“the inflation-adjusted price of LASIK eye surgery declined by 25 percent between 1999 and 2011, even as quality markedly improved. Notably, third-party payers (including the government) generally do not cover the procedure and so ophthalmologists have had to compete directly for consumer dollars. Similarly, though the price of healthcare grew at double the rate of inflation between 1992 and 2012, the price of cosmetic surgery — for which consumers pay almost exclusively out of pocket — grew at less than half the rate of inflation. These examples also highlight that when consumers are spending their own dollars and shopping accordingly, providers have greater incentives to improve quality and cut costs.”
Compare the free market’s influence in decreasing costs with the federal government’s & health insurance's role in inflating them.
https://spectator.org/cabinet-secretaries-third-party-payers-distort-health-market/?fbclid=IwAR0_CbLuxzU7k9qyoAH_-RW8GHTzIi-5zzQxaCN6cWlA7GEUU2LQV6FzxBo
9
Only one candidate has been pushing this issue for over 30yrs.
M4A.
It's time.
5
The medical and pharmaceutical lobbies are going to spend millions -- maybe even billions-- of dollars fighting these proposals to the death. I would be willing to bet they have already hired people to post comments to every article published online to spread lies, intimidation, and fear about changes to the unsatisfactory status quo that is the U.S. healthcare system.
Comment readers, beware!
15
Having just signed up for Medicare after experiencing both Medicaid and (thus avoided) ACA-private plans, I rediscovered what genuine health insurance is—because of the Medigap policies that are regulated and affordable to complete the guarantee of coverage that won’t financially wreck you.
Medicare “supplemental insurance” coverage is kind of risk-spreading that underlies the concept of affordable health insurance, and is most glaringly absent in the ACA private insurance market. As reported, insurers have raised deductibles on private, individual insurance to make the coverage worthless.
As Medicare is considered for the next version of ACA-like expansion, beware the hand of insurers trying to similarly put Medicare coverage out of reach. One of the potential pitfalls of crossing into Medicare at 65 is the misleading marketing for Medicare Advantage plans, the Medicare option now covering a third of all Medicare consumers. These plans are packaged as convenient, friendly, no/low premium plans that also provide a thin slice of vision and dental coverage. But just like the ACA plans, real and complete coverage—and health care—is placed behind a firewall of high deductibles and cost sharing.
5
First we have to dispel the idea that many hold: "Medicare is free." Nope, many people turn 65 and only them discover that while Part-A is usually free, if you haven't paid in long enough there is a monthly cost of $240, in addition if you go to the hospital with a deductible of $1,364/year. If you are hospitalized for over 60 days there is a daily charge. Part-B costs $135.50/month (higher if you are above a certain income level) and it only covers 80% of Medicare's R&C payments. Hence, a lot of people purchase supplemental insurance to avoid co-pays and deductibles. No, it isn't free.
To be sure, having Medicare to keep prices low is a benefit in and of itself.
The private insurance sector is doing quite well with Medicare supplemental plans (much like they are making money in Canada with supplemental insurance).
Yes, we could make Medicare available as an option and allow the insurance companies to compete with them. The $375.5 monthly cost is for one individual, not a family and there are still deductibles to be added. Start multiplying and we discover it isn't cheap. With a bit of a push I'll be that the private sector can come up with a competitive plan that still makes a profit.
8
How much money would be available for patient care if there were no longer huge executive salaries and stock holder dividends being paid out. We accept controls on education, police and fire services, and utilities costs. Why are we so resistant to cost controls on health care? It is used and needed by many more people than the other services that we consider necessities. Just make health care not for profit services.
13
Let's educate more medical staff. Pay for med school grads education if they will work where-ever-assigned for five years at a reasonable salary. Our rural areas need to have local doctors as opposed to the once or twice a week visitation. This subject never gets any attention out of our +20 year healthcare debate.
5
We have to do something to curtail medical costs and ensure equality of care for the disadvantaged. The structure of our medical care system and the politics it engenders makes it almost impossible to make major changes. It would be simpler initially to restore the ACA improve it, and merge it with Medicaid so that there is one system of care for all those who lack private insurance. After that, I think it would be more acceptable to gradually decrease the eligibility age for Medicare, say 5 years every two years. Eventually, a system more like single payer could evolve. However, there is some merit in making rapid major changes to our health care system as an overhauled one would be more resistant to political tinkering than the gradual scenario I have described.
3
With Medicare due to be insolvent by 2026, I think it would be nice to have honest discussions about how much it's going to cost to save the current program before getting too far on expanding it vastly. Then it will be good to have honest discussions about how much that is going to cost. There's the little issue of really paying for all of this in addition to having a serious game plan to overcome the enormous opposition of the insurance industry and their allies in Congress.
7
@BruceE President Johnson wanted to reform Medicare for its being over budget just a year after its instantiation but Congress, lobbied by the doctor's organizations, didn't want to change a thing. Medicare is increasingly over budget every year. .... Yes it'd be nice to have an honest discussion about how much it's going to cost.
2
@BruceE President Johnson wanted to reform Medicare for its being over budget just a year after its instantiation but Congress, lobbied by the doctor's organizations, didn't want to change a thing. Medicare is increasingly over budget every year. .... Yes it'd be nice to have an honest discussion about how much it's going to cost.
Medicare for all or a Single Payer system that includes all is at least initially good for doctors & nurses. Initially there won't be enough medical staff and so the payer, who has deep pockets, will have to afford good med staff salaries to substantially attract willing foreign staff to support demand for service.
1
Medicare benefits only apply to those age 65 or more. But payroll taxes help fund it paid by people of all ages. Thus, people now turning 65 paid in to the system their entire working lives before drawing any benefits. Under Medicare for All, everyone would be entitled to benefits. Obviously, the payroll taxes would have to multiply by many times to pay for it.
Of course, one cannot only look at the increase in taxes. The same people paying into the system would no longer have to pay for private health insurance, either directly or through their employer benefits. Insurance companies will fight tooth and nail to not be cut out of the new system. And hospitals and doctors would no longer have to worry about uninsured indigents who cannot pay their bills.
It makes so much sense, it is doomed to never happen.
9
NYT is to be lauded for articles that educate us, the general public, on the details and probable outcomes, of various health proposals. Please include cost experiences along with patient satisfaction when analyzing these programs. I would love to know more about the Maryland program, the Canadian system, and the various European systems. As a nation we clearly should put together something that provides baseline care at a level that the American taxpayers agree is a reasonable tax burden. And then we should encourage a robust private sector that provides additional care on a fee for service basis. These two approaches could coexist if the patients understood there were limits to baseline care, e.g. no vanity cosmetic surgery, etc.
5
I’d be MORE than happy to pay significantly higher taxes to finance Medicare For All. What most resisters can’t understand is that under such a plan, their high insurance premiums & deductibles would vanish, more than offsetting the tax increase. I’m 57 and have lacked affordable health insurance coverage for a good portion of my adult life, which has caused untold damage to my career and quality of life, despite belonging to several advantaged demographic groups (white, well-educated, and professionally certified in a demanding field). I’m currently enrolled in my state’s newly expanded Medicaid, but will be kicked off once my paltry salary reaches $17K, then I’ll be out of luck, since my small employer gloats about not having to offer health insurance. A healthy population is an economic asset, although Republicans and Amy Klobuchar can’t seem to understand that.
11
Universal healthcare will open the gates and set the captives free. End employer based healthcare and free workers from bondage.
15
Hopefully "eliminating the current structure of...payments and deductibles" would include getting rid of the monthly "supplemental insurance" costs that rise (horribly) with age.
IMHO, no one should make money off of my health, either good or bad. Bring on single payer.
12
Medicare dramatically improved the American medical landscape: millions of Americans turning 65 suddenly had access to full range of healthcare. The result: increased longevity, healthier hearts, lungs, diabetes stabilised. Oh, and a profound social influence: Medicare forced hospitals to desegregate. Suddenly, blacks had access to the quality care previously reserved for whites.
The AMA’s threat that the sky would fall did not materialize. Dr’s were paid a set price — but a set price on time, every time. Unlike the insurance companies that game and con patients and doctors with denials of service and refusal to pay, Medicare is favourably counted on by thousands of Doctors who prefer an honest payment for services delivered. Medicare isn’t perfect —nor is Medicare for All Yet both are better than the cancerous, broken system we have that consumed 17% of our GDP. Medicare For All can be up and running in 2 years if we have the political will — we most assuredly have the electorate will. Medicare for All resembles the exceptional New York Health Act. Passed by the Assembly and under consideration in the Senate, NYHA has been vetted by the centrist Rand Corporation and other leading healthcare experts. Every New Yorker, regardless of immigration status, is covered from Cradle to Grave with access to healthcare. Learn more at NYHCampaign.org Get Smart. Call your electeds. Register to Vote. And Vote. The time is right for New York Health Act, and NYHA is right for the time.
6
You forgot to mention that Medicare is going broke. Social Security right behind.
6
I'm in favor of some form of comprehensive universal health care, but I fail to see value in giving medical providers a lump sum and then letting them decide how to treat patients. I attended many meetings of a rural (public) health care district that operated a very small hospital and clinic near my former home, and was appalled by the switch from"health care" to "wellness." From being enthusiastic about preventive medicine and "patient empowerment" I became cynical about it -- so many big fat grants available for "wellness" programs, so much cost saved by the institution. Who will get good care when they're actually sick? When you're sick or have an accident, you need expert intervention, not a lecture about nutrition and exercise, and a blame-the-victim ethos.
8
Why not shock everyone with the idea of offering a free education for graduates in the medial professions willing to work five years in rural or urban areas at Medicare compliant hospitals/clinics for a below typical salary? Politicians are sick to be tempting people to vote themselves the public purse rather than the nation's welfare.
5
Hard to understand the enthusiasm for a totally government controlled health care system under Donald Trump or his ilk, or on a local\state level run by the same people who run the NY subway or manage the NYC Housing Authority.
7
@Jake,
Because under our current system we are paying thru the nose without any guarantee of services. Services that we are then forced to figure out as the bills come due for the next year plus. What is covered, what isn't. Is this provider in network or out? Why did that aspirin cost $10.?
Not to mention dental, vision, mental health etc. etc.
Monthly premiums and co-pays that go up each year or more so
It is confusing and time consuming.
It is aggravating and maddening knowing that a whole system is designed around preventing or lessoning service for profit. It isn't about healthcare. It is all about making money off the sick, injured and dying.
45,000 'merican's die each year from lack of access to medical care.
Over 1 million 'merican's declare bankruptcy because of medical reasons.
Because tens of millions are locked into a job they detest or would like to start their own, but are afraid to or can't because insurance is locked into employment.
Because the system as it stands doesn't cover 30 million of our fellow citizens.
Because out current system is not working for the vast majority.
Because we see a simpler system working well in other countries and wonder why we can't do the same if not better.
Because not all Gov. services are viewed as disasters. Only those purposefully mismanaged or run by those whom declare gov. as a problem and then make it so.
5
Speaking from the UK where all medical care is free at the point of delivery. It has benefits and drawbacks. The benefits are that everybody even the sick and the homeless and the unemployed and the elderly are entitled to free health care. The draw back is that it is paid for out of taxation, and taxation is always political. Put up taxation and your political opponents with an eye on the next elections see it as an opportunity to score political points off of you. Reduce taxation and your political opponents will point to long medical waiting lists. By, and large, though it is reassuring to know that no matter how ill you get or how long you are ill then you always get care and the Health Service cannot turn their nose up at you or charge you more because of your medical history
26
I think that it is unfortunate that people have started to think that "Medicare for all" means something like Representative Jayapal's bill. The result is that people are forgetting that it is possible to expand Medicare to cover more people or all people without otherwise restructuring Medicare and eliminating private health insurance. Medicate as it is presently structured does not so much replace private health insurance as work together with private health insurance. About 80% of current Medicare recipients also have some private insurance in the form of a private "Medicare C" HMO, a private "Medigap" plan or retiree health care from a former employer. Additionally, all Medicare D prescription drug coverage is privately administered. There is no reason why Medicare cannot cover all Americans while preserving the role that private insurance currently has for current Medicate recipients.
5
I see "Medicare for all" as a good starting point in the discussion. It makes sense to have able bodies working people pay premiums for Medicare that are higher than retirees/disabled people; but likely lower than currently paid to health care insurers. It also makes sense for people to have this as an option and let the market decide. Insurers would be happy with many more covered lives and risk distribution. It is well past time to catch up to the rest of the civilized world in healthcare insurance.
2
While "Medicare for All" is just a buzzword at this point, it's a good start. The American public has neither the time nor the inclination to digest the intricacies and nuances of complex legislation. Instead they respond to soundbites and catch-phrases. Look at how many people opposed to "Obamacare" embraced it when the program was presented as the Affordable Healthcare Act! It's all in the phraseology.
While not everyone has a firm grasp of what Medicare is, everyone knows, generally, that it is a good thing for our seniors have access to good medical care. "Medicare for All," therefore, is the perfect buzzword upon which to push for expanded and more rational medical care for all Americans.
4
Medicare For All is a better explanation than single payer system to be sure. What many people want is a system that divorces profit from healthcare and is available to everyone. A system whereby the eligibility is assured and standard for all so no heart stopping moments over whether or not a procedure is covered, or medication, or therapy. A working committee of best practice folks from across the healthcare spectrum could turn the existing Medicare into a national model easily. Looking forward to seeing this reality.
4
First there is no free Medicare. As a recipient of Medicare, I pay for Medicare Part B as well as Medigap insurance and for many years while working paid into Medicare.
Regarding a physician shortage. Today half the medical students are women and they are in their reproductive years. Just like other women they want to have children and many of them want to spend time as mothers with small children. The effect is that many women physicians share a practice so in a medical school class of 100, the 50 men practice medicine but the 50 women share a practice so in fact there are only 25 or so full time female physicians. The effect is that 100 physicians were planned for and needed but in reality there are only 75 full time physicians.
As these women age, most of them come back to full time practice when their children are older but not all of them.
13
"Medicare for All" may be a buzzword, but it is a much superior buzzword to "Single Payer". I doubt most people even understand what the latter is meant to convey. A catchy buzzword is a political requirement for getting our failing health care system restructured, so let's go with Medicare for All and then try to deal with the incredibly complex details. This does, however, risk allowing the buzzword to take on a life if its own, like the border wall has.
2
The reality is that we have a physician shortage, brought about in part by action by the AMA in the 1970's and 1980's to restrict medical school accreditation so as to restrict the supply of physicians and protect their income. The medical profession saw what the law schools were doing, cranking out lawyers all over the place and flooding the market and they said none of that.
So, with more physicians retiring and aging demographics a flood of new enrollees in medicare would mean more demand when their is inadequate supply. Existing long waits to see a specialist would get even worse.
The physician shortage must be addressed before we flood the market with more patients without enough docs to handle them. Yes, that may seem selfish for those of us who are already on Medicare, as am i, but making long waits for those currently with medicare even longer or impossible, by dumping millions of more patients into the system, is not the solution. We have to increase the physician supply to handle and that is not a spigot that can be turned on overnight.
17
I see nothing in this article about payments to doctors. It is all about payments to hospitals, and yet I think I am typical of most seniors in that most of my interaction with the medical profession takes place in the offices of doctors (and the occasional nurse practitioner) as opposed to hospitals.
11
As things now stand, Medicare For All or any universal access program is largely form without substance.
It misses the most salient point regarding health care in America: what good is insurance, even universal insurance, if there is no functional access to care? An example from the "Albuquerque Journal" [Feb.16] representing a poor state: "As of last week, not a single primary care physician in one of the state’s largest group of medical providers was accepting new patients...."
Lest you think this is just a problem in poor states, consider (from the same article), "The highest average new patient wait times of any city surveyed was 52.4 days in Boston, Mass. Yet Massachusetts has more physicians per patient population than any state in the union...."
Neither Republicans nor Democrats have plans to deal with this fundamental problem. They merely argue over terms of "paper rights", entirely ignoring the real world of real peoples' experiences. In a sense it boils down to a simple case of supply and demand: more patients requiring (or expecting) services than there are available physicians. Unless we address ways to create more supply, increasing demand merely serves to exacerbate the problem.
Incentives for people to choose medical careers, incentives to become primary care doctors over specialists, incentives for doctors to work in under-served areas, and other ideas need to be debated as much, if not more than, the issue of the breath and source of medical insurance.
22
@Steve Fankuchen there's a rush to take the pie and no worry about baking more pies. The voter sought with the promises just want the opportunity to take a bite while not worrying about the possibility of there being no pie to take a bite from. The nation's interest is at stake and the politicians & voter's you would attempt to influence don't have at heart the nation's interest, they have their own personal interest at heart.
3
When you think about costs of medical care in any country one would do well to include the non medical costs incurred by patients. Wait times for procedures and lost wages and productivity. Time spent fighting with payors. Time spent traveling to other states or countries for care. Why is 18% too much. I think because of the costs to businesses and profits for insurance companies but if timely procedures are added in what is the relative cost?
5
Whatever benefits the Medicare4All would provide will be wiped out with long term care costs. People who qualify for Medicaid receive LTC at the state level. Seniors will need to pay smaller premiums and supplemental coverage making the new program difficult to price. When people see the true cost and compare that to their present situation, they might not be so ready to switch.
3
I'm not aware of any healthcare system in the world where patients pay nothing. Most universal systems cover about 20% of healthcare costs, with the remainder paid by the patient and/or supplemental health insurance, with low income receiving assistance from government programs. Traditional Medicare pays about 80% of healthcare costs, with the other 20% being paid by the patient and/or a supplemental insurance plan, and the patient can go to any doctor or facility that accepts Medicare. Medicare Advantage plans have very low premiums or no premiums, but they operate like an HMO, with limited choice of doctors and facilities.
56% of Americans had employer based health insurance in 2017. Many of those people and Medicare insureds are happy with their coverage, although their costs are increasing. The no. 1 requirement for improving the system is that it has to become law. I do not believe that the plan described in the article will become law anytime soon. I would like to see a restoration of the ACA, a public option added, a ban on drug advertisements, a system that produces more doctors for less doc debt, controls on drug costs through regulation and negotiated prices, expansion of and improvement in Medicaid, more regulation of insurance companies, universal medical claim procedures, etc. The public option would gradually grow, and eventually coverage would become universal and costs would decrease as % of GDP.
12
@jas2200
Well hello from down under, Jas2200. Have been spending a lot of time in public hospitals with ill relatives and friends of late and I can assure you, public hospital patients (if they are citizens of Australia) pay nothing at all for world-class hospital care. We all pay a small levy (amount depends on income) added to our taxes, and that is it.
Outside hospitals, it is true that many general practitioners and specialist doctors charge more than the government Medicare system pays, and patients often have to foot the "gap". This results in too many people going to what you would call emergency rooms instead of to a primary care doctor (general practitioner). We need to reduce that by increasing the amount paid to primary care doctors by our public health system. Overall, though, our universal health care system works extremely well and any government that dares to threaten it is buying a one-way ticket to electoral oblivion. Like Canada and the UK.
Do yourselves a favour, go for universal public health care.
15
Medicare for All will be a disaster for current Medicare beneficiaries. They essentially will be standing in line with the rest of the population waiting for services and treatment where timeliness is critical. Medicare for All is a death sentence for seniors.
8
@KB
I'm almost "senior" and I can tell you seniors have nothing at all to fear from a universal healthcare system. Ask any Australian. Or any Canadian I guess. We don't have to lie awake at night worrying that a stay in hospital could bankrupt us. Treatment priority is rightly based on clinical need, and no-one dies standing in a line behind someone whose condition is not life-threatening. Private health insurance buys you better meals and more salubrious surroundings, and you will get elective surgery done sooner in a private hospital. Nice to have but not strictly necessary.
9
@KB
I am dismayed when I hear from seniors that they care little for young people who don't enjoy Medicare benefits. Why shouldn't seniors "stand in line" with the rest of the population? Timely medical treatment is important for anyone at any age.
4
With the rush for equanimity in health care I fear that what I experience now will continue. That is, no one really understands their health care insurance until they go to use it. Good governance takes time. If only the good citizens of our country will allow policies the time necessary to prevent unintended consequences.
6
I have Medicare and do not want anything to change to a socialized system which has to heavily tax people to pay for my Medicare. I pay for an advantage plan at $95 a month plus $135 for Part B, plus co-pays and annual Part A deductible if I need hospitalization. However, the tax burden on others will be a lot more than I pay. And medicare is struggling now to cover 44 million people and reimbursing up to 80% but sometimes nowhere near that and thats why people buy a Medigap policy. It is not workable, not realistic, and too costly in that way it is described here, as socialized system.
9
@Jennifer
I don't think that is true. The risk pool will be spread among a younger healthier population. Also the overall savings from reduced drug costs and reduced premiums will be realized so overall taxes should be lower than premiums now.
7
@Jennifer I pay $400/mo for insurance and don't use healthcare here in the U.S. at all. What services I need I buy in Kiev with cash from my pocket. Cost of the few maintenance services I use in Kiev cost less than my insurance's co-pay and deductibles. The only reason why I have my $400/mo insurance is for the chance that I have an unexpected emergency while I am here in the U.S. which is half of the year.
What I'd wish for is for full income tax deductibility of my personally paid for health care & insurance expenses. No politician will consider this though there's been so much attention given to reforming U.S. healthcare for the last 25 years.
2
@Jennifer,
So our "socialized system" is ok for you, but if we change to a socialized system for everyone it will harm you.?!
You do know that Medicare is socialized healthcare, right?
It isn't ALL about you or I, it is about We The People.
What will work for EVERYONE?!
Yes, some of your services might change.
But EVERYONE will have access to care.
Currently they do not.
Sorry, you might have to share.
1
Medicare for all does not address vital issues for many patients. Will a patient have to negotiate with government employees to get treatment at an excellent medical center or hospital? For complex orthopedic surgery, could the patient choose the Hospital for Special Surgery? Could a cancer patient choose the M.D. Anderson Center for cutting edge cancer treatment? What if you're willing to spend your life savings for a treatment that is only offered at the Mayo Clinic?
Would services decline in a budget crisis, as we have seen with the National Health Service in the UK? Would medical care be dragged down to the lowest common denominator? Do Americans really want to give up all choice in their healthcare and take the doctor or surgeon that is assigned to them, even if superior doctors are available? Lump sum compensation will almost surely degrade the quality of medical care. Need an MRI right now? Don't hold your breath. A hip replacement? Too bad, they're out of artificial hips for the year. Why not a Medicare option at 50, expansion of Medicaid, strengthening the Affordable Care Act, increasing subsidies to individuals that cannot afford a policy in their state?
Universal coverage can happen now and give people far more choice and control. Medicare for All is all slogan and no substance. It fails to address the issues that would make it unpopular with the majority of Americans.
14
I don't get how health care is a right. Health care requires that other people (doctors, nurses, psychiatrists) look after you. Those are people who have a right not to do work they don't want to do. To my understanding, most rights involve not having one's liberty or safety infringed upon. In other words, they protect one from the encroachment or predation of others (upon oneself). They don't guarantee that others will do work for one. Saying health care is a right isn't entirely different from saying that plumbing is a right, but nobody would suggest that a plumber MUST fix your toilet or your sink. I'm not sure that it's justified to say that you have a right to have doctors and nurses labor to care for you.
11
@Anti-Marx
Is it a right to have the fire put out in your house? The firemen are paid through taxes.
11
@Mark, I get your point about the fire department, but I lived in a town with a private fire service. I could pay an annual subscription fee and the fire department would fight my house fire just as a municipal department would. Or I could not pay the fee and they would fight the fire and bill me afterwards. So, in that example, is fire service a right or a service I contract for?
1
@Anti-Marx What about "life, liberty and the pursuit of happiness" does not include health?
3
All Americans deserve the same healthcare as congress. That should be the standard.
15
The real question is, "what would Medicare for all do to Medicine?"
Long term, we could see declining physician populations, and longer wait times for service. As it is, in some markets, we're seeing 5+ months for specialist referrals, and 2-3 months more for surgical scheduling. What happens if future potential physicians decide that $15 capitalized charges for an office visit doesn't permit the kind of care that's required?
Which is not to say that I don't favor a single-payer nationalized health care system. I do. But it will materially change health care delivery, possibly for a very long time.
8
@jljarvis
Forever. and if they require inordinate documentation docs will burn out, not go into primary care and will be advancing based on their data entry abilities and who would listen? The same people that don't now when they have at least a product to sell as private insurers. Be careful what you wish for and make sure you know your purposes before. Not just that it feels good. It is 18% of the economy and probably pays something into the jobs of most people in the country
2
@Wayne Inordinate documentation presently ties up way too many physician hours. Talk to any physician and they will tell you the reality of hours spent by themselves and their staffs as they struggle with insurance companies for reimbursement.
7
As things now stand, Medicare For All or any universal access program is largely form without substance. It misses the most salient point regarding health care in America: what good is insurance, even universal insurance, if there is no functional access to care?
An example from the "Albuquerque Journal" [Feb.16] representing a poor state: "As of last week, not a single primary care physician in one of the state’s largest group of medical providers was accepting new patients...."
Lest you think this is just a problem in poor states, consider (from the same article), "The highest average new patient wait times of any city surveyed was 52.4 days in Boston, Mass. Yet Massachusetts has more physicians per patient population than any state in the union...."
Neither Republicans nor Democrats have plans to deal with this fundamental problem. They merely argue over terms of "paper rights", entirely ignoring the real world of real peoples' experiences.
In a sense it boils down to a simple case of supply and demand: more patients requiring (or expecting) services than there are available physicians. Unless we address ways to create more supply, increasing demand merely serves to exacerbate the problem.
Incentives for people to choose medical careers, incentives to become primary care doctors over specialists, incentives for doctors to work in under-served areas, and other ideas need to be debated as much, if not more than, the issue of the breath and source of medical insurance.
12
@Steve Fankuchen The military answered this problem by educating their own doctors in exchange for service. Many states could used that model.
8
The article oversimplifies the change to a single payer, Medicare model.
To be fair, most who write about or run on this platform are simply not informed enough to communicate the most important issues— the message just gets mired in the complexity of this choice and the partisan politics that only confuse the issue.
Until the challenge of healthcare is REALLY understood by our both government and the market place as a universal right to everyone, the right information and the best way to proceed will always be lost.
Pull it out of politics and put it where it belongs.
3
We need one plan like Senior Medicare. Why one? It will lesson politicians games to nickel and dime us with options that will take lawyers to figure out. If the rich want more then all will benefits.
1
@Bill I am on medicare. it is not what you think it is. you have to pay for part b, which is for doctor's visit and it cost $135 per month. then you have to pick a plan from 3-4 carriers. it ranges from $0 to several dollars. the physician may accept or not accept the plan.
hindsight 2020 I should have kept the group health plan with my former employer.
6
@klueless If only one plan dr's will accept or be without customers. I am on medicare too.
2
As long as nobody discusses how to pay for it, the idea has fans. The UK has a VAT that is about 16%. Ontario has a combined sales tax just about the same. Both don’t allow contingency fee law suits. Both may have long waits for elective joint surgery. One cannot get hands around a half baked pie in the sky proposal. If 100 Democratic legislators want to propose this change get an opinion from the Congressional Budget office and how much and how to pay for it. Otherwise it’s just a campaign stunt.
7
I have spent my entire surgical career in government or HMO on salary. Overall I liked that way of practicing. But in a leadership of a surgical section I found it frustrating in I had no way of increasing the budget of our section by doing better work, better service and introduce validated by innovative procedures or generate resources to support those activities.
When new HMOs came on line to compete with the long standing pioneer HMO did we enter a race to the bottom in costs. Yet because we had to compete on service with other HMOs and with fee for service medicine our institution and our surgery section stepped up and provided better patient customer access and service. Something I could not get the institution to do before as I had been frustrated by aspects of our service that kept patients waiting.
I worry with no co-pays etc. that the over utilization may happen again. That may not be the case in a budget run system as opposed to a fee for service system, but I worry about line waiting lines again.
I think some competition between private and public option might be better.
8
I don't see how this "lump sum" payment to hospitals would work. It would totally reverse the incentives. Instead of striving to provide quality care, to attract patients, hospitals would have an immediate incentive to provide poor care, to drive patients away. They would still be getting the same reimbursement. The current system incentivizes overtreatment, but the system described in the article sounds insane to me. You really do not want to be incentivizing undertreatment.
15
@j
Particularly if, as is true in other systems, medical malpractice lawsuits are substantially constrained.
3
It is tragic that Americans are so ignorant about universal healthcare and how it has been achieved in other developed countries. Expanded, improved Medicare for All is not impractical -- in fact it is the MOST practical way to deliver universal coverage and much improved public health outcomes WITHOUT socialized medicine.
The most credible people working on this are the Physicians for a National Health Program, and they support Pramila Jayapal's bill. Anyone can join, and for non-physicians it's only $40 a year: www.pnhp.org. I've been a member for years; please join me!
4
Pramila Jayapal's Medicare for All sounds like what is now Medicare Advantage run by private companies. The problem with Medicare Advantage is that the companies have decided that if they don't pay claims, they make more money, so that is what they are doing! Original Medicare is NOT run by private companies.
https://www.nytimes.com/2018/10/13/us/politics/medicare-claims-private-plans.html
8
Healthcare will never change as long as Wall Street is the model of care.
9
Some of these comments are laughable. Employers will drop healthcare like a hot potato if there’s a taxpayer supported option on the horizon. It’s wishful thinking they’ll provider higher salaries instead of better returns for shareholders...
6
I’m not sure it’s laughable but it certainly can decrease cost of living. Same wages may spur economy and generate higher wages that way. Importantly it may give advantages to people over capital expenses and automation.
2
Republicans will campaign on defending Medicare for Seniors with no changes. Democrats want to take away today's Medicare from Seniors so they can give it to illegal immigrants.
I'm not saying it's true. I'm saying that's what the bumper stickers will say.
3
"Even if it should make it through committee and to a floor vote, it would not be welcomed warmly in the majority Republican Senate..."
The truth is, establishment Democrats won't like it anymore than Republicans, owned as they are by the same private insurance industry that is spending tons of money (siphoned off of our health insurance premiums) to derail Medicare for all.
Thankfully, we're seeing a new breed of Democrats assert themselves, Jayapal, AOC and others, and there is now reason for hope that we can join the rest of the developed world and enjoy a just, single-payer system.
I would only question their timeframe: nothing good will come out of the Democratic party until we unseat the backwards old guard, Pelosi, Schumer and others.
3
Why reinvent the wheel, do as Taiwan did when they revamped their healthcare system. Look at successful healthcare programs in other countries and pattern yours after what works for others.
8
Think of public schools. Teachers are generally poorly paid in relation to their training and suffer from bureaucracies above them cutting into the total share of money spent, as well as interfering in their work. In other words, we need a system that protects the providers as well. If government is the payer, a system needs to be set up to give power to the providers to make sure their working conditions and pay are adequate. Have boards filled with providers to decide how to use the funds that come from government? How do other countries solve this problem?
3
Costs for procedures, doctors, and hospitals need to be standardized and regulated. At a national level and at a reasonable rate.
Someone getting a CAT Scan in California should pay the same as someone getting one in Alabama. The doctors should get paid the same. The hospitals should charge the same.
The hospital should total up the cost of the health transaction and send the government an invoice.
Boom. Health care for all.
3
So wrong. You can’t pay doctors the same for different patients in different communities with different problems and encourage less time with patients and expect better care. The pay to doctors isn’t even mentioned and to do this in two or four years will make chaos. The people in charge will be the same people in charge of insurance companies now. Appeal will be a terrible process and Republicans will get into power the next chance. Can’t the Democrats learn from Clinton and especially Obama, whose system was slow to implement accomplished many things but not patient choice, affordability or decreased cost. Tremendous political capitAl was lost. Great goal but 3 words does not describe a 3 Trillion dollar industry. We need new ideas that are not centralized and give more choice AND responsibilities to everyone and coverage if some type to all.
5
@Wayne Really? Because this is exactly how it works in Japan, and it seems to run just fine.
5
The question is how to pay for it. Based upon what I see the GDP is 20 T and about 45% is salaries rest in other income. If salaries Ali e were taxed to generate 1.1 T that they took in last year the rate would be 1.1/9 or 8% and if all income taxed it would be half that and could be 2% employer/ employee down from 7.65 an 8.9 increase in revenue. The government can provide reinsurance putting the pressure on the insurance co to provide better care, less work on their part to narrow and pit systems against each other and the government cost would probably be a lot less than the 300b they collect each year. They can require the insurance companies to cover preexisting conditions for three years and POST existing conditions from the beginning. Then they would be very incentivized to improve health and those incentives can be passed on to patient providing non employer based insurance perhaps much less expensive to hire employees instead of robots, avoiding bankruptcy creating illness and even job loss related illness, won’t be called socialized medicine and might even help get elected and stay in power. Please don’t the same mistake again. Insanity is.......
1
One of the biggest hurdles in implementing a "Medicare for All" system in the U.S. will be to wean 155 million Americans from their current employer-subsidized health insurance coverage. Most think they have "good" insurance and will fear the unknown.
But most of these 155 million Americans have no conception of just how expensive and inefficient our "employer-based" health insurance system is - and how much more effectively a true "single-payer" system already works in much of the rest of the world.
Let's recall that our employer-subsidized health insurance "system" was a gimmick started by Kaiser shipbuilding and other war-production industries to attract workers when FDR froze wages in 1940 to prevent massive inflation when WWII greatly increased demand for labor. Our piecemeal system of employer-provided health insurance is no more than a hiccup of history.
America is the only advanced nation which still expects business to provide subsidized health insurance coverage for most of their employees. Hence the incentive for employers to hire contract labor (fueling our "gig economy"). And the enormous costs that most employers pay to heavily subsidize health insurance for their employees are directly passed through to emerge as higher prices for their products relative to their global competitors.
"Medibiz" health care (forged by WWII expediency) is why America spends twice as much on health care as the OECD average - with results that rank near the bottom of the pack.
15
@Dave - We should also not forget that Harry Truman's attempt to provide universal health care was beaten back by, of all things, the American Medical Association. See The Lie Factory at the New Yorker (https://www.newyorker.com/magazine/2012/09/24/the-lie-factory). Note that the campaign to convince Americans, who were initially very receptive to the idea, that it was a plot to turn them into communists is only one of the issues discussed in the article; you'll need to go a ways into it to find the section of what happened during the Truman administration. We're still suffering from that AMA-funded campaign to turn Americans against universal health care.
And isn't it interesting that we really never hear a peep from the AMA about resolving our problems with health care coverage today. The organization, which most people mistakenly think is about providing the best possible medical care for Americans, is in actuality a disguised union dedicated to keeping physician incomes, especially for specialists, as high as possible. It's why a lot of decent doctors I know don't belong.
4
@Annie
Thanks, Annie, for your cogent comments in response to my initial comment. I've subscribed continuously to the New Yorker ever since Tina Brown revamped it (the early 90s). And I just re-read the article you provided the link to.
I remembered this article right away - but I'd forgotten so many of the details. Thanks for sharing it. I hope others will take the time to follow you link and relive the all-but-forgotten fate of Truman's universal health care program. Teaser: the article's author is Jill Lapore - one of the crown jewels of the New Yorker for the last fifteen years.
With medicare as it now operates, I paid taxes for 46 years before I started receiving benefits. I still pay for a Part B premium which is adjusted every year based on income earned. Then there is the Part D drug coverage and the supplemental insurance to cover what Medicare does not pay. With Medicare for all there wouldn't be a lifetime of premiums paid in without service rendered. I favor a controlled and reasonable cost healthcare for all. Eliminating all the layers of profit would be a start. The current system is not sustainable and has not been for many years. A healthy and therefore productive citizenry is vital to a nation. I am just not sure how we can do it. I think ACA was a start and we need to quickly build on what works and rework what doesn't. I think there needs to be a little pain for using the health system financially for everyone to short circuit abusing the system. I think prices need to be negotiated. I think replacing profit centered insurance with a controlled payment system makes sense. If 18% of the US GDP goes to medical care as I have read that is way more than what the total should be for guaranteed coverage (paid by taxes not insurance premiums) for all Americans. It is just a matter of figuring out how to do that and implementing the changes in a way that installs a part of the plan which allows the systems to readjust and continue to gradually redo the whole system. Current Medicare evolved over fifty years.
12
Details. Details. That is more than a small effort though I admire that you say you don’t know.
There are a few things to remember about our expensive imperfect system which has no example to copy for such a large diverse and spread out population that changes characteristics more than any other nation.
1. Health care produces many jobs which benefited from economic recovery and ACA. Many people continue to go into it to improve their families economic security.
2. We have an aging population that will need that service.
3. Centralized care decreases choice of care, providers, and can cost a lot more and creates profits for those centers(insurance and hospitals)
4. US medicine is still an export industry with all its high cost. Innovation is a big part of that
5. US us best in world at creating markets. Big Pharm abuses need to be checked but their innovation would not occur without our market.
6. There are two man purposes of health insurance. Timely care of progressive illness and avoiding bankruptcy from illness
7. We need to take the cost away from business so the employees can move easier and possibly get higher wages. Even if business pays the whole premium of $24k to a $20 per hour 32 hr per week working mother, mom gets 44% of total Cost as take home pay BEFORE FWT SWT. If employer pays 1:2 it’s 27%. Eliminating most of that from business would be an explosive boom overwhelming the benefits of what’s suggested and benefits would be widespread.?htp.
2
@Robert Bunch where there is demand that is willing to pay there is price inflation. Medicare has deep pockets. Insurance companies have deep pockets. All of the services that Medicare and insurance will pay for suffer inflation. Checkout Lasik eye surgery and cosmetic surgery which don't benefit from deep pocket payers.
“the inflation-adjusted price of LASIK eye surgery declined by 25 percent between 1999 and 2011, even as quality markedly improved. Notably, third-party payers (including the government) generally do not cover the procedure and so ophthalmologists have had to compete directly for consumer dollars. Similarly, though the price of healthcare grew at double the rate of inflation between 1992 and 2012, the price of cosmetic surgery — for which consumers pay almost exclusively out of pocket — grew at less than half the rate of inflation. These examples also highlight that when consumers are spending their own dollars and shopping accordingly, providers have greater incentives to improve quality and cut costs.”
Compare the free market’s influence in decreasing costs with the federal government’s & health insurance's role in inflating them.
https://spectator.org/cabinet-secretaries-third-party-payers-distort-health-market/?fbclid=IwAR0_CbLuxzU7k9qyoAH_-RW8GHTzIi-5zzQxaCN6cWlA7GEUU2LQV6FzxBo
2
Universal coverage, yes. But it is a mistake to invent a new system when there are already many excellent systems to chose from. Germany, Sweden, Switzerland and others have worked out the kinks in their systems. A utopian system always seems ideal, but then fails. Reality is better than pie-in-the-sky.
16
Reasoning from statistics makes an argument sound more persuasive, but it frequently ignores common sense reality. "Insurance company thinking" has so dominated our approach to public policy that we tend to forget that the insurance companies have stacked the deck in a way that makes them always the winner.
In order to have a public health system that works, it has to include everyone in its premium paying pool. Those premiums (taxes) need to be sufficient to guarantee care for everyone. If we're paying $10,000 per capita for health care, and 20% is going to administrative costs (probably an under estimated figure) and shareholder profit, then the figure is closer to 8,000 per capita. If the Medicare tax were raised to about 6% of gross income and 5% of unearned income above 250,000, the system could be adequately funded. The motivation of doctors is another question entirely. Out of school with staggering debt, it's not surprising that young doctors choose to pursue high income specialties. Here it becomes a question of why one chooses medicine as a career. Maybe if the option of getting rich quickly were off the table, we'd see more doctors motivated by a desire to be healers, provided their education can be made affordable. Whether our large landmass and commensurate population is a blessing or a challenge will depend on the way any public system is implemented.
Choose your physicians, not your health care plan.
Stay healthy.
7
@michaeltide I'm confused. Do you think people work for the good of mankind? Why spend the extra years in college and training if the only benefit is "helping" others. Also, do we do away with malpractice? Who's going to pay? Just nationalize healthcare and the pharmaceutical industry to eliminate capitalism in the healthcare industry. People can buy bonds to help with research -oh wait, they can't do that because that is bring money back into the industry.
2
@William, thanks for your reply. Actually, I do believe that many people work for the good of mankind. I know this may seem naive or unrealistic, but it's my story, and I'm sticking to it. I'm going to take issue with a couple of words that you've used. First: yes I don't think health care is the proper venue for capitalism, and the costs should be covered by taxes that we all pay (since we all benefit). It is not money I would like taken out of the equation, it is profit, which seems to be the millstone that is drowning the whole system. Finally, the term "industry" strikes at the heart of the problem. I'll continue to think of the practice of medicine as a profession, not an industry, a term better used for automobiles or toy manufacturers, the proper place for capitalism.
There are people, and I know many, whose highest priorities are not the amount of money they make, but how satisfying their work is, and incredibly enough, how much good they can do. They are often frustrated in their goals by being told , "it's too expensive." It's not just the system that needs to change, it's out minds as well.
7
I already have Medicare. It's not that great, private pay is much better. Medicare for All sounds worthwhile but in practice, based on my experience with Medicare, it will be a terrible choice and most likely make current Medicare options worse than they currently are.
10
@Lynn Lekander Please reread the article. This is an improved Medicare they are talking about.
Both parties have sought to turn Medicare into something that was never intended, a public/private partnership, with "fiscal intermediaries" (private insurance companies) taking over billing, operating with a mandate to decrease access through the same nefarious means they use in the private market.
2
@Ed Watters
"changed" is not necessarily "improved".
3
@Lynn Lekander - Than your experience differs from that of most people. My husband and I face more limitations from his employer-provided insurance than our elderly parents do from Medicare.
6
People forget that when you say government, you are saying taxpayers. The high cost of healthcare is due the amount of money it costs hospitals and doctors for liability and the use of very expensive equipment to ascertain the cause of illnesses and/or aches and pains. There is no "take two aspirin and call me in the a.m." diagnoses anymore. Doctors fear that it may be the one in one million that aspirin will not remedy. We go to the doctor for EVERYTHING and, consequently, are also over medicated.
8
@barb - The U.S. is not the country with the highest use of health care providers, but we are the developed country with the highest per capita cost for health care and by far the highest number of people with no coverage. And we're the only country with health care expense-caused bankruptcies.
BTW, one expense that we hear a lot about is malpractice insurance. Keep in mind that most often when a practitioner is sued, a significant, if not all, of the award is to pay future medical costs. With a universal system, this expense would be covered without having to sue. Lawsuits would be limited to other adverse effects of any malpractice.
2
@barb
One way or another, "taxpayers" pay for health care. You can either self-insure as a group via a public scheme paid out of taxes (or a levy quarantined for the health system) or individually pay for one among a dazzling and puzzling array of private health insurance options. Or take whatever you can get via your employer, Which approach delivers the best health outcomes at the least cost? The evidence is well and truly in - the universal, government-run model.
5
Even before the ACA came into existence this country was in trouble. Narrow networks were becoming the norm, insurance companies rarely made exceptions even when requests were made by physicians with good reasons, and out of network costs meant that people could not "budget" for health care. Care was not being given when and where it was needed because people were afraid of how much it would cost.
A universal system would mean that a person who lives in New York but was ill or injured in Wyoming would be able to receive the appropriate care and not worry about out of network costs, having to fight with the insurance company, and would be able to concentrate on recovering. It might lead to better record keeping because there would not be any reason to keep a patient's records secret from another doctor or group.
It's time America entered the modern world when it comes to universal health care. Other countries, some less advanced than us, consider health care a right. Why not America? Why do we force people to go through deductibles each year, out of network costs, and fights with insurance companies who refuse to make exceptions because it will affect their bottom line even if it is the difference between the patient's health or death?
GOP, Democrat, rich, poor, or middle class, we all need to receive timely medical care.
15
Medicare for all is a health care redistribution scheme. It may make sense from a utilitarian perspective but for current seniors it will be disastrous. The amount of money we spend on health care will be limited which means that it is a zero sum game. More health care for others=less health care for seniors. Rationing will be required and limitation of choice of hospitals and doctors will be needed. Who will decide which patients go to Cleveland Clinic, or Hospital for Special Surgery vs the local community hospital? Who gets to see the well trained highly experienced surgeon and who will be sent to the fledgling right out of training?
25
@Jake Government Bureaucrats will decide.
5
@Jake
In Australia, Jake, it is clinicians who decide who goes where, and what treatment is given, and they do so on the basis of clinical need. Seniors are treated very well, as is everyone else, and no fledgling is let loose on his or her own, ever. I know this from very recent experience with very sick seniors needing (and getting) amazing hospital care that saved both their lives. Neither will be billed. As you probably know, Australia has a universal healthcare system, funded by a small levy on our taxes.
7
@Sarah99 - Oh, instead of insurance company clerks, right?
5
We already have a great system to copy. It’s used for our Military and the Families Of active duty personnel. Adequately funded and regulated, it’s great for providing healthcare for ALL, and controlling costs. What we MUST do is get rid of the parasitical Insurance Companies, and Control Big Pharma. That is the key to success.
33
Why does this country have to re-invent the wheel? Look to health insurance in Germany -- a government system that co-exists with a private system. That's the system that has the best chance to make it.
17
@Don Juan It's also why Germany is way more innovative than Canada. We will do clinical trials for things like Cartiva but then not have them available after the trial, due to cost. We have very little robotics here as well, never mind lack of state of the art diagnostic equipment. Many surgical techniques we use here are what are considered old-fashioned. Everything is driven by cost-effectiveness. You don't want to lose personal choice like we did in Canada, so you should copy Germany.
16
@Don Juan The doctors and nurses are leaving to go to other EU countries that pay more. The medical care professionals want to receive compensation for the training and the difficult over scrutinized work they perform. I guess when the EU nationalizes the healthcare profession, they will have no place to go.
1
@Detalumis - Canadians have made a choice. On a per capita basis they pay far less for health care than does the United States and yet everyone is covered. The downside is that there are sometimes undesirable waiting times for non-emergencies and some newer procedures and equipment are unavailable. How many of those problems could be corrrected if Canadians chose to put 10% or 20% more into the system?
3
Some people propose an incremental change such as lowering the Medicare age 5 years at a time, making the change every 5 years. So in another 65 years, everyone would be covered. What about all the people who die during that time because they are uninsured, underinsured, and/or can't afford the drugs their doc prescribes? What about all those who go bankrupt and lose their homes because they can't afford to pay for the treatments that saved their lives?
But my goodness, let's not rock the boat too swiftly for the insurance and pharmaceutical companies.
11
This would be the single payer system that would cut medical care costs and revenues for providers in half. It would free up huge amounts of capital for truly new wealth creating endeavors instead of the wealth retiring use to which that money goes today. But the price would be high for providers. All would receive less revenues and some would just get out of the business. The public would be shocked by the taxes needed to sustain this new system. Employers would drop health care benefits, which might make them increase salaries and wages, at least employees would demand as much.
2
@Casual Observer
Sanders' MFA plan _bans_ private insurance for procedures that MFA covers - so of course companies would have to drop their insurance plans.
However, almost certainly funding of MFA will involve some sort of additional payroll tax paid by the employer, so the savings to employers won't be as great as it seems. Some businesses with young and healthy employees and who offer plans with high copays/deductibles may find that the increased taxes exceed what they save on health care costs so will have to cut back on jobs/wages.
As well, it's almost certain that top employers (such as tech companies) would, to attract and retain employees, offer employees some sort of "premium access" plan which will cost them money. While details will evolve on these, these will be somewhat like how individual doctors/practices are switching to concierge plans. Networks of "premium" doctors and facilities would probably receive a "per visit" or "per capita" payment for providing members of plans better service than the hoi polloi (i.e., everyone who can't afford the $8K/year subscription price) or even accept _only_ plan subscribers. Service improvements would include jumping the queue for appointments, longer appointments, quick access to telephone/email consults, seeing a doctor instead of an NP, seeing senior doctors, access to the "premium" physical therapy facility (instead of the run down one with limited equipment), etc.
1
It is very compelling to have a national healthcare program which actually is based on a budget. Having worked in hospital finance, I can assure you these behemoth corporations are able to work on budgets. There are definitely ways costs can be cut without harming patient care. An example, would be in some of the exorbitant interior decorating of US hospitals, as well as implementing more efficacious ways to treat patients and not viewing them as "revenue generating." Significant reductions could be made in marketing budgets. Also, the US is one of only two countries that allows direct to consumer advertising by drug companies, which needs to stop. Most importantly, Americans would learn that we can indeed spend a lot less and still have quality health care.
54
@Roberta
Your excellent comment reminded me that in addition to ritzy interior decorating, hospitals waste money on other pointless things like the latest food and beverage fads. That’s fine for a restaurant, but not when it takes dollars away from patients and actual medical and nursing care. But patient care isn’t the name of the game anymore. Generating revenue and upholding rankings for more revenue have become the goal. Hopefully some politicians are listening.
14
Hositals in much of Europe look MUCH better than those in the US. The food is much better too. At half the cost.
4
@Roberta Hospitals in Europe do not look like 5 star hotels, have valet parking, pianos in the lobby. Quite the opposite is true.
5
As things now stand, Medicare For All or any universal access program is a bit of a disingenuous promise.
It misses the most salient point regarding health care in America: what good is insurance, even universal insurance, if there is no functional access to care? An example from the "Albuquerque Journal" [Feb.16] representing a poor state: "As of last week, not a single primary care physician in one of the state’s largest group of medical providers was accepting new patients...."
Lest you think this is just a problem in poor states, consider (from the same article), "The highest average new patient wait times of any city surveyed was 52.4 days in Boston, Mass. Yet Massachusetts has more physicians per patient population than any state in the union...."
Neither Republicans nor Democrats have plans to deal with this fundamental problem. They merely argue over terms of "paper rights", entirely ignoring the real world of real peoples' experiences. In a sense it boils down to a simple case of supply and demand: more patients requiring (or expecting) services than there are available physicians. Unless we address ways to create more supply, increasing demand merely serves to exacerbate the problem.
Incentives for people to choose medical careers, incentives to become primary care doctors over specialists, incentives for doctors to work in under-served areas, and other ideas need to be debated as much if not more than the issue of the breath and source of medical insurance.
18
@Steve Fankuchen To be fair, Boston is full of specialists and the wait lists are caused by patients coming from the under-served areas you mentioned earlier in your comment.
1
@Steve Fankuchen I agree with the supply problem, but incentives drive up cost.
1
@Steve Fankuchen Healthcare is a finite resource. There's not enough of it to go around especially if you grant everyone access. It's rationed in every country in the world - by price, by access to it, or by limited amount of operating room times for surgeons (in Norway, for example). We can't train enough doctors to meet the demand. Americans don't seem to grasp this concept. Then add every illegal immigrant in South American who will try to come here for "free" healthcare.
5
Regardless of the specifics, I am worried about what this or any such "medicare for all" proposal will do to those who are seniors and need Medicare, on very limited and fixed incomes. First, we worked hard to get an education and jobs with good healthcare benefits to see them diminished under the ACA in the past few years. Now are we to see Medicare watered down now that we can no longer earn a salary? I am afraid and worried by the use of the term "medicare for all" by the left. I have always believed the profits don't belong in healthcare provision but we had better be sure to protect the care system for those elderly who can no longer earn a living. No one that I have heard is addressing this issue.
17
@Mytake
Today's retirees qualified for Medicare benefits through payroll deductions taken throughout their working lives. Now it appears that seniors will be required to pay higher taxes so that younger people can have the same benefits without incurring those same payroll deductions.
8
@Mytake Imagine a zero premium Medicare Advantage plan with no copay or deductible. If you are a very rich senior you will pay some added taxes. Otherwise you will psu nothing compared to the added premiums you must pay for part D and part B supplements. 95% of seniors will pay less and have no restricted hospital or physician networks.
2
@Mytake
Why would Siemens or GE developer and build MRI they are not allowed to make a profit? Why would Pfizer, Johnson & Johnson, Merck, or Wyeth produce drugs without a profit? Why would an investor invest in a pharmaceutical startup (which do a surprising amount of the innovation - if the drug they are developer is successful, they get bought by Big Pharma) with no expectation of a "profit" (i.e., 0 ROI)?
Some important drug patents are owned by foreign "for profit" companies -- would Americans be denied these drugs because there was a profit involved?
How far would you carry the "profits don't belong in healthcare"? When building a new hospital, must all the contractors and subcontractors be denied a profit? What about the pipe, drywall, electrical, etc products used in such a construction project - will we create non-profits to make all these things (at great cost due to duplicative effort)? What about the excavators used to dig the foundation - would these have to be developed and built by non-profits?
If you think healthcare is expensive or unavailable now, removing the profit from the system would make it much worse.
4
No healthcare system has unlimited resources . There will need to be some sort of gate-keeping system - an issue never mentioned in the feel good sales promotion for a proposed system more generous than anywhere in the world.
14
@AlanInAZ the gate keeper to our current health care system is money. If you have it, no problem. If you don’t, no health care. Surely we can do better than this.
5
@AlanInAZ
We spend over $2 trillion per year on healthcare. We should have the worlds best healthcare with comprehensive coverage for that kind of money.
5
@Mark Actually we spend $3.5 trillion per year, not because we have fantastic resources but because we have fantastic prices. Ratio of doctors to population is at low end of OECD.
4
Drop the Medicare age to 60... then 55 in five years... then 50. Removing the sickest part of the population from the private market would make it much more viable. The gradual changes to Medicare could be absorbed as we go. Wholesale changes like this bill are silly in our system. 80% of the people get health insurance through their employers and are happy with it. Are you going to force Medicare onto them ? It isn't going to happen. Just isn't and I'm a great proponent of a single payer system. It just isn't practical for everyone right now.
11
Derac, I agree with you.
1
@Derac - According to the Kaiser Family Foundation, 49% of Americans get their insurance from their employer.
Why isn't it "practical"? Why is it that the United States, out of all industrialized countries (and some developing countries, as well) is the only one unable to come up with a good plan for providing medical coverage to all of its citizens? Are we really so incapable?
2
A commenter in this thread writes:
"... expand Medicaid in all states, fix the exchanges, empower reinsurance, offer a public option, allow people 50-64 to buy into Medicare, adopt the Mayo Clinic model of salaried physicians and a move away from fee-for-service models, and allow banding together to extract better prices from drug companies."
The commenter probably does not realize that -- except for the 50-64 buy-in -- he or she is describing existing 20-year-old public Part C of Medicare, which is currently the most popular choice (that's what the C stands for) by far of people fully signing up for Medicare today for the first time. Medicare Part C has grown from zero percent of beneficiaries to over 35% of beneficiaries in 20 years (those are different beneficiaries of course). Many group retirement plans now use a Part C program option called Eggwhip.
Here's the rub. Medicare Part C (and anything that is not fee for service) is accomplished via "premium support." In Eggwhip plans, popular with unions, the employer or union gets the premium support. But premium support in Medicare has been opposed by the Democrats for over 25 years, when ironically it was first proposed by two far left Congressional aides to Ted Kennedy. So it is a non starter
2
@Dennis Byron.. it's typically called Medicare Advantage and the plans are offered by the private insurance industry. It works well. However, the support for anyone over 50 is a major change and dwarfs anything else you discuss. A simply method would be to lower the age to 60 first... then 55 in 5 years.. then 50 in 5 years. Let the market adjust to the new dynamics. Getting the over 50 crowd out of the private insurance market would lower rates for all those under 50.
2
@Derac No you're incorrect in three ways:
1 Medicare Advantage is just one type of public Part C Medicare health plan.
2. Most public Part C plans are sponsored by integrated health delivery systems (just as the other commenter suggested), not insurance companies
3. Almost all of Medicare -- Parts A, B, some of D and all of Medigap -- is run by private (your adjective although it makes no sense) except for most public Part C health plans. So what's your point?
I suggest you direct the rest of your comment to the person who talked about 50-64. It was not me
2
Call it whatever you like .. but get the for profit insurance companies out. There's no need for them. They just siphon off 20% of the money to profits and paperwork. The government will be the middleman, and won't worry about making money off illness and people in need of care.
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@Doctor Woo
What about the for-profit hospitals, the for-profit doctors, the for-profit labs, and the for-profit nurses? How much of the economy should be run by bureaucrats in Washington making decisions about who wins and who loses?
2
@Doctor Woo Wow - You expect the government to save money? Better service? Lower cost? I guess you think you don't pay enough taxes in that tax friendly state you live in.
5
@William - 1. Medicare (government-run, if you didn't know) does an outstanding job with very low overhead. 2. Americans' taxes are historically extremely low (especially if you're Rich or a corporation) - time to drop the "high taxes" canard.
The myth that "private" works better is belied by the performance of Big Auto, Big Airlines, Big Insurance, Big Finance, Big Ag, Big Pharma, blah and blah.
7
Medicare for all.
What are the details? Doesn’t matter.
What will the cost be? Doesn’t matter.
How can we afford it? Doesn’t matter.
Socialists Bernie Sanders and Alexandria Ocasio-Cortez want it, and are forcing the Democratic Party to support it.
Unfortunately, the push for socialism will also push many voters to vote for Trump in 2020.
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@Mal T Yes, it is much better to see our neighbors and fellow citizens go bankrupt and die under the current policies. Universal Health Care is attainable in the U.S.
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@Mal T
The details DON"T MATTER AT THIS POINT.
It will depend on the results of 2020 election and how many Senate seats the Dems can win.
We CAN AFFORD IT , because we are PAYING TWICE WHAT OTHER COUNTRIES PAY NOW.
Medical Bankruptcies should NOT BE HAPPENING in USA
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@L. Finn-Smith
Yes, we are paying, and some 10% of it is due to the insurance overhead. As for other 90%: our doctors and nurses are paid twice that of their peers elsewhere, and our hospital administrators 3x; our hospital footage per bed is 4x that of most European countries; our value of the advanced radiological equipment (from MRI machines to proton beam accelerators) per capita is 3x. What you'd like to do: (a) cut people's pay by 50% (b) have contractors build and lease out lofts in some hospital wings (c) have a yard sale for CAT-scanners (d) all of the above?
5
America's current healthcare system - built around employer provided insurance - is in cardiac arrest. Bloomberg, hardly a "socialist" source of information, released its Global Health Index on Sunday. https://www.bloomberg.com/news/articles/2019-02-24/spain-tops-italy-as-world-s-healthiest-nation-while-u-s-slips The US has fallen to 35th healthiest country while Canada rose from 17 to 16. According to Peterson Kaiser data, in 2017 the US spent $10,224 per capita while Canada spent $4,826 per capita on health care. And the US cost disadvantage is accelerating. Employer provided (but not individually purchased) insurance is tax free; this is the single largest tax preference in the IRS code and costs us about $1.6 Trilllon a year. And to get that "employer provided" coverage - the average employee pays a30% of insurance cost at large employers and40% at smaller employers - and that's not considering deductibles or co-pays. And of course if the employee loses her job she and her family are uninsured. How many Americans are essentially tied to a job they don't like soley becaaise it provides at least some health coverage? Persuading Americans to move from the devil they know - employer sponsored coverage - to single payer is a heavy political lift but the idea that there really is any choice is delusional.
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@KenC
"The US has fallen to 35th healthiest country while Canada rose from 17 to 16."
Spain tops the list. It has nothing to do with the healthcare system and everything to do with lifestyle. I would propose that Spain's diet of sardines and red wine and the US diet of french fries and pizza have more to do with it than healthcare systems. People with employer sponsored healthcare are not complaining.
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@Dave - Yes, some of them are as the portion of the annual premium that they, rather than their employer, increases along with the annual deductible and co-pays. Other people have had run-ins with their employer-paid health care for one reason or another--surprises in what is not covered, employer changing insurance company, etc. Furthermore, a large proportion of our health care dollar going for marketing and administration. Corporations, health care providers, and insurers themselves all spend dollars on administering insurance coverage.
And then, there are all the people who do not have employer-paid health insurance. But, I guess in your world, they don't matter.
4
Our current healthcare system is unsustainable. We pay way too much for administrative costs (30%+), we have 30M uninsured and more than 40M under-insured. People live in fear of what next year's premiums, deductibles and co-pays will be. They cannot afford to use their insurance. Medical debt is growing and causing many bankruptcies (other countries have none of this). Why would you need choice if every doctor, hospital and pharmacy is included? Privatizing elements of Medicare was never a good idea (anything with "AARP" on it will never be worth it). Yes, payments to doctors and hospitals will be less, but they will not need the dozens of people dealing with 10s of insurance companies. So, the issue is how to transition to a system that covers everyone for less than today's costly and unfair mess. Let's focus on the real issue, not your fear of change.
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@Charles Pack - Excellent, thanks Charles. My sole-practitioner family doc has one full-time employee just to manage the private health insurance jungle created by having to deal with dozens of "insurers", each with it's unique, constantly-changing schemes for delaying any payments as long as they possibly can.
The spouse and I - active, fit, no prescription meds, good diet, etc. - are both on Medicare. We spend $10k/yr above and beyond Medicare, mainly on a BC/BS supplemental plan. Our largest annual expense supports a Big Insurance bottom-feeder that squats in the middle of the revenue stream, sucking up profits while adding no value and grossly over-paying "executives". We'd be happy to pay $10k/yr more in taxes, if it eliminated predatory Big Insurance from our health-care system.
1
Using the Medicare for All designation was a serious mistake from the start. I have only been able to use my own Medicare when I have been in the USA and as I understood the system - never studied it - it was essential for me to have my Aetna complementary insurance that I was able to contract on retirement from the University of Rochester and pay for quarter by quarter. It appeared that physicians were not interested in taking on patients who only had medicare.
Someone better informed than I can correct me.
I prefer that the discussion use examples, one of which I naturally would recommend is Swedish Universal Health Care. I have made extensive use of that system and have always been able to consult a private physician if I wanted to, paying that person a fee that after a deduction provided by the UHC system was always quite reasonable.
I have had the same physician for decades, a woman who is now head of my neighborhood clinic and who after my annual free checkup is giving me a level of attention I do not think I ever experienced before.
We have a system 1177.se that enables us to go into our medical records and see diagnoses, all results from such as blood analyses, and much more. Fascinating.
Only-NeverInSweden.blogspot.com
Citizen US SE
1
@Larry Lundgren -
"It appeared that physicians were not interested in taking on patients who only had medicare."
I've seen no evidence of that.
As for health care records, more and more are now available online and can be viewed by the individual.
1
Original Medicare, as it currently exists, is not an adequate blueprint for universal health coverage. Rep. Jayapal recognizes the program's shortcomings.
I've always been wary of the Medicare-for-All slogan lest it mislead people into believing that Medicare -- without significant changes -- is an adequate health care plan. To be adequate, Medicare currently needs either a supplementary "Medigap" plan, which costs extra, or some form of supplementary coverage from government or financial assistance from hospitals.
No plan, e.g. Medicare, that can allow patient bankruptcy can be considered adequate.
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@Ellis6
What is being proposed then, isn't actually Medicare for all. It adds long-term nursing home care, vision and dental benefits and eliminates deductibles and coinsurance, which are common aspects of Medicaid programs. The proposal would be more accurately described as Medicaid for All, but I suspect that would be harder to sell to the public.
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@Ellis6
Sanders' MFA bill (https://www.congress.gov/115/bills/s1804/BILLS-115s1804is.pdf) eventually eliminates virtually all premiums, deductibles, and co-pays and bans private insurance for anything that MFA covers. It covers everything that is medically necessary or appropriate (services, drugs, medical devices, labs, etc.). It also covers dental, hearing, and vision care. It also is available to everyone - even those who never worked a day in their lives or were married to someone that did so never paid a penny of Medicare payroll tax.
Sanders' MFA bill does allow up to a maximum of $200 of cost sharing per year per person for drugs - but this cap doesn't apply to name brand drugs if a generic is available.
In other words, it's really nothing like "Medicare" - that's just a marketing ploy because "everyone loves Medicare" (or, so I'm told).
How this will all be paid for remains a mystery not addressed in the bill.
2
Medicare for all would quickly become Medicare for none. Unless all members of congress are limited ONLY to Medicare (with no in house doctor at the capital building), they won't care that the original Medicare recipients (many of whom have paid in for 40 years) will get minimal medical care because the funding is just not there for MORE people.
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@Juanita K.
Yes. Sanders and 1/1024th *never* mention that "boomers" have paid into Medicare for 50 years.
And now, with the few years we have left, it is our turn. And any political clod who goofs that up, they better start looking for a new job, because they will opposed strongly.
AARP won't support M4A. Why should seniors?
2
The Canadian system does not include a drug plan. That is a separate purchase, although it is well thought out. The type of system that this article reveals will cause lower spending on patients, since a service to a patient will no longer be a billable part of the annual reimbursement. Essentially hospitals will be paid to not treat in many instances and the independent practice of medicine will end. A race to the lowest common denominator.
I do support at this time a Medicare Care For All single payer option... as a competitive option...another insurance choice in our system that doesn't exclude providers nearly as much, have narrow provider lists, investors, or private CEO level pay either...just focus on quality, outcomes, and cost. Probably three premium levels for each age group over 26.
6
As this articles suggests Medicare as we know it would cease to exist and be replaced by something altogether different.It would require a drastic reduction in payments to hospitals and providers and the certain elimination of at least tens of thousands of jobs in the healthcare sector.It would create a big mess very quickly. and force people out private insurance which many are happy with.
We have a system while far from perfect is very good in many ways,lets expand on the Obamacare model and offer a variety of health insurance coverage options as is done in
Germany,Holland and other countries.Even the UK allows people to buy private health insurance.
24
The article compares this plan with the Canadian plan which is said to be similar. If this is such a great idea, why do many Canadians, especially those living near the border, come to the US to obtain timely treatment and tests? Leave things the way the are but increase penalties for Medicare fraud.
12
@Mike That doesn't seem to me to necessarily be an argument against Canadian healthcare, on the face of it. Even in cities where driving is more convenient, there'll always be someone who prefers to bike (or vice versa). US higher education is better on the whole than many of its competitors, and that can be the case even if some American students decide to go to college abroad. A given system doesn't have to be better -- or preferred by consumers -- in every single case even if it is better for the majority.
6
@Mike, The answer is... they don't! There is a far higher number per capita, of US citizens leaving the US for medical treatment, than there are Canadians leaving Canada. Some Canadians experience some wait times for elective procedures... just like we do here. But the difference is that here, unless you can afford it, your wait time for any medical services... not just elective... could be your entire life! The only reason for wait times in Canada is that they are spending only a small fraction of what we spend, and yet literally everyone is covered there. Here, we have tens of thousands who die every year because they cannot afford coverage at all, and hundreds of thousands of people who are technically covered, but cannot afford to use it due to high deductibles and copays. There are many myths about Canada and other countries with government-run systems. They are manufactured by the middlemen... the for-profit health insurance industry and "Big Pharma".
12
@Mike, The answer is... they don't! There is a far higher number per capita, of US citizens leaving the US for medical treatment, than there are Canadians leaving Canada. Some Canadians experience some wait times for elective procedures... just like we do here. But the difference is that here, unless you can afford it, your wait time for any medical services... not just elective... could be your entire life! The only reason for wait times in Canada is that they are spending only a small fraction of what we spend, and yet literally everyone is covered there. Here, we have tens of thousands who die every year because they cannot afford coverage at all, and hundreds of thousands of people who are technically covered, but cannot afford to use it due to high deductibles and copays. There are many myths about Canada and other countries with government-run systems. They are manufactured by the middlemen... the for-profit health insurance industry and "Big Pharma".
2
The healthcare system that is nominally free for the patients but whose capacity to serve them is restricted by the availability of resources (doctors, nurses, labs, hospital rooms, etc.) is prone to creating much grosser unfairness than what we've got now, and with a thick layer of corruption to boot. Essentially this is how the medical system in USSR looked like in the 1970s and 1980s -people getting in line at 5 am to get one of the limited "see the doctor" slips (doctor can see only so many per day), hospital beds lined along every hallway, shoving cash to every nurse's aide just to have them do what they are nominally paid their salary for - and envelopes full of cash to other people to let you get to the better hospital (or be assigned a better doctor as your PCP).
5
@cobbler - We cannot take you seriously since you choose as your basis for comparison the USSR in the 1970s and 1980s.
I have written often and do so again that my 22 years of experience with Swedish Universal Health Care (SEUHC) and more than twice as many as an adult getting American care has taught me that SEUHC is far superior from the point of view of public health and cost to the patient.
SEUHC faces its own problems as does every system you can name but the good statistics tell the story.
Only-NeverInSweden.blogspot.com
Citizen US SE
6
@Larry It is entirely possible that all doctors in Sweden are equally qualified and every hospital is similarly equipped and staffed, and the numbers of doctors and of hospital beds matches the demand. Moreover, it is possible that the Swedes decide that they need to go see the doctor only when truly necessary, are conscientious of the public finances and don't ask/request/demand MRI every time they bumped their knee or pulled their back. It is also possible they all are happy with their PCPs and want to see the specialist only when the PCP tells that's necessary. However, in the society with much lower level of social solidarity - and much greater of me-first mentality - the system will crash in flames of plunging average quality of care and corruption. With zero cost-sharing, demand for services here will be essentially unlimited (while the data is not easy to find - make an effort and compare the number of doctor visits per year by "pure" Medicare patients who have 20% co-pay, and dual-eligible ones with zero co-pay...) and impossible to meet (within budget) without drastic steps such as strict controls on the number of specialist referrals every PCP can make, or on how much money the system can spend on any particular individual's condition. Our current system needs to be made less expensive both for the society and for individual patients - and single-payer with some cost-sharing is quite legit option, going "everything free" road will end about as well as the USSR.
5
I am a lifelong Democrat, but I would never vote for a presidential candidate who supported this or any other measure that seeks to eradicate employer-sponsored health insurance. We need to finish the job that Obamacare started: expand Medicaid in all states, fix the exchanges, empower reinsurance, offer a public option, allow people 50-64 to buy into Medicare, adopt the Mayo Clinic model of salaried physicians and a move away from fee-for-service models, and allow banding together to extract better prices from drug companies. But, you will never get my support for upending the private-pay system completely. There is no reason to throw out a system that serves 60 percent of Americans. And, I suspect I'm not the only Democrat that feels this way. There is no surer way to see Donald Trump reelected and the Congress firmly in back Republican hands that for Democrats to seriously pursue this brand of "Medicare for All".
33
@CS Some excellent points here, particularly regarding salaried physicians. A study was done recently that indicated that salaried physicians, in plans like the Mayo Clinic, Kaiser Permanente and VA hospitals, who mostly earn somewhat less that other physicians have higher job satisfaction. Yes, expand the Affordable Care Act to include a public option. Make Medicaid a strictly federal program - the federal government already pays a lion's share of the cost - which would immediately extend coverage to those individuals in states that purely through spite have refused to expand Medicaid. Aggressively negotiate with drug companies to bring costs in line with what the rest of the advanced countries in the world pay. Keep private insurance, with increased regulation. If private insurance can compete with expanded Medicare so much the better.
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@CS
people should have a CHOICE , what good is employer provided health insurance with the jobs of today that are often temporary or seasonal or "gig" type jobs.?
Health insurance should be continuous and guaranteed ,just like Medicare. Everyone in America has a relative on Medicare, they LOVE It , it works , its a non profit system with low overheads.
46
@CS, It is profit motive that has caused the US to have the worst healthcare system by far of all developed countries, even though we pay double the amount (or more) than any of the others. Insurance companies do not provide healthcare. They are simply middlemen who add a layer of high-paid bureaucracy to shuffle our money around and make it harder for us to get our health needs met in order to generate profits for their investors and huge bonuses and salaries for their CEOs. Profit motive is like cancer... leaving any of it in the system is like a surgeon leaving intact cancer cells in a patient. It will come back and take over! There is no need or use for investor-owned for-profit health insurance.
22
Regarding Medicare for all - I ran a few back of the envelope numbers. Here in the U.S. we spend 18% of GDP (.18*$20.5 trillion) = $3.7 trillion on health care yearly which is almost twice the percent that the rest of the world spends. Do you think that $10,000/person/year would be adequate to cover medical care? So we could spend $3.3 trillion ($10,000 per person - 330 million citizens) and save money over what we are doing right now. Actually it would be much less because $10,000 is what the government spends per participant in Medicare Advantage plans and that is for people older than 65 when health care costs are at their highest! If medicare is opened up to every citizen and their children without any commensurate increase in the number of health care providers I fear that rationing would be introduced until supply and demand come into balance - which could be a generation or two!
8
@Jim Porter, Getting rid of the onerous practitioner costs that are due entirely to having for-profit insurance companies in our system, will end the current losses of practitioners we have been experiencing. Drs want to treat people for their medical problems... but are having to spend more of their time on dealing with insurance company issues than on patient care. They have to hire huge clerical staffs (often larger than their medical staffs) just to deal with billing and prior auths, etc. Those on the right, are always praising the "free market" but in the case of healthcare, their insistence on allowing investor-owned for-profit health insurance, has completely eliminated any "free market" in terms of choosing a Dr. Instead, we are forced to choose from only a small limited network of physicians... thus eliminating anything resembling a "free market" for patients. The correct improved and expanded Medicare for All plan would also re-incentivize more people to become physicians by removing the main reasons for all the burn-out and dropping out of physicians and RNs today, while actually creating a totally "free market" where patients get to truly choose their physicians and other providers... and the laws of demand and supply (instead of applying to insurance choice) will apply to providers... raising the quality of our healthcare, while lowering the cost of healthcare by eliminating the unneeded insurance middlemen entirely.
7