http://fortune.com/fortune500/.
47 GAO, “High-Risk Series,” pp. 243 and 250. In fiscal year 2018, the Medicare Advantage and Medicare Part D programs had improper payment rates of 8.1% and 1.66%, respectively. However, because private insurers deliver these programs to seniors, and because the single-payer bills would make private health insurance “unlawful,” the improper payment rate for traditional, fee-for-service Medicare provides the best point of comparison.
48 CMS Office of the Actuary, “National Health Expenditure Projections,” Table 2.
49 International Monetary Fund, “World Economic Outlook Database,” April 2019, https://www.imf.org/external/pubs/ft/weo/2019/01/weodata/index.aspx.
50 Nick Corasaniti, “Opening Arguments in Menendez Trial Focus on the Meaning of Friendship,” New York Times, September 6, 2017, https://www.nytimes.com/2017/09/06/nyregion/senator-robert-menendez-trial-melgen.html.
51 United States Department of Justice, “Senator Robert Menendez and Salomon Melgen Indicted for Conspiracy, Bribery, and Honest Services Fraud,” April 1, 2015, https://www.justice.gov/opa/pr/senator-robert-menendez-and-salomon-melgenindicted-conspiracy-bribery-and-honest-services.
52 Matt Friedman, “Testimony: ‘Angry’ Menendez Hung Up on Bureaucrat Who Wouldn’t Help Melgen,” Politico, October 2, 2017, https://www.politico.com/states/new-jersey/story/2017/10/02/angry-menendez-hung-up-on-bureaucrat-who-wouldnt-help-co-defendant-testimony-114817.
53 Ibid.
54 Ibid.
55 Matt Friedman, “Sebelius Believed Menendez Wanted Her to ‘Take Some Action,’” Politico, October 3, 2017, https://www.politico.com/states/new-jersey/story/2017/10/03/sebelius-menendez-wanted-me-to-do-something-114850.
56 Matt Friedman and Ryan Hutchins, “Justice Department Drops Corruption Case against Menendez,” Politico, January 31, 2018, https://www.politico.com/story/2018/01/31/dismissal-of-menendez-case-380230.
57 United States Senate Select Committee on Ethics, “Public Letter of Admonition,” April 26, 2018, https://www.ethics.senate.gov/public/index.cfm/files/serve?File_id=49C12C75-7A26-4FE6-B070-19FCEF4D7532; United States Department of Justice, “South Florida Doctor Convicted of Sixty-Seven Criminal Counts Related to Medicare Fraud Scheme,” April 28, 2017, https://www.justice.gov/usao-sdfl/pr/south-florida-doctor-convicted-sixty-seven-criminal-counts-related-medicare-fraud.
58 Federalist, No. 51.
59 Ibid.