Family medicine

The researches find that the Healthcare dominated early, with Sens. Therefore Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums. But the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.

The Healthcare insurance

Only two candidates New York City Mayor Bill de Blasio and Warren raised their hands in favor of banishing private insurance in favor of a government-sponsored Healthcare for All approach. Klobuchar; a single-payer skeptic; expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage; with 49% getting that insurance through work; according to the Kaiser Family Foundation.)

Former Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a so-called “Healthcare for America” bill in Congress. The single-payer talk set off other discussion about the role of health insurance and the cost of care. We fact-checked some of the biggest claims. They contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.

Private insurance system

The report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior. This came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear. This is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled.

But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients. Also, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.

Medicare’s overhead

The insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion; with administrative expenses of $9.9 billion.

That comes to 1.3%, less than Booker said. A 2005 study Warren co-authored and a 2009 paper both found that health care expenses were a leading cause of personal bankruptcy. But these claims have come under dispute; in particular from academics who suggest that people may overstate the role medical bills play in their financial problems. Other research suggests a far narrower impact, though that in turn has been criticized for focusing only on adult hospitalizations.