Here we go with the big lies. Canada has an equivalent standard of living as the US, everyone is covered and pay 58% per capita compared to the US. The simple reason is that the balance of the costs in the US goes to insurance companies for profit and overhead. This inefficient system has caused approximately 45,000 deaths per year due to lack of health insurance somewhat more than are killed by terrorists. Mr. Brooks is concerned about keeping them in business. Well if we saved 2 trillion on healthcare it just does not disappear. It could be spent on sustainable industry an provide an equivalent number of jobs.
Think of premiums as taxes and Brook's argument falls apart. In Brook's world employees and employers would prefer to pay twice as much for medical care through insurance companies than they would directly to the healthcare providers.
73
House calls anyone?...the rest of the civilized world still has them. Your very own PCP actually being permitted to visit you when you're in the hospital?...the rest of the world still does it, not "hospitalists" like in the U.S., who don't know you from Adam, and who change shifts so you have no idea who, if any of them, is actually fully aware of and on top of/supervising your case. I've been in the hospital once in my life as a civilian and felt lucky to get out alive. BTW, the CEO of that "community non-profit hospital" makes a reported $2.7 million annual salary.
32
David, your wealthy (compared to over 50% of people in the US) status shows in your article. Those of you secure in your current insurance program refuse to do the work to create a path to a goal and that is why nothing ever gets started toward "Medicare for All". Look how other countries did it (many just after WWII) and study how the switch over is possible. It isn't difficult. It takes the will to work on it. For 40 years I have been under 2 healthcare systems that work very well for at least 95% of the population, Japan and Thailand. I am not a specialist in this industry but even I could come up with proposals for transitions. You are a very smart guy and I think if you spend a little time understanding how most people in the US really suffer under the current "non-system" you also will see a way to get to where everyone can be covered without national or personal bankruptcies. Sit down with your wife and kids and discuss the issues and then work with them to draw a road map. You can do it.
25
Didn't have to go far to find the first dishonest statement: "since health care would be a public monopoly." Countries with universal health care also have private hospitals and physicians for those who are able to pay for it.
35
So, your main objection is jobs? Tell that to the people who are uninsured or underinsured.
"Sorry about the cancer, but the county hospital had three positions we wanted to keep."
27
I read most of the comments. We declare ourself the richest nation on earth, - i.e. not per capita of course. Other western industrial nations have all a form of 'universal healthcare for all', at a much lower cost per capita than what we pay. Do we live longer? Is our infant mortality any lower? Absolutely NO!
Few of the commentaries have a thorough knowledge of how the systems in the other western countries, except that they all work.
I read about increased taxes. Why? We already pay compared to some countries twice what they pay per capita, so why? With a 'modern' one payer system, the burden falls, yes on the individuals, freeing the industry for this 'burden'. Please also keep in mind a great many of the bureaucrats presently working in the health insurance business (top heavy) may start in a productive job :-) and
contribute to strengthening our society.
Brooks is correct in mentioning some of the pitfalls. Everybody has to contribute, i.e. everybody must pay Federal Taxes. This included everybody in the South as well. And that's a big problem, a huge problem.
17
All this talk of costs is ridiculous -- the Democrats call it MEDICARE for All because it steals the Medicare Trust Fund that seniors paid premiums into for 45 years every payday. Higher taxes? -- if they meant that, it would be called MEDICAID for All.
Too bad for our seniors -- they are not faithful Democrat voters and are going to die soon anyway.
Hey, if you're buying votes, somebody has to pay.
4
Brooks is doing his best to help the GOPnik party push America into the third world status. It's like a ten year old who still wears diapers saying he's a big boy and doesn't need switch to underpants. That is what American healthcare is like compared to that of civilized nations.
23
America, the Can't Do country.
How sad is that?
40
Oh the have and the have -nots, the middle class was killed off years ago by these old white Oligarchs, now it’s the ultra rich and poor! America is in turmoil because Republicans have kept us in this struggling, suffocating, and dying slavery! Americans are underpaid, under constant control, and underclassed to extinction! When will we on both sides rise up and make the rich pay, this war is getting old and we’re getting powerless and our voices aren’t being heard, and when we win an election they still override our agendas! That’s authoritarian and Fascism not Democracy! Enough!
18
Isn't this the can do country? This country put people on the moon; did Canada? If Canada can do this, we can't? Why? New York Times: please inform your readers exactly how Canada somehow managed to do this, step by step. Send reporters to Canada to see how it really works on the ground (it's not far, they just need a passport). Don't forget to explain why the same drugs cost so much less up there in the frozen north than they do here; was this done by voodoo or policies? Planes fly there regularly and most people speak English you can do this! Just don't send Mr. David Can't Do Leonhardt on this mission.
32
It is a disingenuous argument to make that if if you shrink the cost of health care by 30% you will put a lot in the health industry out of work. The size of the industry is bloated because of the excessive profits. You will still need an x amount of practitioners to look after the same number of patients regardless of who is the boss.
As for the argument the transition will not work because we have too many vested interests is precisely the reason why we need to move to universal healthcare.
18
We have money for never ending wars and never ending meddling in the politics and economies of other countries around the globe. We have money to put Black and Brown boys and men in prison for decades for petty crimes. We have money to arm the neighborhood cop with ak47's and tanks and robots in order to keep America "safe". We have money to give millionaires and billionaires huge tax breaks and credits. But we do NOT have money to provide our own citizens with the same thing citizens in All of Europe,Canada,United Kingdom,Cuba,China,Japan etc....provides for their citizens.I see your point Mr.Brooks. Thanks for the reality check. It is obvious no other first world country has ever done this. Why should WE even bother?
28
Yes, David, to change we would have to change.
33
David Brooks poses as a moderate. He is anything but. I stopped contributing to the New Hour because he appears there regularly. It's always "both sides do it" and Obama was as bad as Trump and only right-wing solutions work. Sorry, David. Intellectual bankruptcy.
17
Omg, I can’t believe you are even saying these things! I thought you were supposed to be smart! So we have a greedy, inefficient, wasteful health care system that costs twice as much and delivers poorer outcomes than other rich countries and it just has to stay that way because, welp, you can’t get there from here!
32
One place to start: eliminate the special free health care that's part of the benefits package for our Congressmen ( incidentally it continues after they finally leave office.) Maybe they would start trying to find ways to make things work.
30
The transition is actually the easy part. One model is to start Medicare for all with everyone born on or after, say 2020. Children would grow up with MFA, parents would love that as there is no doctor transition, they are born with medical coverage, and as they grow into adulthood, they take the MFA coverage with them. Such a start would give the country plenty of time to work out the kinks.
I think Mr. Brooks just doesn't like Medicare for all and is searching for reasons to discredit it.
17
First you pay your FICA for Social Security and Medicare Part A and Medicare Part B and Medicare Part D.
When you are of retirement age and decide to get you SS money you automatically Medicare Part A which covers 80% of hospitalization and costs $134 a month deducted from your Social Security Benefit. The patient is responsible for the other 20% which can amount to thousands of dollars ($10 a pop in aspirins does add up). Then you enroll for Medicare Part B for doctor visits, Medicare Part D for Drugs at $32 a month, then on the private insurance market you get Medigap insurance whose costs rise every year because your getting older. Depending where you live you get coverage cost around $200 a month or more at the start. One person on SS can and up paying $400 a month not to mention co-pays.
On the other hand you can enroll in Medicare advantage programs which are less expensive but similar to preferred provider with all those problems, it's similar to the Kaiser Permanente system.
So David Brooks is misrepresenting the idea of Medicare for all. It would be the same as for retirees, but it eliminates the middle men insurance companies that rake in a substantial profit. And medical insurance is very lucrative.
Don't forget that insurance companies often refuse to pay for insurees' treatments, and seriously patients end up fighting to get their care paid insurance companies and they also ration care.
12
Transitioning to a universal health care system needs not to be complicated. When Australia transitioned about fifty years ago all they did was to create a scheme that could (and still does) operate alongside the private health coverage industry. Everyone is covered by the public health scheme and can choose to opt in or out of additional private insurance cover.
The public scheme was funded, not by tax increases, but by a very sneaky 3% "levy" (it was really a tax) which was proposed to run for three years and then indefinitely. After fifty years no one remembers the levy. But no one cares because we have one of the best ever universal health schemes.
The private health insurance schemes in order to survive learned very quickly to change their ways and offer affordable alternatives. In other words, David, market forces ruled!
Our country has not fallen off a financial cliff because we have a universal health scheme. In fact our society is all the better off for it. We have no "death panels" either: that was part of the oppositions main claims here too. If our citizens need medical treatment they get it for free (courtesy fo the 3% levy) or can opt to use their generously subsudised private health insurance or their own money if they want to use the private system.
Nothing is impossible. Once you get passed the private health provider boogymens artificial roadblocks and adopt a positive approach it will be easy.
23
So I am paying $500 a month for garbage coverage and a HD for myself and my daughter and am supposed to be happy? Give me the Medicare option and let others keep their great private insurance. It can't be worse than the status quo.
19
As a small business owner with 700 emplaoyerees, there is nothing I would like more than being relieved of the cost and responsibility of providing each of them health insurance. I am certainly willing to pay a tax equivalent to my current after-tax costs.
There are three reasons it won't happen in my lifetime.
The major employers in this country like the current system. They use it as an attractive benefit.
The insurance companies like the current system, for the obvious reasons stated above.
And most employees like it. Why wouldn't they? They get great coverage at a very moderate costs.
It's pointless to think there is the political will to overcome these obstacles in the near future.
5
I think that it would have to be a staged approach to get this done. First create the system. Then, over time, nationalize the insurance companies, letting the employees that deal with claims, etc, retain their jobs as contractors making what they make today. Get rid of the stock market aspect, buy it out. Get rid of the multimillionaire boards. Then go after the Medical conglomerates, forcing them to comply with strict regulations, unified billing solutions, etc.
It is doable, and to say it is not possible shows shortsightedness, or maybe a lack of interest by those that say it cannot be done.
6
One problem is in thinking of the situation in the US as a health care "system." There is no system! It's more of a hodgepodge of incompatible special interests all trying to have their way, with greed as the motivating factor (which is a different thing from "the profit motive".) These special interests (doctors, hospitals, insurance companies, drug and device companies, pharmacies and assorted middlemen) all tell a semi-plausible story about why their needs must be met. Who's left out of the discussion? Patients; i.e., ordinary people who need health care in the normal course of living their lives. So yes, creating a rational system would indeed be disruptive. Some things may be worth disrupting.
15
The reason single-payer cannot succeed in the US is not because of the reasons Brooks cites.
Instead, more than half the US population has a pre-existing condition which makes the entire population non-insurable.
Until that underlying malady is addressed, no health system can survive in tact.
2
The transition seems to be the problem. Make it gradual so doctors, hospitals, insurance companies, and individuals can adjust without sudden disruption. The simplest way to make it gradual would be to lower the enrollment age by one year every year until everyone is covered.
4
Yes, the transition would have to be well thought out. But two things that are important: the cost of medical insurance when all participate are three things, 1. Health of participants 2, the plan of benefits 3,administrative costs. Any medical plan must be adjusted annually to control costs and put the participants in control of costs and premiums. The only part the government should play is to subside the poor and working poor and transitions costs. Premiums not taxes.
There are too many inconvenient truths in this piece for the fervent supporters of Medicare for All to accept. For them, the argument is more one of religion than it is of facts on the ground.
Separately, the first question I have when this subject comes up is this: where on Earth are the doctors, nurses, et al. going to come from to make this vast expansion of the medical industry work? If I recall correctly, we've already imported every English-speaking nurse willing to relocate, and I imagine we've done the same with physicians.
I doubt that if this idea were fully fleshed-out in a manner that every American voter could wrap their mind around, it would sink without a trace due to the practical issues involved, only some of which could be outlined by Mr. Brooks in less than 850 words.
1
An idea that was expressed by our hospital CEO was to have a Medicare system for all except that certain things would not be covered. For example artificial knees and the like would not be covered. There could be a whole list of things that you could exclude and tell people to get private insurance for these things if you want.
What happens to all of those happy folks with employer assisted healthcare when they turn 65? Well, they go onto Medicare and are truly happy at last.
12
Why couldn't we transition to the German system, which incorporates private insurance, is not single payer, but is universal health care, controls costs effectively, and delivers quality care?
5
A phased in approach is really the simplest and most likely to pass. Drop the eligibility age to 60, then 2-3 years later, drop the age to 55. We can still have private insurance, like many seniors currently buy, to fill in the gaps. Private insurance does not go away. Ask ANY senior on Medicare how they like this "socialized" health care program, and they'll respond overwhelmingly positively. I am 62 and very happy that I qualify for subsidies thru the ACA, but I DON"T like the fact that my federal government is paying my premiums to private insurers, who dictate the ONE doctor in may area I can go to for annual well exams. Insurance companies are in the business to make a profit. They are not responsible for public health; this is the rightful job of a government: ensuring the public health.
8
No where are the Haves as far from the Have Nots as when talking about Healthcare. The Haves are talking about dollars for accessible and affordable healthcare; the Have Nots are talking about barely accessible healthcare even if they have a few dollars.
It seems to me the if the Haves have the healthcare and insurance in part because of government intervention (e.g., tax breaks for individuals & businesses) the Have Nots are just as entitled to healthcare and the dollars to pay for it from that same government.
3
Here's the GOP/Brooks line in a nutshell...yes we spend 2X or more what other countries pay for health care...yes our profligate spending yields abysmal health outcomes...but good lord! let's not fiddle with the system...it might disrupt something (like million compensation for insurance industry execs and hospital administrators).
You just can't mess with health care. Even our beloved leader has told us: "who knew health care was so hard". We need to focus on realistic, achievable goals like "Iraqi Freedom" and turning Afghanistan into a model of democracy. We fought those glorious battles and look--we're winning! And all for a measly $10 trillion.
15
Maybe check out how other countried have managed the transition?
7
Right, David. Because American Exceptionalism! Because every other civilized country in the world is able to offer medical treatment to all their citizens without sending them to the poorhouse except us. Because...greed? More greed? More and more greed?
8
Well David, this column proves you really are a Republican, even when you write like you are not, with reason about a particular issue. Guess you really have been drinking the kool aid from Fox News water coolers, after all. To quote:
"If this version of Medicare for all worked as planned, everybody would be insured, health care usage would rise sharply because it would be free, without even a co-payment, and America would spend less over all on health care."
Really? If this is true, how come I racked up almost $5000 in co payments for a routine open heart surgery????
"About 70 percent of these people say they are happy with their coverage."
Source please??
I haven't even finished reading, but I'm pretty sure I am going to find more erroneous "facts."
5
David, you have to be kidding us. It's quite an easy path from A to B here. All you have to do is look at the opposite of what the the GOP does. In 2010 the GOP made a desperate fight to keep a public option out of the ACA. They did it. And it was a major stealth victory for them, because they knew what was at stake.
So, to make this work, a public option is created. It offers the same benefits as private insurance, but with about a %20 mark-down in cost (that's the profit margin that the public option doesn't imbed). After a few years that will put all the private insurers out of business. (Wipes hands and walks away) This isn't hard at all, and I'm ashamed of you for proffering this tripe.
10
In 1824, in France, under the Restauration of Monarchy ( Louis XVIII ) , the Chambre ( after the Assemblee Nationale's dissolution ) decides to abrogate the laws of the Revolution. 1 st gesture : closing of the Ecole Normale Superieure ( Philosophy ) and closing of Ecoles de Medecine . Then give power over universities to bishops.
The wait time for Canada is a disingenuous point. Ever try to get in to see a dermatologist in the US ? Two month wait at a minimum.
5
Nice advertorial for the Affordable Care Act.
The heavy weight of our current gouging middlemen, wasteful advertising, money scarfing, "Your Money or Your Life". medical system, has to be cut loose.
We should not go broke just so those at the insurance teat can continue suckling.
2
There is only one word for this piece of sophistry and it is--pathetic. But, the sentiment is pure American. Look at education, look at housing, look at the criminal justice system, look at obstacles to political participation....
4
Don't make Medicare mandatory, but let it be an option for those over 50 or 55, or, heck, anybody, and let the marketplace decide which one is better.
3
No serious discussion of a single payer plan can occur without free medical education that would have to accompany it. Without financial assistance from some quarter, medical education currently costs $250,000 in this country. We happen to have good medical schools and good doctors. Why would any potential student ever enter into this losing proposition?
Furthermore, the UK health system rations expensive medical care. People over 45 years old are not eligible for hemodialysis, for example, should they acquire end stage renal disease. There are few ICU's in the UK, more of course in Canada, which has a different system. These treatments are expensive and not rationed here.
No one currently peddling "medicare for all" has taken the real problem seriously.
3
If this argument was truly valid (in that the pains of transition overwhelm the benefits), then we'd still be making buggy whips, smelting copper ore in the middle of Tacoma (look it up), and playing our 8-track tapes. Of course transition is needed and of course it will affect some people. The trick is to do it over time. What we need is Medicare for More now and Even More in the near future, until it is the same as Medicare for All.
12
Interesting article but there are some glaring omissions and distortions. First, the simple answer to “How do we get from here to there?” is “public option,” which goes completely unmentioned. Second, the idea that a universal healthcare scheme necessarily entails abolishing private insurance ignores the example of countries like France, which maintain a supplemental private insurance and healthcare system along side a government run program. Third, the discussion of cost savings focuses on hospital and physician fees, and fails to mention the excessive administrative expenses, profit, and monopoly powers of insurance and pharmaceutical companies. To give some credit, David Brooks identifies perhaps the single biggest hurdle: to shrink an industry that comprises 18% of our economy to, say, 10% entails a lot of job losses and disruption. But I’m not sure that is a rational argument for maintaining an inefficient and inequitable system.
6
Medicare for All is not an Impossible Dream.
It's a dream the time of which is almost here.
If a Democrat wins in 2020 & fips the Senate without losing House, a legislation to gradually trasforming the current Obamacare to Medicare for All is highly probable.
It may not be the way Pramila Jayapal assured us on PBS the other day, but a little less ambitiouisly. The cost will gradually come down to near those of other developed countries. When properly explained to the public, they will accept it, rather overwhelmingly.
Remember, nobody thought Gay-marriage will become the law of the land in 2004. But it did. Sometimes things move a lot faster than we imagined.
4
According to the Sander's Plan federal spending would increase by $32.6 trillion. We could find the money if we stopped giving tax cuts to the Corporations, the 0.1 and 1% who don't need it anyway. Besides, defense budgets can be slashed. We don't need those next gen supersonic fighter jets every few years considering we are being attacked in cyber warfare. I know it does'nt ( can but won't) work that way. True there will be a lot of pain going around. But parts of the health care system should be held in place like the employer health benefit plans Or we could transition through the German Health Care System which is funded according to payroll and beneficiaries can choose between an array of health care
insurances. The greatest problem for Americans will be the strict regulation which has to come into play. And we know how Americans love regulations!
1
Trump famously commented "Who knew health care was so hard" or something to that effect after Republican efforts to kill Obamacare failed. Anyone who uses health care services & who is not part of the 1% class, could probably teach Donald Trump about the complexities, shortcomings & the inequities of the American health care system. Health care providers, like doctors, nurses & hospital administrators could no doubt add even more anecdotal commentary on the challenges inherent in navigating the Byzantine labyrinth of the American health care system. It's an incredibly complex system made incredibly more complicated by the involvement of a for profit private third party industry, insurance.
Approaching "Medicare For All" as an impossible dream will be a self fulfilling prophecy. Within the richest nation of the world possessing more than its share of great minds, it would be reckless & lazy to think a workable solution to achieve "Medicare For All" could not be achieved. The most sensible approach, no matter the details to get there, would be to gradually phase in universal care over perhaps a decade or longer. Lowering the Medicare eligibility age incrementally over time would allow the US health care system to adapt to this new system with fewer disruptions & hardships for all existing participants. Perhaps the Federal government could offer to cover all Medical School expenses in exchange for new doctors who would be receiving lower negotiated payments for services.
4
This is a discouraging opinion piece and I'm surprised it's coming from Mr. Brooks. Sure, the country is a hot mess right now, but why not do some more in-depth research and at least TRY to offer a positive thought? I have relied on employer-provided health insurance my entire adult life. I have a chronic medical condition that, fortunately, has not disabled me yet. I've also had a couple of spans of months between jobs, when my symptoms returned. And there was NO WAY I could afford either COBRA coverage or a plan from the Exchange. How is this a fair system? And the thousands of people who go into bankruptcy every year over medical bills they can't afford? Fine if you don't want to support a "Medicare for All" plan, but then make some suggestions on how to fix the impractical cob job of a system we have now.
2
There’s no need to scrap the private insurance system. Companies that want to continue to provide it could continue to receive tax breaks, while others who don’t provide it would pay taxes to fund Medicare instead. The logical next step in our healthcare system is to open Medicare for all, in competition with private plans, and let companies and individuals decide which they want to pay for.
Just food for thoughts: My fixed salary without bonus is about 80K Euros per Year. I pay about 24K for taxes and another 13K for health insurance and pensions. That is automatically deducted from my salary each month. My employer pays another 15K on top of that. But that is okay. I don't have to worry about anything. If I am sick, I am sick. How much days that takes? I don't care. And that's on top of five weeks paid vacation. I personally pay another 100€ per month for additional private insurance. But that just gets myself a nicer room in the hospital and some perks.. My mother earns about 20K per year and insurance and pension is about 6K combined. But she gets the exact same treatment I get. No difference at all. No problems with preexisting conditions, NO deductibles. The insurance pays ALL the costs, when anyone goes to the hospital. So why on earth are you imagining, that your absolutely broken system is better? How can it be better when a middle class family is ruined when mum gets cancer??? my father had some form of cancer that was detected very early on and cured with no problems, because he used to go to testing from his 40th birthday on at no costs to him! I would say the early detection saved the health care system a lot of money because treatment was easier, faster and way more cheaper!
I can't fathom why ANYONE would defend the american system with a clear conscience...
3
Kind of hard to understand this column. Taxation of individual making more than $500,000 a year and corporation is at the lowest it has ever been thank to 40 years of give away to the rich.
Stop the give away, have nice tax increase for those people ad corporations and we can very easily get "Medicare for All". As most Western Democracies do.
4
@Davide
Why should other people pay for you?
1
I am a retired Canadian and a major supporter of our health care system. In most cases, it provides excellent service and is supported by the vast majority of the population. So much so, that our health system is one of the main components of our identity as a fair and functional nation.
It works for us on numerous different levels, whether it be in terms of efficiency or balancing the well being of the individual and the nation. As well, in terms of equality, it unites Canadians of all social classes together. The founder of our system, Tommy Douglas from Saskatchewan is still by far the most popular of all Canadian public figures.
The United States is the richest country in the world. It consumes over 20% of the world's GDP and makes up only 4% of its population. And there my friends is the problem. It is not about efficiency, but rather about greed. The old adage of the more money you have, the more money you need rings out loud and clear. Do American patriots put themselves or their country first? The answer is pretty obvious to me. Thanks once more to the right-wing propagandist, David Brooks, who is so good at making his biases clear!
4
The United States government has had no problems with the loss of American-based production—and the vast loss of employment for average Americans—when such changes benefitted stockholders (i.e. the upper middle and upper class). Yet here we have the chance to transition to a system that will benefit lower and working class Americans, who often have substandard health insurance or none at all, and suddenly David Brooks is super concerned about the loss of jobs? Hmm.
My household income sits at exactly the 50th percentile for a family of four. We have decent health insurance through our employers. It is adequate, but it routinely gobbles 10% of our yearly income or more. However this is accomplished, I would love to move toward the Canadian system, which would save us $5,000 a year. Surely we would spend much of that on things we can’t afford right now, like replace one of our 15 year old cars. I imagine much of the middle class would act similarly, bolstering the overall economy and adding jobs.
Providing health care and security for all people are two areas, any country can be proud of. Some how, when it comes to health care, there is always the question.
A main problem is with the high costs of health care and the exorbitant price of drugs. So much to say that the private sector is controlling the lives of the people. This is one reason why millions of people either prefer to stay uninsured or do not want to have health insurance, due to unaffordability.
It is the system. If the government has to take over people's health care, how do you do it? Does this mean, you have to impose higher taxes on the people, or on a section of the people? Or would this mean, to cut down on other entitlements. There is already talk of slashing the existing Medicare, Social Security, and Medicaid.
If the government has to handle health care, what happens to all the health care insurance companies? Would this not amount to adopting Socialist policies? This is the argument today, and so much of rhetoric out there.
If we do not call it 'Medicare for All", it is still "Health care for All". Yet, as Mr. Brooks, points out, the question is - how would the plan work? No politician has come forward to provide the details, which the people want to know. Simply saying "Medicare for All", is to not to say that you can implement the plan overnight.
When telegrams came online, the Pony Express had to transition. It was gone in a week. When the railroad came online, horse-drawn carriages had to transition. When airplanes came online, railways had to transition. When newspapers went digital, Linotype operators lost their careers, gone the way of the Pony Express. Progress means change. Change for the better. A one-payer system saves money and means EVERYONE gets health care, not just the rich and people lucky enough to have health "insurance" through their jobs. Health care is a human right. Period.
5
No, proponents of Medicare for all are not saying, "We’re going to take away the insurance you have and are happy with, and we’re going to replace it with a new system you haven’t experienced yet." And they're not saying that because people are generally not, in fact, saying that they're happy with their insurers. They're saying they're often happy with their doctors, not their insurers. You're purposely conflating the two to confuse the issue. No one need have their doctors taken away from them if they like them.
The transitioning you're so fearful of (and scaring others about) would obviously be properly phased in to avoid "shock".
I'm glad that you're so concerned about governmental spending. Would that concern had been triggered years ago when a 2012 Cato study revealed that "the government spends about $100 billion annually on corporate welfare."
1
Its not complicated. Under Medicare for All more money would be available to pay for medical supplies and services because private insurer's profits would be eliminated thereby increasing the reserve available for medical payouts. Pharmaceuticals would lower prescription costs because the buying power of MFA would force them to negotiate. Health care providers would not see their income seriously impacted. The only ones who would experience pain are the private insurers. But after all the economic pain they have inflicted on the American public my sympathies are limited. Yes it would increase the medical budget but it would increase it less than it would under a private system, cover everyone and overall decrease the cost of healthcare to the public. I look forward to a time where the too common description of our medical care system is "economically brutal".
1
You make a crucial mistake early in this piece when you claim that Medicare reimburses hospitals at 87 percent of their costs.
Remember that costs are not fixed. They can include anything from the $1 million plus salary awarded to the CEO to the expensive glass entryways and fountains in the lobby. None of that money does anything to improve the quality of care, but it all gets added to the price. Companies that can't compete on price in the marketplace strive to improve efficiency or find another competitive advantage. That doesn't happen in healthcare.
There is also such a thing in healthcare as "preference-sensitive care." Every hospital in the city where I work is building a brand new Cancer Center to attract more privately insured patients. The same for heart centers. When those expensive new facilities are built, they will be filled with patients. That's why hospitals have been aggressively buying up physician practices in recent years.
MedPAC, the Medicare Payment Advisory Committee, has stated that hospitals should be able to make money on Medicare reimbursements. Many hospitals do. The ones that don't aren't being squeezed by the government, they are being squeezed by their own inefficiency.
Brooks distorts the reality of the present system and offers no potential solutions for a better health insurance system.
First, Medicare for Some (i.e., those over 65) is not a freebie. It's paid for by a tax paid over a working career plus an additional "tax" or "premium"--call it what you will--that is deducted after retirement from the individual's Social Security payments. Further, most people on Medicare also purchase Medigap insurance on the private market--yet another expenditure. I don't hear America's senior citizens screaming to junk Medicare for Some, do you, Dave?
Second, working people love the health insurance that comes with their jobs. Why not? That benefit is heavily subsidized by their employers, apparently invisibly so to many. Insurance for a single person costs $6,896, of which 82% is covered by the boss. For an average family, the figures are $19,616 and 71%. What difference does it make to whom those premiums are paid? It's still money out of the worker's pocket. Actually, there is a difference: Medicare's overhead costs are about 6%, while the private insurance companies run 20% and would be higher without the ACA.
True, anything based on fact is a hard sell to a lot of the American public. Perhaps a mixed public/private system with serious regulation might get us to the real goal, which is universal health insurance coverage for all, however that might be achieved.
1
Mr. Brooks
How about a gradual adoption of Medicare for all so that the costs do not appear up front. For example, 5 years of medicare eligibility compared to the previous year every year. Keep the rest as is and have the employer, if there is one, pay into Medicare. Allow private care with private funds besides this for those who are especially worried and have the means.
Such a negative article David. You totally ignore all the positives. I currently am using the Medicare system, and there is no problem with Medicare. The problem is with our current healthcare system, where an appointment with a specialist can be months away, despite the need to see one immediately, which increases the possibility of requiring emergency treatment instead! All the issues you list can be mitigated!
How did all the other developed nations transition? They found a way; private insurance is still available in those countries and doctors and nurses make a good living.
I paid a $134 premium each month last year for my Medicare. If every working citizen did the same, we could easily have Medicare for all. Don’t forget the 1.45% payroll tax paid by employers and employees, as well. Congress doesn’t negotiate payments; CMS does. I think David’s argument is both specious and disingenuous.
The median wait time David cites includes referrals for non critical care; if one has a serious illness one can see a specialist immediately. It seems like David is employing scare tactics on behalf of Big Pharma, Big Medicine, and Big Insurance. How much stock does Mr. Brooks owns in those sectors?
1
It's not that complicated. In the beginning, there would be 2 parallel systems: full private and public.
As more people switch to the public system either out of own preference or because a growing number of employer no longer offer full private to their employees, a euro-style private complementary insurance starts to take off.
This insurance version assumes basic coverage by another plan (e.g. public) and offers additional services like a private hospital room, coverage of uncovered treatments by the basic plan, some residual charges coverage, etc.
Whilst pressure on drug prices can produce results pretty quickly, it will take a long time for the inflated prices to come down on the services side. All the more reason to get started soon.
3
David Brooks has restores the good name of conservatism in his moral and cultural insight into things he knows. When he strays into health care economics, he loses track of evidence and logic. Of course getting from here to there is the hard part, and "Medicare for All" is a slogan, not a road map. But then Mr. Brooks proceeds to assume, rather than argue, that there is no way to transition to a health care economy without immediately throwing all private players on the streets. Next he describes a resulting medical care economy in which no savings are realized by removing funding or reimbursement routes full of players who add cost without adding value. Finally, a thumping non sequitur tracing the problem to the American Revolution. Of course we amateurs should be encouraged to comment on topics without first becoming experts, but please, Mr. Brooks, ask ourself how your premises and conclusions are connected.
2
The US health system depends on number mof things to maximize cost and profit:
1. Make the groups as small as possible, to spread risk to a small group.
2. make in network as small as possible.
3. Divide of states into the smallest rating territories as possible.
4. Give tax breaks to employers to provide health insurance.
5. Create monopolies with as few insurers as possible, with the ACA.
6, Practice age discrimination by charging higher premiums older Americans, even if they are healthy.
7. Allow drug companies to charge as much as the market can bear; then some.
8. Allow creation of health care monopolies by mergers.
9. Drive community clinics and hospitals out of business.
This article makes a case to keep the current system, sow all the sharks can continue to have a feeding frenzy.
There is no reason to keep down costs, currently, if anything, it costs much more to provide health care to an American $10,000 per capita, than in the nations mentioned.
Is it true, that people love their current insurance? Many people I know complain about the high premiums they have to pay to take care of their family, in higher deductible plans, employers are now going to.
The cost of Medicare fro All, overall, will be less than the mess we have now. The so called "new taxes", would replace premiums paid now. Cost of insurance is reduced by spreading risk across the entire population.
Greed is the only reason to keep the current system.
4
Americans are not able to envision a health care system because they are too conservative in their way of thinking. They believe that if it is the way it is it is because there is no other way. Because everything is like that in the US . Poverty, education, health care ,child care , violence, 2 % of the population in jail, etc...
That's the way it is.
There is no other way. Or it is communist.
Don't even look at other systems to see how they work.
2
Brooks distorts the reality of the present system and offers no potential solutions for a better health insurance system.
First, Medicare for Some (i.e., those over 65) is not a freebie. It's paid for by a tax paid over a working career plus an additional "tax" or "premium"--call it what you will--that is deducted after retirement from the individual's Social Security payments. Further, most people on Medicare also purchase Medigap insurance on the private market--yet another expenditure. I don't hear America's senior citizens screaming to junk Medicare for Some, do you, Dave?
Second, working people love the health insurance that comes with their jobs. Why not? That benefit is heavily subsidized by their employers, apparently invisibly so to many. Insurance for a single person costs $6,896, of which 82% is covered by the boss. For an average family, the figures are $19,616 and 71%. What difference does it make to whom those premiums are paid? It's still money out of the worker's pocket. Actually, there is a difference: Medicare's overhead costs are about 6%, while the private insurance companies run 20% and would be higher without the ACA.
True, anything based on fact is a hard sell to a lot of the American public. Perhaps a mixed public/private system with serious regulation might get us to the real goal, which is universal health insurance coverage for all, however it might be achieved.
3
Everyone I know can't wait to get on medicare...they love it! and it very efficiently covers huge numbers of people. A system that would use government health insurance to be the backstop for the uninsured or those who don't have employer sponsored plans (like Switzerland) would be great here.... Brooks you just have no imagination or flexibility.
3
Big Pharma for none. We're paying for all those TV commercials, you know. Ask your doctor if he likes them.
1
Thought experiment for David Brooks (assuming the Times will print it):
You are fired from your job(s) and let’s assume your spouse (I am not sure if you have one but it is a thought experiment anyway) is not working and has a disability that makes her ineligible to work for medical reasons.
Now, you still have a choice with ACA but let us further assume that your beloved GOP killed it finally.
Would you write the same article you just wrote?
I believe you are a mensch enough to answer at least.
115
@Blunt
You make a valid point. So now consider the converse: in a government funded system such as here in Quebec, it takes three to six months to get an MRI. Or it sometimes takes a month to get a biopsy for cancer screening. There is no way anyone would want to wait that long for what is, essentially, a life saving procedure. Free health care is basically a rationed system, simp[y because it has to be to keep costs down. It is not the answer, in my opinion. A blended private/public system is.
12
@Rick Morris
I have gone through this in BC. I was diagnosed in late October 2016, had the biopsy, the battery of tests, including a PET scan and was placed on immunotherapy in early January. At no cost other than my social contribution to medicare.
I think the way our system works is to triage the needy cases to the front of the line. Sure there are sometimes wait times for some procedures but overall I am happy with the system.
29
@Rick Morris And if you have no insurance - and lack the thousands of dollars required for an MRI in the United States - you do not get the test at all. Private for-profit health care systems ration care as surely as single-payer systems. The criteria used to determine the rationing may be different, but millions of Americans receive no health care at all due to cost.
38
First, just what is the "cost" at which Medicare reimburses hospitals at 87%? How is it measured? And given that it is measured by the lobbying organization for hospitals (the American Hospital Association), I have a hard time believe the 87% is anything other than 87% of what hospitals SAY are their costs ... including whatever profits they need to pay their shareholders.
Second, 70% of Americans with insurance through their employer are happy with that coverage compared to what? I'm happy with it compared to NO health insurance. I don't know if I'm happy with it in general, though, because it's expensive and has a lot of annoying features, like forcing us to use certain pharmacies and not paying for tests (not even if there is a diagnostic need for the test).
Third, where is the accounting for all of the expense associated with maintaining the myriad insurance programs we currently have?
Fourth, where is the discussion of whether doctors would be better able to set up their own practices, free from the need to employ a small army of staff to deal with insurance issues?
Fifth, why the assumption that "Medicare for all" would be administered by the government. A system to administer it through a private, not-for-profit could certainly avoid some of these pitfalls.
3
The emperical assertions to policy paper references is so high that it makes this article entirely worthless to read. Maybe Mr. Brooks should skip a couple weekly opinion pieces so he can write something of actual substance.
2
Is this a joke? These are some of the lamest excuses I’ve seen to let Americans continue to needlessly suffer, and die in the name of profit.
6
So why is it works in every other country in the world--including China, Russia, Germany and France? Please check your prejudices from the 1970's when you enter an adult conversation.
2
Whatever happened to the American can-do spirit, Mr. Brooks?
Whatever happened to American exceptionalism or are we exceptional in that we don't care a whit for the welfare of our fellow citizens?
Nah, can't do universal health care. Can't do single payer, can't even do Medicare for all. Too expensive. Too complicated. Never mind that Americans pay several times what every other industrialized country pays. With higher infant mortality and shorter life spans than those countries. That's exceptional okay.
Can't afford it. Got to have space forces and border walls and mega trillion defense department and no taxes. Especially no taxes. Never mind that in the long run a single payer or even Medicare for all would save a lot of real money.
Can't put a whole industry out of business. Never mind that the insurance industry does nothing for its mega billions but just say no.
Health care should not be a profit making business. It should be care. For health.
The system shouldn't make indentured slaves of employees who can't afford to quit crappy jobs because they would lose their crappy insurance coverage.
You'd think business-adoring republicans would love to dump employer funded, third-rate health insurance for their employees and put it on the taxpayers. That makes too much sense.
3
You know when I was at school in our history and geograhy course we were told vabout the American way of life, how Americans were ingenious, not afraid of challenge (after all the USA is the only country to have send men on the moon), inventives, problem solvers. So I am appaled when I read from David Brooks that Medicare for all is an impossible dream. Come on man! Where is the great ingenious, inventive American? Are you now a nation of morons who can not do innovation anymore? If Great Britain right after WW II could implement medicare and a small nation like Canada or a poor nation like Cuba could do it, surely the greatest powerfull nation ever build in the history of humanity could do it? Right? Time to be back to the pionner spirit!!!
It will not be easy but if Canada could do it, you should be abble too.
1
"Of course you're too heavy! You're my brother."
1
Straw dog nonsense.
2
The real reason that it so hard to transition to "Medicare for All" or "Single Payer health care" is that "American Politicians are the best that money can buy."
2
Yes, it's so impossible that nearly every other developed country has either a government managed system, or some version of Medicare for All.
2
The same hand wringing and scare tactics were used to argue against Medicare before it was passed in Canada, in 1968. And it was amazing how quickly every single party involved adjusted - the government, the insurance industry and the medical profession. More importantly, the beneficiaries - read here the Canadian people - adjusted with lightening speed. And while we may sometimes grumble and whine about wait times for knee replacement surgery, we know that any life threatening condition we may suffer will be treated promptly and with a high degree of skill and compassion. So go for it America. It's easier than David Brooks leads you to believe.
David should read his colleague Tim Wu's editorial.
To David Brooks - from and 85 year old Canadian woman.
You say "health care usage would rise sharply because it would be free, without even a co-payment," . SERIOUSLY? Americans would needlessly go for health care they didn't need? What in the world would they say to the doc? "I need/want/am here because it is free!"I suppose that would might work if they went to a psychiatrist [completely covered here].
Yes a lot of people would have to transition - I expect most of them would transition into the government managed health care system. No?
Yes indeed most Americans are more suspicious of their government and "tend to dislike higher taxes". Who doesn't dislike higher taxes. Canadians do pay higher taxes when we are young healthy and in higher tax brackets. It comes back to us when we are sick or old.
"Once they learn that Medicare for all would eliminate private insurance and raise taxes, only 37 percent of Americans support it". I suspect the total amount of private insurance paid in the U.S. would equal more than we pay in taxes.
My main point is that people in Canada don't die for lack of medical care. I have lived in the U.S. and I had a friend whose mother stopped taking her cancer meds so she could leave the money to her daughter. She died before her time. Another black friend's uncle died in the ambulance on his way to a "black hospital". Disgraceful.
Share the wealth eh!!
2
What loser attitude! "It's too hard, we can't do it."
Well, every other civilized country has figured it out. Even David Brook's native country, Canada.
Where's that can-do American attitude we're famous for?
Come on.
Mr. Brooks, did you research what was said about Medicare when it was still a proposal in the early 60's? The AMA fought it tooth and nail fearing how it would decimate their comfortable livings. Lyndon Johnson got it passed anyway. The result: a gigantic boon to physician income. With all those older folks now having insurance their practices grew and their already comfortable middle class incomes became top 1%ers. Mr. Brooks, you are smart. Doctors are smart. But sometimes you all spout the dumbest beliefs and fears. The government proposes to increase their market by about 20%, cut their administrative overhead by even more, and they think that's bad for business. I want to say something nice, but really, what idiots.
How's your health care, Dave?
1
All this pile of nonsense reaches a final bang at the very last paragraph:
In order to get to a single-payer system we would have to go back to the creation of the US.
Thanks, David, for being so up front.
Since I cannot imagine you being paid ... By the Pharmaceutical Manufacturers for exemple ... Since you are a supposedly honest NY Times journalist ... We are left with a simple choice:
Either you know nothing about budget, taxes, profit margins, etc, as Paul Krugman has often had to point out.
Either you have a problem with your IQ.
PS. It's funny: I usually do not believe too much in IQs.
There has to be an exception to everything, though, right?
Yeah, Right, Right, Right.
1
That was enough straw men to cause a city size self combustion. America is not that much more stupid than Europe. We can figure out how to do what they did decades ago. Yes a lot of fat cats will lose some of their fat - that is a feature not a bug.
2
Translation: I don't need it, so let's not do it.
How callous and tone-deaf can you get?
3
So Brooks sounds resigned: good idea but there is "no plausible way" to get there from here. Really? Not that hard. It's simply called a "public option" whereby citizens can choose whether to pay market rates for health insurance from private companies (if you like your insurance you can keep it) or pay a premium to buy into the Medicare program. No taxes need be raised; simply offer Medicare premiums to those who want to buy into the program. The idea of raising taxes is brought up just to scare people into sticking with the same old broken and dysfunctional system we currently labor under.
Employers could still provide insurance benefits (and being compensated with tax credits) as a benefit/inducement for workers and those who don't have employer-pproivded plans would get the government plan. Medicare Advantage plans are offered through private companies, and they seem eager to provide coverage, so it must be working out for them.
I have good insurance. I made an appointment to see my doctor for a physical. Five week wait. Big whoop.
1
I was getting worried about good old David Brooks, steadfast supporter of the Republican cause. He got a little side tracked by the crazy uncle now in charge of his party, but Mr. Brooks seems to be back on track spouting Republican talking points. So the undeniable fact that transitioning from the current unsustainable system of health care to something undeniably better (call it Medicare for all or whatever) is hard, very hard indeed. But does that really mean that it cannot be done? Does that really mean that people will continue to go bankrupt due to medical debt? Does that really mean that I cannot afford my entrepreneurial urge to start a new company because of the unaffordability of health care? I suppose that is what David is telling us. Nope, cannot be done. Greatest country on earth, but nope, we cannot do that. Richest country on earth (well the top 10 percent perhaps), nope, cannot be done. So, David, congratulations on getting back on your Republican track. You found your way out of the frightening wilderness of optimism and strange thoughts about how to make this country a better place. That must have been frightening.
1
I support M4A, but unlike many proponents, I contend that it needs to be done gradually. Essentially a public option that expands as more and more of the public buys in.
And would they buy in? Well, as David points out, most people tend to like their employer-provided health insurance....that is, until they have to use it. I don't mean for a check-up or an ear infection or something minor. But a serious illness or injury? There's a reason we have an absurd number of medical bankruptcies in this country. Most employer-provided insurance plans still leave patients woefully exposed in the event of a serious medical emergency.
Making Medicare available to those who want it is the way to go. Private insurance will need to make the necessary adjustments to face this new entrant into the market.
The transition to a single-payer, universal plan could be managed relatively painlessly by expanding Medicare in stages by age group: first cover people 60-65, then 55-60, and so on. With each new cohort, the private insurance industry would lose some business, but could partially offset that loss by offering supplemental insurance plans for those who wish to enjoy better coverage than Medicare offers.
Another, similar approach would be to expand Medicaid to cover groups with higher and higher incomes - first to 150% poverty level, then 200%, and so on. (Actually it would make sense to merge these systems into a single coverage plan - call it MedicAll.)
In both approaches, the private insurance industry would have time to adapt, and the many workers employed by it would transition in stages to employment in the expanding Medicare/Medicaid system.
To those who think government would be incapable of managing this, consider how much less time is spent today debating the coverage limits and costs of Medicare and Medicaid, compared to our insanely complicated private insurance system.
There needs to be better healthcare choices for people who do not get their insurance through their employers. Big corporations, I think, have sequestered pools of relatively healthy, young people to insure. There are probably not many who weigh 400lbs and smoke 4 packs a day in these sanctums. The corporation I worked in everyone was under 40 and no one smoked. The people outside of these oasis' of healthy workers, on the other hand, are in the same boat as everyone else which is why they're getting hit, the ones who don't get subsidies. Obamacare mandates that all these corporate "outsiders" have to be treated the same, so insurance companies responded by raising rates on everyone.
Dont get why Republicans always make it so complicated.
I guess they are desperate to make the case for why it will not work.
Medicare as presently constituted isnt very good insurance anyway. It's just better than what was/is available to seniors in the private market if they dont have group insurance at work. Hwvr, seniors can get supplementary insurance to go with medicare and "never see a bill".
There's no reason we cant have "medicare for all (if they want it)" and leave the private insurance arrangements in place.
1
Funny how we always have money for war. . .and tax breaks for billionaires. There is a way there: it goes right through (and over) the shills who do the bidding of Big Pharma and the insurance companies. Health care is a human right, and the so-called free market is not the mechanism for ensuring that right.
2
One question. Since for all of the countries that have single payer systems there was a time when they did NOT have single payer systems, how did they make the transition from one to the other? Since all of them succeeded in doing it, it should be obvious that it isn't impossible.
Another question. In all of the countries that have single payer systems, were there people like David Brooks who insisted there was "no way to get from here to there"? I'd be willing to bet there were. We certainly know that when Medicare was created in 1965 there were Republicans who called it "socialized medicine" and insisted it would ruin our healthcare system. Were they right? If not, should we still be listening to them?
A third question. Every developed country EXCEPT the US has some form of national health insurance system that covers most citizens. If they can do it, why can't we? What do they know that we don't?
4
In the health care industry, only hospitals and insurance companies make money. Hospitals make money by a lone person in a hospital room in the basement who makes up prices as he likes.
Insurance companies make money by denying insurance. At least hospitals are a place patients are treated with the best available technology. Insurance companies do not contribute one bit to health care in America. We let them get off the hook for so long so that we call this capitalism but I call it kind of insurance welfare.
Medicare for all is at least should be tried but the media should ask republicans what their plan is. They do not have any plan. How many remember when Trump said he will get rid of Obamacare and replace it with much better system that is cheaper and covers everybody.
3
Once again David Brooks; the master at setting up the straw man argument display his utter lack of imagination and forward thinking. As a surgeon I can tell you that MOST patients are very unhappy with their insurance experience. Its the whole package David; not just reimbursement; its coverage, lack of medical record integration, hopeless delays in billing and reimbursement, forms, more forms, endless forms, denials..etc.
Your lack of insight in this matter is stunning.
5
Wait times are a problem here in Canada bit don't relies on teh Fraser Institutes's report. Look at the actual wait time for a procedure. Here in Ontario one can check oneself.
https://www.ontario.ca/page/wait-times-ontario
One is triaged based on severity and if urgent one can see a specialist very quickly. If it's not as critical it can take longer.
Well, that's the kind of can't do attitude that made this country great.
2
Universites de medecine are free in France. You can become a doctor for free. Doctors don't have any college debts to pay back.
Same with nurses.
1
Thank you Mr. Brooks, everyone in America should now understand that "NOTHING CAN BE DONE!"
3
I think Donald Trump's re-election is a given at this point. What a fabulous time for the realignment of the Democratic Party.
Wait, but you're an American conservative. We KNOW you're against medicare for all, David. This is just lying. You wouldn't support it even if it were easy to implement. A universal system is clearly the only efficient and moral system for health care, and the majority of Americans support the idea. It's only difficult to achieve because people like you are standing in the way.
3
70% of people surveyed are happy with their coverage. Ok, now take a survey of those who have had a major medical event. How many of those are happy with their coverage? How many are in bankruptcy? Please, get real.
2
Excuses, excuses, excuses. I bet you have good health insurance. This is being done all over the world. Your argument is one of the few times I've heard a "patriot" uphold American exceptionalism for one of our failures. Oh, and by the way, people are dying for lack of access to health care. But you can sit there (how many appointments with a doctor do you have on your calendar?) and promote your lack of imagination. I'm angry enough to say things that this paper will never print. But consider them said.
2
Based on this logic, we shouldn't have adopted the Internet or the automobile. Think about all those landline technicians that are out of a job! Think of all the horse groomers that have to "transition"!
2
Just read up on why California and Vermont could not implement their versions if you want the non-pundit truth.
What is it with you Americans? You have the lowest life-span, with the highest infant mortality, the worst health insurance coverage and the highest costs of any country, and you say it is simply impossible to do what other advanced nations did decades ago. Why are you so paralyzed?
3
"‘Medicare for All’: The Impossible Dream, there’s no plausible route from here to there"
More utterly disingenuous claptrap from David Books? Healthcare for all in the USA is an "impossible dream"? Despite the fact that ALL other industrialized democracies CAN provide this? What does this say about our nation?
As context, a recent SAT essay question asked students to analyze the famous JFK speech where he said the USA should explore space, "not because it is easy, but because it is hard"! Guess that view is too ancient history for Mr Brooks and his ilk? (Why do anything hard? We've got our loot!)
And what does David Books' sophistry about all the reasons why the USA "can't" implement a comprehensive healthcare system say about him and his values? Full of the all-too-usual excuses, double-talk, and faux-intellectual approach too.
So the "the trick is in the transition," Mr Books?
Really?
Gee, nobody ever thought of *that*! How about explaining HOW the "transition" might work? And how vital a better system is to our nation? Not interested in that, I guess...
And all this sophistry after admitting that "Brits and Canadians I know certainly love their single-payer health care systems"?
How many people in the USA would say THAT? Isn't the clear frustration and anger with the USA's healthcare system by its citizens reason enough to demand change?
Oh right, I forgot, only functioning democracies give a fig about the needs and demands of their citizens!
3
Our system needs drastic changes. My ninety-two year old neighbor fell and broke his pelvis. Medicare would nor permit him to be moved from “observation” to “admitted” status in the hospital, despite the fact he stayed for nine days. He and his eighty-one year old wife are now saddled with the entire bill for his stay. Because he wasn’t “admitted “, the rehabilitation facility will also charge him, without reimbursement. What has our healthcare come to in this barbaric country. While executives receive outlandish salaries, the average American is spending outrageous sums for inadequate coverage. The plutocrats have a stranglehold on our legislators, and the public is getting little for their tax dollars.
2
I am 67 and have Medicare, my wife is 63 and does not. She pays $14,000/year for a high-deductible policy from Florida Blue. $14,000/year!!!
Meanwhile, Florida Blue (and the other Blue Cross/Blue Shield affiliates) raise their rates each year, and reap record profits.
EVERYONE agrees our health care system is broken. Next column, David, can you please advise how to fix it?
4
"Proponents of Medicare for all are saying: We’re going to take away the insurance you have and are happy with, and we’re going to replace it with a new system you haven’t experienced yet because, trust us, we’re the federal government!"
"Proponents of Medicare" do not say "trust us, we’re the federal government". You, David, made this up to make your opinion piece make sense. ALL POLLS show the vast majority of people on Medicare ARE happy with it - so you are very wrong here. Some of your pieces make sense - but now, less and less. Is the weekly pressure to write something? Anything? Perhaps consider a sabatical?
1
It is worth noting that David Brooks was not enamored by the ACA and favored single payer over the status quo. https://www.youtube.com/watch?v=cej7ljgeaz8
Why the flip flop? Maybe he parrots the messages by the Partnership for America's Health Care Future or maybe he is not sure of what he believes?
Why are we unable to figure out what Otto Van Bismark figured out for Germany in 1880? Are we really THAT stupid? Well, we did elect our current Liar in Chief, so I guess we are pretty dimwitted. The trick is threading the needle". Those foolish enough to go with the present insurance could do so. All others would be allowed to buy in to Medicare. If companies dropped their insurance they would be taxed what their insurance cost the prior year and it would be adjusted for inflation each year. Eventually, private insurance would, over time, disappear. We are on Medicare and we love it. Back it up with private insurance to cover what Medicare does not cover. Why we do not allow Medicare to lower drug costs the way the VA does is beyond comprehension.
2
Mr. Brooks, I’m sure that if at your insistence our healthcare reform issues stagnate and you end up qualifying for Mediare 7 years from now at age 65, you won’t be turning it down, and you’ll be purchasing supplemental insurance for the items not covered under Medicare.
In the meantime, consider yourself lucky that you don’t have to give up paying your bills for a month in exchange for the purchase of some insulin.
1
I think the author exaggerates the problem of the transition. The American society is built on the transitions. I thought it used to be called 'creative destruction' that causes short term of pain but leads to greater goods. As matter of fact, our health system right now is a constant transition. Employers change the insurance all the times forcing people to adjust to new insurance. Changes of jobs, martial status, death of spouse, change in income all could lead to new insurance policies and to adjustments. If anything, the Government insurance offers continuity, that will stop all these unnecessary adjustments, and brings security in the people's lives. Hospitals, doctors, drug makers negotiate contracts with a number of insurances, how it will be different for them to negotiate just with Government? And industry disappear all the time - miner, phone operators, travel agents, shop clerks, blue collar workers in different industrial areas, and yet they all were able to find new jobs. Why should we value insurance workers any more than miners?
Consider the outstanding, highest quality and solvent universal health care system in Taiwan (Republic of China). It is excellent. It is affordable. Twenty-four million people have great care. Uninsured American tourists can afford and quickly get great healthcare if unexpected problems arise during their visit.
World class best practices.
Now look at Communist China’s system on the mainland.
It does not exist.
1
It is less difficult to travel a road if somebody else has done it first. Britain in the 1940s was not remotely as rich as the US then (or now). It was nearly bankrupt, in fact, but the National Health Service happened. I have no idea what the previous system was, but it must have been a mixture of private and public, as the American system is now.
There is no magic in this: if you want universal provision of a service by the state, taxes have to pay for it. And taxes in America, for much of the electorate, are more or less like mentioning the Devil at a born-again Christian rally. Like everything else, it's a choice people make.
1
Mr. Brooks is right only to a degree. He should look at South Korea's blanket coverage. There everybody is and must be covered, everybody contributes tax like mounts they can essily afford, the richer you are the more you pay. And there is NO wait time to see neighborhood doctors or your primary care physician. Here the people can be given a choice -- keep your present insurance or go with no questions asked Medicare with small co-pay.
1
A good American Model is Kaiser Permanente, a not-for-profit, integrated health care provider with the emphasis on "health-care provider", not health insurance. Kaiser focuses on keeping their patients well thereby reducing hospitalizations and critical care costs. A big portion of their wellness approach includes patient education, which is available online, through workshops and printed material. They use the latest digital tools for patients to communicate, make appointments, order prescriptions and have access to their medical history. They attract top graduates from the best medical schools in the country, and are now building their own medical school in Pasadena, California to educate future doctors in their integrated approach. KAISER is a model for the nation. I don't work for Kaiser, I'm just an extremely satisfied member, one who purchased my own Kaiser membership (insurance), when I was self-employed and have never regretted paying the premiums.
2
@JBS that's a good point but how many poor unemployed, people do they cover? How many people do they care for that have Medicare alone. Maybe something to build with because of the integrated care expertise but as an example, I have my doubts.
It's easy enough to start with allowing a Medicare-Opt/Buy-In as the public option for the ACA market. And yes, this will both stabilize and, eventually, eliminate the private ACA market.
For the huge number covered in the employer market there is not need to do anything, but ..... employer's themselves have a huge incentive, since if its employees chose to opt/buy-in to Medicare, then the employer no longer has to spend the money to cover the employee, and can pocket the difference between what it was paying for a cadillac plan and what it now pays for a Medicare plan.
IF the cadillac plan costs $20k and the Medicare plan costs $10k then creative employers could pay their employees to move to Medicare (which it would also pay for.) So if the employer gives the employee a $3k bonus and pays the $10k Medicare plan it still saves $7k per employee, and employees get a raise, finally.
The 3rd market is the Medicare market which is already in medicare.
1
We are not a blank slate; we have a private insurance model, like it or not. The transition to Medicare for All is indeed the obstacle. What happens to the shareholders in insurance companies? Do they just give up their holdings? Or does the government nationalize the industry? And all those employees who work for the industry? Where will they go? And if there is a role for them in a new system how do they live until it happens? Etc. Etc. Etc.
3
To all supporters of Medicare for All, please explain why this would be different than the abysmal care of the VA Hospitals system.
3
@Dave Fried;
The difference is the patients don't have leverage. OOps. Wouldn't that be true with a government plan?
@Dave Fried
To Dave Fried, please explain why you have made such a blanket statement, even though it's obvious you have no idea how many hospitals provide VA benefits and you've never even set foot inside one VA hospital.
Insurance as a business thrives on increased medical costs because you can prove the need for increased premiums. We have over 30 years of increasing costs to make our system the most expensive among developed nations and nowhere near the top in services. We have a senior's program called Medicare that is more effective in [performance and cost than the private systems. Insurance as a business thrives on increased coverage (covering everyone) and no limits on coverage. With all these factors, even I can establish a combined medical insurance program that is a single payer system including private insurers and Federal supports providing continuous coverage for an American across his lifespan. Not including everyone costs us money in skewed services and increased reliance on remediation. Our current systems creates social structures of doctors and mega structures of hospitals with no opportunity to serve rural areas of our country. There is a way to establish this problem for a combined solution but we need problem solvers not profiteers.
1
@Ray
Yes it will take a little more effort than three words. It can be done but Medicare for all as a slogan is a Democratic Party killer
I don't underestimate American smarts. If other nations have done it: we can do it, and even find a way to do it better.
But we shouldn't pay double or triple or more than other nations for medications WE developed and manufacture. Insanity.Costs are vastly inflated--drug hospital etc--due to greed and layers of middle-persons. The Epipen stands as proof of how a cheap drug (dollar a dose) and a delivery system originally funded by taxpayers becomes 700 dollars, 300 for generic.
Health Care has to take the huge profit-motive out of it. Doctors and pros should be paid well, research for drugs and new treatments deserve generous funding, but 19+ million pharma execs getting bonuses from exhorbitant drug pricing, hospitals overcharging, etc, that has to get out of healthcare. Good preventive care, consistent medication and procedures, where people don't have to put things off or not afford them at all (with insurance, we still had 20% out of pocket, and with CAT scans, procedures, that can totally send a family into a financial tailspin).
There is always pain in change until it stabilizes. This is a pain we better figure out how to minimize and endure in order to have medical JUSTICE and a healthier populace.
1
Medicare.
Medicaid.
CHIP.
The VA.
Military Health System.
Indian Health Services.
They are all federally financed health insurance systems (some, such as the VA, are virtually complete healthcare systems). They all depend on taxpayer-provided funds to pay the bills. They all have their failings and they all could be more efficient.
But they all ensure that those who are in need of health services have access to healthcare without going bankrupt.
And all of them are less expensive per person than our private health insurance system. And because the populations they serve (elderly, disabled, military personnel and veterans, the poor) in general have greater healthcare needs, their total cost is more than half of the total healthcare costs of the country.
But somehow, we can't figure out how to extend this insurance to the rest of the population, most of whom have fewer health issues than the people served by these programs?
C'mon. We're Americans. We've already got these templates in place. We can figure this out.
5
Medecine universities are free in France . You can become a doctor , even a specialist ( 10 years ) for free . Pay only inscription = 300 $ / year. ( and have free health care included as a student of course ! Free Food also and free lodging. )
Of course the competition is tough. Those who cannot pay 80 K $ / year are not eliminated like in the USA .
3
@JPH
Yep. They are civilized. We are not.
They are a democracy. We are an oligarchy on the way to fascism.
Theirs make sense to humans with a sense of fairness and justice, ours don’t.
I wish we got more than the Statue of Liberty from France.
2
@Blunt You have a lot more than the Statue of Liberty but it has been hidden to you .
Or it has been erased or covered.
@JPH
Thank you Sir. As a frequent visitor to Paris (that fine Hotel Bristol still is the epitome of civilized hospitality) and gastronomic tours in Burgundy and the Rhône Valley; admirer of Haut-Brion, Cheval Blanc, Mouton-Rothschild and of course, Château Rayas’ wonderful CDP in good years (I bought wine before Robert Parker, someone you should honor more than the Legion d’H with, made it unaffordable in large quantities en primeur), I have enjoyed your gifts to the world in abundance.
Plus loved reading Balzac, Beyle and Proust by the Charles River when I was a younger man.
So you don’t have to uncover or unerase your good for me. They are abundantly visible.
I was just joking about the Statue of Liberty.
1
Mr. Brooks, here's a thought, why don't we ask some of the medical experts and politicians in countries that have universal health care how they managed to create it. We have a myriad of other countries to ask. What it takes is desire, which most Americans do have and a government that starts working FOR the people. Not simply for the corporations who make money off of a disease.
2
Contrary to what is said here the British health care system is very badly organized and of very bad quality.
English people come to retire in France to benefit from free health care ( which will disappear after Brexit ) and doctors still coming in the middle of the night to your house for children and elderly people.
1
Unless I missed it, Brooks fails to mention that Americans will no longer have to pay high insurance premiums though taxes will rise. That’s intellectual fraud IMO.
2
And one additional point, countries with nationalized healthcare have healthcare budgets. Just like we have defense budgets and highway repair budgets. So if you max out the budget something gets cut. This doesn't mean the death panels threatened years ago but it does means different procedures getting delayed and experimental ones denied. And very expensive drugs with questionable efficacy also denied. Now this may all be for the better for society as a whole but if you or your loved one is the person denied it will not over well and it is not the way we are used to it working.
1
Few insured people in the U.S. -- except those already on Medicare -- have a plan that includes all of their preferred doctors, specialists and hospitals.
2
I support some form of universal coverage, but I do not believe "medicare for all" is necessarily the best way. There are other medical systems in Europe (The Netherlands, Switzerland, Germany, etc) that offer a mixture of private/public services that have better outcomes and have more favorable patient experiences. These countries are also reasonably controlling costs. The UK is rated 15th in this detailed report:
https://healthpowerhouse.com/media/EHCI-2017/EHCI-2017-report.pdf
1
We have health insurance for everybody in France since 1949. Eyes , feet ,and teeth. Even for those who don't work. We also have 5 weeks paid vacation per year from minimum wage up.
35 hour week work time.
A special antibiotic for our daughter cost 1000 $ in the USA. In France the same product from same laboratory in Germany cost 45 $.
The USA have the number 1 Health care cost in the world and 34th in quality rank.
France has 38th health care cost rank in the world and no 1 in quality.
7
And 9% unemployment - 30% among young people.
2
@Gimme A. Break
and not having to have a significant defense budget. Perhaps the cheap medicine was available because of the US market. Something we need to consider when we develop a heallth care system
@Wayne Cheap medecine available because of the Us market ???
What are you talking about.? Made by a French /german laboratory .same regulated price all over Europe. if it costs 20 times more in the US it is because of your health economy system. does not have anything to do with Europe.
As someone who now has Medicare I will clue you in to Medicare: You get what you pay for. When I was covered by my employer (minus a few years when I had "good insurance") I now pay for a plan that covers all my medical costs. This means, of course, that my premium is considerably higher than an HMO would charge. The trade-off is I don't have any co-pays and if a provider accepts Medicare they have to accept what Medicare (and Part B) cover.
Is this what the government plans? Will we have a Medicare Part A that individuals will pay for? The only premium is for Part B (covers MD appointments, outpatient services, etc.). Will everyone in the country have to pay for both services? How will it work?
Frankly, I don't think this will happen and if it does, it won't happen for a long time. But I'll say this: If the Congress and the Senate will give away their current cadillac care and go on the same plan that the rest of the country will be forced to pay for (as there will be no alternative) then I will start taking this whole subject a little more seriously.
Let Congress put their money and their own healthcare where there mouths are.
1
Transition! Mr. Brooks says transition will be difficult, but his discussion is all about sudden changes. How about we transition by first lowering the Medicare eligibility age? Make it 55, get the least healthy sector of the population off the insurance companies. There is a start. Let get together and think of more transitions and drop the false equivalency!
1
@SWatts
Why should I, as a taxpayer, get to take over the COSTS of the "least healthy sector" from the insurance companies? Can I get some of the PREMIUMS that the 30 year olds are paying them? I doubt it.
The insurance companies would probably support lowering Medicare age to 55 or 60 and socializing some of their losses, but would start to oppose it when the age cutoff got low enough to socialize their profits.
1
Because Medicare is an existing system, the easiest transition would be to gradually lower the age requirement. Medicare also needs to be able to negotiate drug prices. We could learn as we go along. And yes the insurance industry would shrink.
1
So then, I guess we should all just accept the fact that Americans will never be able to access the same type of health care services which most of the Western world benefit from, simple enough to digest. Let us not forget, however, that this is happening the self proclaimed 'greatest country in the world'.
Incredibly sad, and so very short sighted.
2
Mr. Brooks,
I tend to be wary of medicare for all for the reasons you outlined in your article. However, I find the current system impossibly unfair, complex and cruel beyond belief to anyone who has ever been laid off, poor or self-employed. It should lead every common man to the same conclusion - major change is necessary.
I, for one, support the ideals of the Affordable Care Act which I see as a middle ground of tight regulation to insure costumer protections and control cost, and free market ownership which can provide innovation and avoid an overly complex transition such as the one described in your article. This seemed to be a great idea when Republicans first presented it as a free market response to Hillary-Care and later implemented it under Mitt Romney in Massachusetts. It didn't become unsavory until Obama introduced it. I say it is time for Republicans and Democrats to admit that the ACA is the only mutually agreeable and tested plan. Time for our Congressman to roll up their sleeves and fix it.
1
I can largely agree with you and the most important thing that we learned is that insuring more patients dies not destroy the economy but both sides need to learn that it wasn’t complete or in most cases less expensive. The problem that all those ideas put forward don’t put at the center the doctor/relationships and the non medical cost of poor health.
Medicare for all is a relatively meaningless slogan and not a plan more dies it emphasize the above values. Talk all you want about the insurance companies but they were the main people at the table with HRC and BHO. if you shrink the insurance companies and expand Medicare the same inmates will be running the asylum.
@RAlbert
Also, I think Massachusetts was a poor model because overspending on the health care industry benefits Massachusetts where medical care is an export business, though it is also true for the US but to less of an extreme.
Clearly a vision for better American health insurance is not in Mr. Brooks' must do list. However for 70% of Americans it is.
They realize that such programs cost less and provide more. Denying people care seems to be Mr. Brooks idea how you save on medical expenses. For shame that he is willing to leave people out of a system necessary for survival. It should give any decent person the creeps.
Fortunately present MFA bills provide for a just transition preserving Health Insurance Company's employees pensions, cost savings to cover all bringing medical peace of mind, paid job training for displaced workers from the industry, and protecting the income for people near retirement from these unneeded companies.
Medicare enrolled those eligible in less than 1 year. Mr. Brooks has a case of "can't do" when this is a time for good old "American Can Do." A better tomorrow for all Americans, no matter their income, gender, or race starts with a nation that is as healthy as it can be.
I expect these for profit exploiters of the country's purse to use their considerable influence with money and lobbyists. They were mandated by Congress in 1970 to keep costs reasonable. They have failed and should be dismantled in an orderly and fair manner.
3
I am currently managing end-of-life care for a family member on Medicare and am repeatedly struck by how well Medicare--yes, the government--has thought through the medical coverage for this difficult and painful process.
It's not perfect (how could it be? this is death.) but it is quite amazing how much thought and care has gone into providing resources for a dying elderly person.
It IS indeed the model we need to expand.
3
Wow, David Brooks sounds so dramatic in this post. Two obvious points that are missing from the post: 1) if the nation saves money, then that means we have more pocket change for other priorities (spending elsewhere in the economy) - this will create a boom somewhere else in the economy that is currently depressed because all our savings are going to healthcare. 2) With universal healthcare, employees are free to leave their jobs and create new businesses without fear of losing coverage. Thus this type of socialism aids capitalism by increasing business formation (just like the socialist program called public education).
Now, I support Medicare for all, but I know it will not happen overnight. The best thing to do is expand Obamacare's Medicaid provision to cover higher and higher income threshholds, and only if they are willing to buy in. Thus, the government does not have to tax you - you pay a monthly fee to join. Since it will be cheaper, more and more people will gradually choose to transition, while Big Insurers can have time to downsize, and Big Pharma can moderate their profit expectations now that the government will negotiate prices... Off course, these big Corporate Welfare Queens will lobby hard to subvert any reforms.
2
I guess we'd have to do what we did when the automobile replaced the horse.
1
Mr. Brooks makes some very good points. Yes, people would have to adjust, hospitals as well, doctors and communities. But isn't this part of life, change? Maybe if doctors would make less money and be burdened with student debt than maybe college is too expensive? If the hospital is the only main employer in a community, maybe the way we live our lives needs to change as well. All of these negative scenarios may in the end turn to something great, something positive. Mr. Brooks has too much faith in capitalism and not enough in government.
I am a physician on a sabbatical currently in Greece. I just spoke with a pharmacist about a medication for a patient. Because the patient had a reaction to several generics I suggested to change to the brand medication. The brand though is not covered by the insurance and the out of pocket cost is around $850. The same medication - brand - here in Greece cost around 20 euros. Which patient has more access to better care I ask than? How in the world is that ok? It's predatory and greedy, it's theft.
Plus as far as I know, in most countries a single payer system coexists peacefully with private insurers. Why not?
Dare to dream, Mr. Brooks! At least that is free!
4
Wow, 70% of employed people who get insurance through their companies are happy to have it?
Duh.
I'm glad conservatives are thinking of all those insurance executives who earn six figure salaries whose jobs might be threatened by single payer.
Oh, and Medicare for all doesn't mean no more private health insurance--just like in Europe--if you're rich, you can buy what you want.
2
Doctors hate Medicare. How will you force doctors to accept it universally, and how will you introduce that or any kind of universal healthcare without tort reform, as a doctor today can get sued for millions of dollars for malpractice (deservedly or not)?
@John Xavier III
That's the point. When Medicare is the single payer, there is no choice but to accept it.
David:
You are sounding an awful lot like a Republican again. It is certainly not impossible to do what many others have done, but the Medicare for all option does need to be aggressively sold starting with opinion leaders such as yourself. First, no-one has disputed that costs would be lower with a single payer plan, with much of the savings coming from reduced insurance costs. The excess costs associated with private insurance come from two primary sources: legions of staff to decide what is covered and insurance company profits. A single payer plan changes who pays, but reduces total cost so it is theoretically possible to make everyone better off. Second, eliminating many health insurance jobs would be a net economic gain. Insurance workers are for the most part very talented people who are needed to meet other employment needs. Most would soon find themselves doing far more useful and satisfying tasks rather than working in an unnecessary insurance industry. Third, if people eligible for Medicare prefer private insurance, nothing need prevent them from buying it or just buying a supplement as many do today. There are many ways to finance a new lower cost health system, although there would certainly need to be a transition period as premium costs are equitably shifted to Medicare taxes.
The discussion on "Medicare for all" often stresses the inefficiency of Medicare. As a senior citizen who had to move to Medicare as primary coverage when I retired 4 years ago (at age 76!), I do disagree.
Yes, I have had to use medical services in recent years (reluctantly, to be sure). I have not had a single problem with my Medicare coverage. I cannot say that about my coverage during my working years. There were frequent denials of covered procedures and many phone calls to resolve disputed charges. Medicare works for me.
2
We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.
JF Kennedy
2
When social security was first proposed I'm sure there were many naysayers like Mr. Brooks. Try taking away social security today and there would be a revolution. Ironically, the ones contributing to Social Security seldom live long enough to collect. The rich who do live longer, do get to collect. If most developed countries have a single payer system why can't we? Because we as a society don't have a conscience and don't believe in helping each other and working for the good of the community.
2
Once again, a critic of single payer ignores the key problem it aims to solve: the current system's inability to cover everyone. Right now around 10% of the population, around 30 million people, have no coverage. How do critics of universal care propose to remedy that? Besides, there IS a way to implement single payer: a gradual expansion of Medicare to cover younger cohorts over, say, 30 years. And single payer would NOT put private insurers out of business. They could still sell supplementary policies, just as they do now under Medicare advantage.
1
"...we choose to go to the Moon in this decade and do the other things, not because they are easy but because they are hard; because that goal will serve to organize and the best of our energies and skills..." JFK, 1962.
In almost 60 short years, we have become the "can't do" nation. Of course we can do Medicare for All. We simply choose not to. What has happened to us?
2
So David's argument, basically, is that this is a good policy in a vacuum, but we are already so screwed up in the other direction that the transition becomes impossible?
I am reminded of a famous quotation
"We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too."
1
Anyone who thinks our government can manage health care is an idiot.
2
@Joe
Anyone who thinks it will be cheaper is an idiot as well.
1
"The insurance companies would have to transition. Lots of people work for and serve this industry. All-inclusive public health care would destroy this industry beyond recognition, and those people would have to find other work."
That's the idea, David. To paraphrase Grover Norquist, let's shrink this body of parasites until it's small enough to drown in a bathtub.
Don't complicate & obfuscate the issue, David.
It's really quite simple: start by offering a "Medicare for All" option ("public option," anyone?) for people to CHOOSE the health insurance they want. All those who are "happy" with their employer-funded insurance can keep it.
So, David, all that's proposed here is something that you & your fellow Republicans adore: free market. Let the "invisible hand" of the free market solve the so-called problems you mentioned.
1
How can you reform anything if you don't know what the true costs are? Have you ever looked at an invoice from the hospital? They all look like:
"we bill $10,000
"insurance paid $500"
"you owe: nothing"
It's 'Hollywood accounting' at it's finest.
so the two solutions you're offering are scrap our political system/scrap the us congress and go back and undo the american revolution -- how incredibly helpful... bravo david brooks, bravo...
4
"There’s no plausible route from here to there."
Yeah, they said that about the Moon once, too.
1
With this kind of mindset, one wonders how we ever sent a man to the moon.
1) Can you please address the current rampant cost of healthcare? High premiums, high deductible, obscenely high drug prices ... We should also study wait time in the US. Doesn't seem as far off as in Canada, especially when private insurance has to dictate your medical care and drug prescription.
2) Stop that myth that people are attached to their private insurance. They are attached to their doctors and hospitals.
3) Try to call your insurance provider and spend two hours to check why you didn't receive your medical benefits. There is built-in bureaucracy ($$$) for one not get reimbursed.
4) There will be disruption with private insurers and job losses. But offset that with current number of uninsured (and those who have a coverage with $6000 deductible!)
1
The way we do it is the way every body else does it. We the people, that means all of us, must recover more of the enormous wealth that is generated in and because of the shelter and safety of this country. Warren Buffet has pointed out that the biggest bit of good luck that any one can have in this world is just to be born here. The wealth that is found here is not the creation of one or a few, it is the creation of us all. David when you were in Kindergarten and you tried to take all the blocks and keep them in your corner the teacher stopped you and made you share them. How could you or any of us have forgotten that simple early lesson in our lives. Clearly some of us need to stay after class and help clean the black board. David!
1
I would be interested in Mr. Brooks’s response to Dr. Jamie Daw’s piece (NYT 2/20/19) regarding the German health care/insurance model: universal coverage and multiplayer. While some of the transition issues still apply (e.g., medical student debt vs lower pay for docs), there is much to recommend it.
1
This is the usual conservative hogwash which is why conservatives tend to be takers and not doers.
We live in a nation that put men on the moon, has landed robotic spacecraft on and explored Mars. We are a nation that was the king of industrialization. We are the most technologically advanced nation in the world. We were somehow able along with our allies to fight and win two world wars. We are a nation that has spent $7 trillion on Middle East conflicts.
Britain was able to launch, and continually correct their single payer system not without its bumps and bruises. We can certainly devise a plan, a better plan to insure all Americans under a single payer system or are we that stupid or powerless against the for profit system. The advantages alone of having a totally portable health care system will free employers and employees both to take risks that perhaps they wouldn't or don't for fear of losing their private insurance, All of these people that like their present insurance provider do not know any different but in the end wind up on Medicare and make the transition. And what of the millions that have no coverage, are they just disposable.
Will this upset the apple cart, yes but what happened to conservatives and their "creative destruction model" of capitalism or is that just reserved for billionaire CEO's and Wall Street.
You constantly want a village Mr. Brooks now support it.
3
If you read the comments, it's a big fat NO GO on this issue. Too many cooks, pots and sponges in the kitchen at this point.
Right on, David. Can you imagine having to transition from private employer-provided coverage to an unknown, monolithic government system? The chaos! The carnage!! The human devastation!!! Wait, millions of Americans do that today when they retire. And in the US it is the elderly who are most satisfied with their (government-provided) health care coverage. As Emily Latella would say "Never mind".
And in what wonderful liberatarian, individualistic world would you expect your employer to make personal decisions for you? What car you'll drive? Where you'll to go on vacation? Why should the NY Times decide what health insurance is best for you and your family? Corporate paternalism is OK, but government paternalism is tyranny.
Boo hoo. A centralized system would shut down duplicative MRIs and other excessive health care services. I think that's what economists refer to as bending the cost curve. Labor and capital would be freed to pursue most productive opportunities.
3
If 70 percent of people are happy with their parasitic private insurance tug-of-war, they’re nuts. And if everybody thought like you, innovations like the V8 engine or Amazon would never have materialized. It’s easy to find reasons something won’t work. It takes vision and positive thinking to know that it will.
3
@Anonymous
That's 70% of 181 million or roughly 35% of the population determining the future for the other 65%.
I believe that we all agree that USA having the best hospitals in the world has the worst health care system – and ALSO – the best universities – worst educational system. Why is USA so unique been so rich?
Medicare for all would decrease the quanity and quality of health care. That is why the King of Jordon comes to the USA for his healthcare and not England, Sweden or Canada. To quote the left "resist."
1
I don’t know about the King of Jordan, but there is a whole medical industry in Germany catering to wealthy Arabs.
Let me add Tammy Baldwin wrote an article before her election endorsing this- no interest from anyone . She never mentioned it again and ran on a popular provisions of the ACA and won.
Want to "honestly" address fixing the worst (yet most expensive) health care system of the industrialized world? The essential first step is to reform the lobbying system. In the past ten years, the most powerful lobby is that of the Drug Companies $4 billion. 2and is Insurance Lobby at $2.7 billion. 8th Hospitals paid $1.6 billion to gain influence from our politicians. 12th is Doctors/other providers who chipped in $1.5 billion. Finally, HMO's spent over $1 billion. No wonder David Brooks says "no way' to reform this massive system. Well David how about starting with reforming the corruption of the "buy a politician" system we now have. How can we NOT afford to reform the existing system?
4
What's interesting here is for all the "Americans love their private insurance" the insurance lobby went and launched a mini war to prevent a public option during the ACA debates. Think about it, so called free-market advocates denying people even a choice. Health care is subsidized, period. Having most resources go to care, hospitals and doctors just makes sense. Having them go to absurd corporate profits does not. I purchase my insurance on the New York exchange which saves me 210 dollars a month from even the minimum plan offered by my employer. Clinging to the employer based coverage that has the United States spending more per person on health care per than any other western nation because some people "like" it is not sound policy. Moreover, the health care usage would rise because of increased access argument is tiresome. Early detection and preventative care are already proven to save billions in care costs(see recent programs from private insurers). Rehashing the same arguments does not make them valid
3
If we annually reduce the eligibility age for Medicare by several months, and annually increase the eligibility age for Social Security payments, the eventual goal of Medicare For All and continued solvency of Social Security could both be achieved without institutional trauma.
This "transition" is simple. Lower the age for Medicare eligibility by five years each year for the next 12-13 years. For example, next year lower the age from 65 to 60, then from 60 to 55, etc., until everyone is covered. This is plenty of time for the people that would be effected by an immediate transition to find alternative employment.
1
As an American who experienced the transition to medicare in Canada, admittedly as a child, I remember how all the older doctors fought against it (PS. it only takes a second or two to Google the 1967-1971 transition period). This was part of the old (American) medical culture, where young doctors bore the brunt of the work, at reduced pay, while the older doctors reapt grand profits.
Now the younger doctors enter the profession at nearly the same scale as their elders, earning more at the start of their careers. The exception being working in remote areas where their earnings are increased to compensate for the 'hardship' of not living in a big city (the government as insurer can practice social engineering that for profit companies can not). The doctors from the beginning are paid for services rendered, they do not need to fight with multiple insurance companies, or debt collectors, reducing their overhead and uncertainty. Remote areas get better hospitals and medical care.
My father had over twenty years of treatment and open heart surgery. My mother has two new knees, and cataract surgery. I've rarely waited longer than an hour or two to see a GP, unless it was for something elective. My children were born in state of the art facilities and my greatest worry was to remember where I parked the car.
Canadians did not need to revolt to make this happen, simply agree to do it and get on with life.
3
I guess you never heard of Medicare Advantage plans. They look like private insurance, because they are private insurance. They pay hospitals and physicians what they negotiate. Payments are quality adjusted. Could do the whole thing for less than what Americans now pay. Would be an easy transition because while Americans would have different plans, they would look and feel the same as we have now,
Auto insurance will never work either because non-drivers won't contribute.
2
So, Mr Brooks, do we let people go without healthcare? Will we watch EMTs check first for insurance cards before the sick and injured are given CPR, for example, or taken to hospitals? Will we allow children to die from treatable illnesses because their parents either can't or won't acquire healthcare insurance? Medicare for all doesn't necessarily mean the government is the sole source for healthinsurance. Medicare Advantage Plans and/or Medicare Supplement plans allow for private insurers. ACA seemed an innovative route to covering everyone, but the GOP has gutted ACA. After reading your column, I found myself turning to Herman Melville's "Bartleby, the Scrivener" and its last line: "Oh humanity!
Yes, it's impossible. America is not capable of achieving what France, Canada, UK, Taiwan, New Zealand, Australia and the rest of the developed world have achieved - health care that costs roughly 11% of GDP, with longer (and still increasing) life expectancies, lower infant mortality, less addiction, better overall health. Impossible I tell you.
3
There's another facet to the discussion that never seems to make it to the surface. Our economy is already severely distorted by the for profit medical establishment. That shows up in the percentage of GDP that the US spends on medical expenses vs the percentage of GDP that all the other developed countries spend on medical expenses. The set of numbers that I just found indicates that the US spends about 17% of GDP on medical expenses, the other developed countries (averaged) spend about 9% of GDP on medical expenses.
When the US system is altered, either the entities that are currently collecting 17% of GDP are going to suddenly lose half their income, or, their income is going to stagnate until the economy grows to make their 17% into 9%. That's going to be just ugly. Necessary (because of the current distortion), but ugly.
Question - why can't you have your medical insurance from your job exist along with universal medicare.That insurance fills in where the universal system doesn't provide -- e.g., payment for a private hospital room, kids' braces, ability to have consultations outside your jurisdiction, etc.
Other countries made the transition, why can't the US? I just don't buy all these so-called hurdles.
1
The majority of Americans are happy with the insurance and healthcare they have. That renders Medicare-for-All DOA. The Dems who have already announced that they are running - Harris, Booker, Sanders, Warren- are all far left and WOULD be easy pickings for Trump the bully.
Fortunately all of these candidates will be out of the running after a few primaries, and moderates like Biden, O’Rourke, and Klobuchar will win the day. They won’t be running on Medicare-for-All. They’ll be running on real tax cuts for the middle and lower classes, and a promise to rebuild our unstable infrastructure. Simple as that.
1
David, you are wrong. Medicare, with all its faults, is more efficient than private insurance. It can drive doctors nuts trying to deal with the multitude of private insurance companies. Medical facilities would save money by eliminating the extensive staff it requires to deal with all the private companies including the notorious pre-authorization for tests, admissions etc. If medical education was free then a 30% cut in salary wouldn't be too bad. Also, the turmoil of change could be reduced by slowly lowering the age of admission to Medicare, rather than doing it all at once. Also, those private insurance companies could be hired to administer the Medicare in local districts as they do now. Being stuck in mud doesn't do the country good. I am a MD
2
Brooks shrugs again. The man whose columns on morality and whose book will travel the same terrain, can't think of a way to take the profits out of health care and have every life equally valued and cared for.
1
" About 70 percent of these people say they are happy with their coverage. "
This is a cooked stat. When you drill down, people like that they don't have to think about it. The money comes out of their paycheck, they have a couple plans to choose from, and it's just there waiting for them.
I know of almost nobody who is happy with *using* their health insurance, especially if something catastrophic occurs. Nobody wants to be comparing hospital prices while the ambulance is on it's way or calling up the insurer while having a heart attack to find out if you're covered (but the insurer only picks up during business hours. Better not have a problem at night or on the weekend!)
Everything most people like about private employer insurance would be replicated by medicare for all. Additionally, you wouldn't be exposed to the nasty, ugly interfaces of the health care system that anyone who seriously engages with their health insurance will inevitably face.
This whole op ed is written in bad faith and I'm tired of these bad faith arguments.
3
You are right. Most of the 160 million with employers sponsored health insurance are happy and Medicare Advantage Plan plans are increasingly popular. American patients expect all care without any wait times. Also expect constant innovation. I am one of them. If democrats were smart they would strengthen the ACA. This would be popular and successful. Medicare for all is just politics. Not the only solution and likely not the best and it will not be embraced by most voters.
1
"At this point, the easiest way to get to a single-payer system would probably be to go back to 1776 and undo that whole American Revolution thing."
EXACTLY !
If America fought against a tyrannical British Colonial power to freed itself from the shackles of Colonialism to bestow its citizens the exhilaration of Freedom and the inalienable right for the pursuit of happiness then America can now fight a tyrannical corporate, capitalistic, greedy, bully to free it's citizens and bestow on them a Universal Health care that will provide them Health and Happiness and save the country from an economic collapse as a result of continuing this unsustainable cost of medical care.
Wow! I said it. Brooks, can you follow what I am saying?
The Impossible Dream---except for every other major advanced nation in the world.
1
This column was blatant, reactive fear-mongering. This was very similar to the line of reasoning put forth by gun advocates. Gun advocates jump through all sorts of hoops trying to create an argument where guns are either safe, increase safety, or are impossible to live without. All while the whole of the rest of the civilized world just moves right on ahead having tackled the problem already.
Are we really, truly supposed to believe that the United States is about the only developed nation that is too poor, and too inept to figure out healthcare properly without the help of a time machine to go back to 1776, as David Brooks would have us believe?
It is far past time that we as a nation started thinking about, and moving towards what will benefit this once great nation, rather than pandering to the most scared, or most privileged among us.
3
Heaven forbid that a Doctor comes out of medical school saddled with thousands (if not over a hundred thousand) of dollars of debt that is difficult, if not impossible to pay off.... Oh wait that's already the case.
As a former healthcare worker, I can confidently say that the only people who enjoy the current byzantine system of healthcare billing are those who profit off them, e.g. the insurance companies. At our practice, even the billers didn't enjoy working with the healthcare companies!
Are you saying the reason we can't have universal healthcare, is because Americans can't accept transitions? Europeans transitioned peacefully to the Euro, you're saying that Americans simply are not able to change?
1
I am a dual American/ Canadian citizen who is living in Montreal.The Canadian system is not perfect but it is available to all. Wait times are going down for MRIs and CT scans as they are using the machinery at night. I have experienced through family and my own experience that if you have a serious medical problem, you are seen right away and care is usually excellent. My grandson was born with a medical problem and needed to spend over 3 months in the Neonatal Intensive Care Unit of the Montreal Children’s Hospital. He was given excellent care, is now a healthy toddler and the bill was $0. When people or loved ones are sick and need hospital care for so long, dealing with the illness is very difficult. Adding financial difficulties is just unbearable and for sure America is much better than that!
5
Medicare part A only covers 80% of hospital stays (which are what? $7,000 a day now?, and part B, which pays for doctors, has a $135/month premium (and only pays 80%). Part D, which is supposed to, but generally does not pay for drugs, costs at least $20. So your not in Canada yet with Medicare.
2
What you have written is correct in theory, but lacking in execution. Medicare games the system by denying a patient “admitted “ status, thus leaving them on “observation “ status. This is very common practice, and it saddles the patient with the full cost of the hospital stay. How do I know this? It happened to my neighbor, causing me to do further research on the topic. What I found was horrifying.
1
@Renata Davis Yes, my point was that going to Medicare doesn't actually get us to where we want to go. The slogan "Medicare for all" is used precisely because it's viewed as familiar and thus easier to do.
Bringing Medicare into it at all makes the idea more vulnerable to fear mongering the people already dependent on Medicare. So you can add that to Brooks' list of obstacles to overcome.
1
I have had experience in both the US and Canadian health care systems: 4 stiches in my thumb in an empty, private hospital took all of 15 minutes and cost me over $2000 as a visitor. Four stitches in and an x-ray of my US grandson’s index finger, 5 hours of waiting while people with greater emergencies preceded him, cost a little over $300. I’ll stick with the Canadian system, thank you. Of course it has flaws that need addressing as the population ages and in some cases excessive waiting times but let those who can afford it and want to spend their money that way line up south of the border. It will free up doctor’s time here for those who can’t afford to go elsewhere.I am happy to pay higher taxes and get world class medical care even if it takes a little longer.
3
We could probably get to better system eventually if republicans would quit undermining reforms every step of the way.
5
I’m in, but I want exactly the same coverage and cost that government workers and teachers get.
No exclusions.
It was unconscionable that those getting Obamacare without subsidies bore thehardship of exorbitant costs and immorally hi deductibles while government workers and others who largely supported the bill didn’t sacrifice at all.
1
The UK has national health service, which has always been able to be supplemented with private insurance for those who choose. Stop peddling lies to support your foregone conclusion. A Kaiser Family poll, really? Kaiser, as private insurance, has a vested interest in maintaining the status quo. 70% of those who are insured enjoying their insurance doesn't change the fact that we have a massive population of under-insured people or people with no insurance.
The sticker cost is too high? Simple, divert the tax money we currently spend on a massive military budget and endless wars to healthcare.
It is not nearly as tough a transition as you are envisioning. We just have to rethink our priorities.
3
Not sure I'm feeling sorry for medical professionals in this scenario, they've been on quite the gravy train for a long time. Job security (who ever gets laid off in the health care field?), plus good salaries and benefits, and for most doctors, an obscenely good living (so many I personally know live large!).
1
What is the evidence that people will "overuse" healthcare if there is no upfront cost? Newsflash: a trip to the doctor is not considered a recreational activity. The fact that people tell pollsters they are happy with their employer-provided insurance may merely be a statement that they're just glad they have at least somewhat reliable insurance at all. The corollary may be that they feel they can't leave their job, even if they are dissatisfied with the job, because they will lose their insurance. We need to improve our system so that necessary medical care is available to everyone, but the discussion should be based on facts, not unsupported assumptions and a few anecdotes.
3
Most of the concerns Mr. Brooks raises, which are legitimate to be sure, could be resolved by gradually phasing in Medicare. Initially the eligibility age for Medicare could be lowered to 55, then 50, then 45 etc. I am 70 and had excellent private health insurance with my employer when I turned 65. Nontheless, I was glad to become eligible for Medicare. So too was my wife, when she turned 65. Most people I know were thrilled to "graduate" to Medicare when the time came. By gradually phasing in Medicare coverage, all of the players Mr. Brooks mentions would have time to adjust. Medicare would become accepted by the vast majority of Americans, just like similar systems are accepted by the people of Canada and Great Britain. They are not nearly as different from us as Mr. Brooks seems to believe.
4
Nothing kills an argument than facts. Here are a few: 29 million citizens are without medical insurance. The loss in terms of productivity to the GDP must be staggering. There is one set of statistics that put the irrationality of the current systems and that is the budgetary effects of major tax expenditures on the health care system. These expenditures are exclusions from taxable income. There are a number of these exclusions, such as that for charitable contributions, however; the major exclusion is that for employer-sponsored health insurance. In 2013, according to the CBO, it amounted to 1.5 percent of the GDP or $248 billion.
The CBO projection is that between 2014 and 2023 it will total 3,360 billions or 1.6 per cent of the GDP.
This amounts to a subside paid by the tax payers to corporations who offer their work force expensive inducements. So, those who are without health insurance are subsidizing the upper middle classes, who then hide from themselves a subsidy that benefits them but who will oppose any federal plan that will aid the others.
2
And there, in a nutshell, is why the Republican Party has nothing to contribute to governance.
Today's GOP: The Party of "can't"
2
David, this column lacks in imagination. There are a myriad of ways one could transition from a private health system to a public one. Two easy ways to start would be (1) to decrease the Medicare enrollment age to 55 - many people become unemployed or underemployed in their late 50s and early 60s and are unable to hang on to private insurance until they become eligible for Medicare and (2) Permit the "public option." Allow a Medicare buy in option on public exchanges, so long as it is priced appropriately, many people will prefer it, due to lower rates from reduced overhead. We have many creative business and medical professionals who if they negotiate in good faith, could work toward solutions to these problems.
A couple corrections: Medicare for all by no means, is the end of Private Insurance. Almost all countries with public health - the UK, France, Germany etc. permit private insurance on top of govt health care, which gives people additional options.
Everyone says Medicare for all will entail massive tax increases. On one hand, yes, the responsibility for paying for care would shift to the government, On the other hand, these costs are now largely paid for by corporate America. If a company's health costs went from $10,000/year per employee paid to a Private health care provider, down to $8,000/year to the government, it is a win-win-win situation. I am not going to cry for bloated insurance company employees who lose their jobs so coverage can increase.
2
Spoken like a true conservative, David...."we can't do it...we can't afford it...it's impossible." All of that is defeatist (and protectionist) talk from the right. The provision of health care across the board, through a coordinated program with a core benefits plan (upgradable and customizable for those who want more) is both achievable and practical in a society that is disintegrating before our very eyes.
The program has to incorporate big changes to the tax treatment of health care benefits--and instead of providing their own in today's crazy-quilt of insurers, employers, unions, and governmental units must contribute financially for each employee. The benefit package must be made uniform. The actuarial fundamentals have to be worked out, and that includes a firm tie to the definition of service units and determination of fair and equitable prices for those services--whether physician/surgeon, pharmaceutical, durable medical equipment, or any of hundreds of categories of services.
It's a big job, and since organizational lobbyists are present at every turn, it's going to take time and persistent adjustment to accomplish. But your stated opinion is just that--an opinion--and from my perspective after a long career in the medical sector, it's neither well-informed or accurate guidance for what the nation should aspire to do.
3
The actual mechanics of Medicare for all will be daunting but first and foremost will be the need for rationing because we know that unlimited demand is not possible. Do you want the rationing done by doctors or politicians. Time for reality not fantasizing. Also be prepared for severe doctor shortages and the need to import more foreign trained doctors. Everyone seems to be fixed on the cost but that will be easily handled, just be prepared for higher taxes.
2
We already have severe doctor shortages. Much of it has to do with the cost of medical school. The cost almost forces people to specialize in order to make the large sums of money required to pay for their education. Thus, general practitioners are in shorter supply. But fear not! Pharmacies are now becoming the new doctors office.
1
Health outcomes have more to do with where you grow up, where you go to school and where you live. Social reforms to lift more out of poverty, improve education, and build communities would likely have a larger impact on health than any healthcare policy. Neither Medicare-for-all or complete repeal of the Affordable Care Act with “something beautiful” will make large improvements in public health.
1
This scary, horror fiction is better than even Stephen King's latest fiction work. This is just a mild preview of what we will face in the forthcoming election campaign, folks. Brooks has used all false premises, lies, absurd comparisons, and even scaring intimidation tactics in this Brouhaha.
What did Brooks mean by "..the easiest way to get to a single-payer system would probably be to go back to 1776 and undo that whole American Revolution thing.."?
He means that if US remained back as a British colony as Canada did then we could hope for a Single-Payer system of Health Care. I don't know if he is insulting Canada or if Single-Payer system of Health care is unfit for a freedom loving Americans who revolted against the Brits.
What can you expect from somebody who takes a $120,000 per person 24-day world tour vacation and says that the people who can afford it are just plain rich and not fancy people. Did he know that the annual income of the top 5% wage earners is 120K and an annual income of 250K will qualify for the top 1%? ANd more than 50% of wage earners make 30K or less? And he calls those people who could afford 120K just for one vacation as plain rich and not fancy?
And this person says that Universal Health Care is like asking for the Moon! Actually worse. Today's Gazillion worth rich people may be able to buy the Moon but how can we go back to 1776 and annul our Declaration of Independence just to be able get Universal Health Care?
3
The problem is how and why your medical system has developed the way it has. Basically, it’s because you are a revolutionary society based on a frontier mentality. You have a constitution set in stone and a belief in individual action rather than a tradition that we have of collectivity and state intervention where it is appropriate.
Therefore, to some people even the most conservative proposals for any form of universal Medicare such as Obamacare which seeks to ensure that people at all levels of society at least have some kind of cover is seen as dangerous socialist extremism. I spoke to someone recently who has lived and worked in the US who said that profit plays a big part in society in the States so reform of a private health system is difficult.
What I think you have is an ideological problem. The real ideologues here are not on the left. In fact a universal health care system paid from taxation, free at the point of use is both sensible and practical. It is the right who want to maintain a system where the private sector runs virtually everything.
What I would suggest US citizens do is take a step back and ask yourselves whether you consider it appropriate or even moral for corporations to make money at the expense of sick people.
It won’t be easy but there appears to be some form of popular support for a universal system. It needs political will as it’s not that you don’t have the money.
2
David, millions of people convert their insurance to Medicare every year and I don't see the outcry you suggest. In fact, most are quite happy to transition. The other straw men you build are also easily blown away by the big bad wolf.
2
Here let me sum up David's column in just a few words:
'Yes, our current system sucks, but change is hard, so let's not even try....waahhh."
There, that about sums it up. Pathetic.
4
Here's the true facts about moving from our current health care system to a Medicare for all -- it would benefit the truly poor in this country who can't afford private insurance or don't have a good job that has good health insurance. It would negatively affect those who do have good private health insurance.
I have had throughout my life private health insurance through my or my wife's employers. It has never been anything fancy or special. but it works great. I can schedule any kind of procedure with any kind of doctor within a short time. That simply wouldn't happen under Medicare for all.
So the very poor would be helped, the middle class would be hurt. If private insurance were not completely banned, then the rich would buy their own insurance, would have their own doctors and hospitals that took only private payments, and would get the best care which would be deprived to the rest of us.
If private insurance were banned, then some of the rich would not be able to do that. Instead, there would be hospitals set up in foreign lands to cater to the ultra-rich, and that's where they would go. And many of their patients will be the Democratic legislators and celebrities pushing for Medicare for all.
1
I traveled to Costa Rica a few years ago and ran into an American couple who routinely travel there for their dental and medical care. Their Harvard trained doctors charge them a fraction of the cost. For example, he had $50,000 worth of dental care during this particular visit, but only paid $15,000 for his care in Costa Rica. They were middle class people. My fractured arm cost me $90 in a French ER room.
1
Glad to hear that those who have insurance that “covers everything” are happy with it. I certainly would be too but unfortunately my so called “cadillac” policy which costs about $1400/mo doesn’t cover much. No dental, no eye, high co-pays, no discounts for exercise, good food choices. Forget about covering functional/intragrative medicine. Nope they want to put you on a pill. I’m more than happy to pay that amount in additional taxes (although once you take profit out of health care it’s not likely to cost anything close to what most pay now when all costs are factored in).
Make no mistake, you are one layoff, major financial or medical event from loosing yours. My SIL was denied a life flight after her dr gave her a blood thinner until after she literally bled out in her hospital room. She had so called great insurance too. Stop being one of those who think it won’t happen to them. It will.
2
Yes, Mr. Brooks "Blank Slate".
Ah the U.S. can't do anything about our current health care system and has never been able to come up with solutions to any problems because of that "American Revolution thing." Apparently in your view our American path has been predetermined from the 18th century. What brilliant insight to our country's innovative history. Oh, and the countries that have a cheaper, inclusive health care system for their citizens, which also produce better patient outcomes than the United States system, in your view must have all began their health on an historical "blank state"? I am amazed at your lack of knowledge on this subject, yet you feel compelled to write on this subject as if you have some expertise. So yes, let's just walk away from this issue and depending upon one's opinion of the current U.S. health care system, curse or praise our founding fathers for their prescient vision.
1
Canada spends less per capita on health-care than the United States and performs better on life expectancy, obesity rates, infant mortality and “amenable mortality”— i.e., deaths that could have been avoided if the deceased had received timely and effective medical care.
3
Thank you, David Brooks. Moving directly from our current complex, entangled, over-priced, under-controlled, for profit "private system" to a single-payer Medicare for All system would not be comparable to the old analogy about the difficulty of turning a battle ship a 180° and the time it takes to do it. No, the shift to single-payer will like turning the entire fleet at the Norfolk Naval Base in the confines of the harbor while three tankers and a cruise ship are coming into port.
As Mr. Trump noted in one of his "Eureka!" moments, healthcare is really complicated. Mr. Brooks' commentary is excellent, but only touches the surface of the problems. I've worked as a healthcare marketing and communications consultant for 30 years. The transition from the current system to Medicare for All cannot be accomplished in one massive shift over a few years. It likely will take at least a decade if it can be done at all.
In any case, the only approach with any prospect of succeeding is one of gradual, incremental steps beginning with some form of a single-payer option, a gradual lowering of the age for Medicare enrollment or other progressive steps. I'm all for Medicare for All, but I have yet to hear a serious plan addressing the mechanics of doing it and paying for it.
Canada made the transition to national health care in the 60s. Yes, insurance companies were forced out of the health insurance business, but they transitioned to focus on life and other kinds of insurance and have thrived; big Canadian insurance companies now own major American insurance companies, such as John Hancock. The Canadian federal government mandates universal coverage, but actual coverage is administrated by each province. Primary care physicians--in family practice, internal medicine, pedriatrics--do better in Canada, by and large, because they have no bad debts, don't have staff to deal with health insurance companies, and tend to see more patients over all (since every one is covered and there is no worry about cost). My mother went through two rounds of breast cancer treatment in Ontario and could not have received better care. If hospitals in Ontario can't handle urgent cases right away, patients for heart transplants, etc., etc., are transferred to hospitals in Detroit, Cleveland, or Buffalo for treatments and procedures and the Ontario Health Insurance Plan covers all the expenses involved (this happened to friends of my parents). If Canada could do it in the 1960s, why can't the US, with all its brainpower and resources, do it now? The main reasons are ignorance, fear of the unknown (yet eminently knowable from abroad), and the irrational fear of "socialism," even though Americans, would never give up socialist programs like Social Security, etc.
4
“Medicare Advantage Minus for All” (MAMA!) solves most of these problems. The Advantage model retains a basis for private insurance and benefit plan flexibility. Everyone is ensured coverage, but you can choose who you purchase it from, so long as it meets standards. Under the Romneycare model the money doesn’t even flow through the government.
The Minus represents a slimmed down benefit plan. If you want full IVF coverage, you need a private plan, but everyone has coverage for basic preventative and emergent care. The reduces the political risk of ever-expanding benefits/expense since the majority of patients will be in Advantage plans (as Medicare is trending towards today). This will cut the Berniecare cost significantly.
Most importantly, this shifts accountability to address the biggest source of US healthcare cost: nobody is managing cost. Most patients have insurance, so it’s not their money (deductibles are starting to change this); employers have no leverage because they don’t want to lose employees by limiting the provider network. Providers need the latest equipment to appear prestigious and win share, and nobody asks them their rates.
This is a solvable policy problem.
1
“To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go...
This is my quest, to follow that star
No matter how hopeless, no matter how far
To fight for the right, without question or pause
To be willing to march into Hell for a heavenly cause...”
- Not David Brooks
145
@Trader Dick No, sounds like Robert Goulet and Vladimir Lenin.
1
@Trader Dick
First learn to count on more than your toes, then dream on....with OPM: other people's money
1
@Maggie Yes Maggie, and the enormous salaries and golden parachutes given to execs of companies such as Blue Cross/Blue Shield will go a long way toward helping to cover the costs. OPM indeed.
9
Generally, I support and enjoy David Brooks' views on things ... not on this, though. Rather than a route from here to there, let's go there to here. Let me explain.
1. We've spent over $3 trillion on the war on terror, a nice down payment for Medicare for all, for something totally avoidable.
2. Saudis backed the 911 horror, and had their nationals as key players in it. We back them even when they murder in the plain light of day.
3. Our Afghanistan fiasco made the world safe for Afghan heroin, fueling the disastrous and expensive opioid crisis.
4. Then you have the lost-opportunity costs of those 100s of thousands of victims of war and addiction who will never contribute their wealth of existence.
5. Wall Street launders all this drug money to keep their merry-go-round spinning a few more months.
6. Few cities attempt to capture the trillions of dollars in land value, created after public investments in infrastructure - money plowed back into the pockets of those who run for office to keep this mess spinning.
Plenty of money. We waste money saying there isn't enough money.
4
Keep in mind that the Canadian and British systems are different. A great book I highly recommend is T. R. Reid's
somewhat misnamed "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care". In an entertaining fashion based on first-hand experience, he compares health care systems in various countries.
Universal healthcare does not imply that all medical care is provided by state entities. Instead, it implies that the body politic recognizes the necessity of universal care to the overall well-being of the society and is willing to invest the resources to support that goal.
For those who argue that the cost is prohibitive, as Mr. Brooks speciously asserts, we should note that most nations with universal healthcare spend less per patient with better overall outcomes.
Consequently, I assert that those who claim the cost is too high are using cost as a stalking horse, and are instead concerned about receipt of healthcare by those they consider ‘unworthy’ for one reason or another.
We’re a rich nation, with very inequitable distribution of that wealth. Let’s go back to Eisenhower-era tax rates, adjusted for modern income, and fund wonders like we did during the fifties and sixties....including universal health care.
1
Revolution is always a mistake. Cost control and universal coverage are possible without single payer, witness Germany. Obamacare would work fine if Republicans would stop the sabotage and the two parties would just compromise on solution to it's problems. The government can apply more regulation to insurance and drug companies and supply more help to the poor, without becoming the single payer.
1
Mr Brooks, you reveal yourself once again to be a defeatist in the service of the status quo. The basis of a thriving civilized society is first and foremost a visionary approach, the will to create, the willingness to experiment, and the determination to move forward and find solutions in the face of potential failure.
We can easily find examples from the past for why anything at all potentially won't work. We can use these examples as reasons for clinging in fear of failure to the status quo. Instead of viewing the problems of the past, and the difficulties we potentially face in the present, as reasons for continuing what clearly hasn't worked, we can view these difficulties as challenges for the future. We can see them as signposts for the pitfalls and problems we need to confront and resolve.
All of these arguments against Medicare for All ultimately, in the final analysis, don't matter. Physics teaches us that the past, of itself, does not create the future. Statistics do not create the future. What creates the future is our vision for that future, and our unwavering commitment to bring that vision forward, no matter the challenges we face.
"We are the music makers. We are the dreamers of dreams." -- Arthur O'Shaughnessy
Thank you for outlining and making clear some of the challenges we face. Now please get out of the way and let the rest of us get to work on creating a world that works for everyone.
2
The current system has proven incapable of controlling costs. When calculating the necessary taxes needed to pay for Medicare for all you are simply taking the costs of the current system and assuming that will be the cost of the new system. As the piece points out Medicare already pays less to providers than private insurance. That extra payment from private insurance would go away.
States would no longer need to pay for Medicaid or health insurance for all their employees which should reduce state taxes. Employees like getting insurance through their employers but when employers are no longer paying 20,000 for a family policy that extra money will be available for raises. Would people have to wait longer for certain appointments, elective surgery or tests. Yes but everyone would be covered and the country would be paying less as a whole
If this opionion piece were a homework assignment for a health policy course, it would get a C. Certain key factors go unaddressed. For example: A single payer system would greatly reduce administrative overhead for healthcare providers. Current billing procedures for healthcare services are massively complicated and consume an excessive amount of time and resources. Why so complex? Multiple insurers with multiple plans of coverage. And, by the way, all but the dullest health insurance experts and workers will be able to find work in a single payer system.
2
People work over 40 years to get this benefit so why should we give it to everyone even though that haven't donated to the system. That doesn't seem fair plus the system will go bankrupted if everyone is placed in the system.
most people have not paid anything like the health benefits they receive. doctors are ok with getting paid a little less because dealing with Medicare, as I do daily. is simple
the administrative costs are about 7%. the agents are nice and mistakes are rare and easily fixed. I wish people 50 and up could buy into Medicare. the reason employer paid insurance came into being was price controls. so instead of salary increases to hold onto workers, health care insurance substitutes for pay increases and people got thus a tax free increase in compensation. Medicare for all replacing employer paid is a non starter. I always wondered why employers did not glom onto single payer thus reducing their hr departments. no doubt lobbying, ie bribing legislators produced the mess we have now. after I broke an arm in Japan, total cost including pain meds and green tea while my husband waited at the pharmacy of $150 led me to suggest that people with a broken arm should fly to Japan. a leg is different.
2
Health care in the United States has big problems. But there is no magical cure. Those who tout a "Medicare for All" system as solving the problems are selling snake oil. Don't buy it.
1
of course it will be difficult.
of course there will be twists and turns.
but don't we owe it to ourselves to have this fight? don't you care at all about your neighbors?
1
While Mr. Brooks rightly notes that "patients" and the "American people" would have to adjust to a transition to any type of universal healthcare system, his major objections to universal healthcare seem to be about the difficulties that politicians, government, insurance companies, physicians, and hospitals would suffer while making such a transition. Let's concentrate first on what works best for consumers of healthcare, and then work to help those other entities adjust to the new reality.
1
The US has "much lower bed occupancy than comparable European nations have" because the might of the private insurance industry is arrayed against patients, especially the un-insured and under insured. This is the same reason American's pay more for health care and have worse results than those European nations.
1
We have an RN friend from the UK. When she came to visit, she was amazed at her tour of a US hospital. She said it was like stepping into the future and a five star hotel compared to her prison-like hospital in the UK. She was envious of US RN wages and lack of a waitlist.
"over to the federal government"
Name one thing that the federal government does better and at less cost than private enterprise.
"public monopoly"
That means the government gets to decide who, how, and when people get treated. We already have a govt run healthcare system called the VA. Patients are abused, waitlisted, and die waiting.
"could pay about 40 percent less"
Blahous must have flunked math. Ctotal=0.87xC1 + 1.47xC2. Changing 1.47 to .88 does not change Ctotal. What he is really making the case for is for medicare patients to pay more of their own costs so it is not subsidized by everyone else.
"usage would rise... spend less"
LOL. How do costs go down when demand goes up? Costs can go down with technology breakthroughs, competition, and scaling. But technology in healthcare causes costs to go up, a government takeover decreases competition, and scalability doesn't work well with in-person services. Congress cannot change the laws of economics any more than it can change the laws of physics.
"referral and an orthopedic surgeon, it’s nine months"
I experienced this exact scenario (in US). My wait time was 3 days; two of those days were a weekend.
I am surprised that Corporate America is not interested in Medicare for All. Corporate America is the one overpaying the current system. In Europe in most countries you have Universal Health Care at a price half that of the US. If you want to top your governmental health care with a private one you are free to do so. Yes, it is going to be painful to clense the current system, but in the long run it will free a lot of money for the benefit of the people.
2
David's point is valid and improvements to ACA (Obama care )are a doable and a just solution. We cannot start over without a huge economic disruption.
Medicare for all is a laudable goal but just not yet achievable and probably never will be. It is not the only way to bring health care for all about.
1
The argument seems to be... it'd be hard to execute a major national policy shift, therefore we should not do it/it's impossible? You could make this argument in favor of literally any element of the status quo.
2
"Medicare for all", single payer, universal care. These terms are like a Rorschach test for Americans. They snap on their perfect health care system to the term with little care for the downsides or consequences.
In fact, it's the downside or consequences that make or break the success of something. With so little thought given to the negatives, costs, etc., and so much blind faith, it feels very likely proponents are ready to push Americans into yet another big health care gamble.
Let's talk about rationally expanding Medicare. Let's make sure the system can actually handle more enrollees. I'm not giving up my private health insurance for anyone's utopian fantasies. Been there. Done that.
3
Mr. Brooks’ fear of a Canadian styled health care program is singularly based on the challenge of transitioning from the current profit oriented system to a government controlled costing system.
How did the US survive the initial implementation of Medicare and Medicaid programs?
American health care profiteers are themselves fearful of the answer.
3
David Brooks, you could not be more wrong. My mother, who is on Medicare, has no problems getting appointments with her primary physician, a recent trip to ER was covered 100%, and her Rx's are reasonable.
The fact of the matter is, Employer-based insurance is not better and maybe worse than Medicare.
As an example. I currently have a silver plan, pay $255/mo, with a $6000 deductible. So any doctor's visit besides my annual exam will have to be out of pocket. Let's do the math, ($255 x 12) +$6000.00 = $9060 a year for a sorry a$$ plan, and this from a major telecommunications company (think recent HBO acquired).
I am closely approaching Medicare eligibility and will happily pay that monthly premium and improve my medical coverage.
5
David is right when he says there needs to be a transition to a single payer health system such as we have in Canada. That's what happened in Canada. We started with private insurance, transitioned to provincial insurance and then a national plan. I suggest expanding Medicare by allowing people to sign up for it and eliminating fees for medically necessary services for all recipients. Allow people to keep their private plans if they want to pay for them.
We still have private supplemental insurance plans in Canada for things like prescription drugs, dental care, chiropractic etc.
As far as the quality of care is concerned I have had an excellent experience with my health care and I don't know anyone in my family or friends who would think of going to the US for treatment unless they had a very rare disorder that could not be treated here. Then it would be eligible for reimbursement if medically necessary. Our hospitals particularly in urban centers have expertise which equals and often excels that available in the US. Waitlists occur for certain specialties but often it is part of the guidelines for treatment, for example, knee replacements aren't done until bone on bone contact is made.
5
@Barbara Greene
"Waitlists occur for certain specialties but often it is part of the guidelines for treatment, for example, knee replacements aren't done until bone on bone contact is made."
************
Most people wait until this point to replace a joint but I would wager that Americans will not appreciate being told when they can have it done.
Americans like to be in control, which is behind a lot of their issues with insurers. They are mistaken if they think they will be any more amenable to government controls.
And controls will be imposed. Look at how NYS is starting to manage it's wildly expensive Medicaid system, which had some of the worst outcomes in the country.
Americans' health care will be managed for costs. They just don't realize it.
1
I am not sure what America you live in but it is not that easy to get an appointment with a specialist even when you are already a patient with said doctor. My husband has Parkinson's. He had a mild stroke in November. We could not get a follow up appointment with his neurologist until mid-January...7 weeks. Our healthcare system is broken and too expensive. People can and will adapt/transition. Face it David, you Republicans have always hated Medicare until you've got it. And Medicare is not free...you pay for it monthly plus you pay for your supplemental and prescription insurance to cover what Medicare does not cover. Republicans need to tell the truth and stop scaring Americans who love their Medicare once they've got it.
5
David Brooks trots out all the old, tired reasons why Medicare would never work in this country, BUT:
(1) People might want to keep their own health insurance. I don't know any, but then I'm in the wrong socioeconomic class, I suppose. Everyone I know can't WAIT to get old enough to be on Medicare and away from $1000/mo premiums with $5,000 deductibles (minimum).
(2) If they want to keep their own health insurance that bad, let them. Let the rest of American opt-in.
(3) The cost! The cost! $32 Trillion over 10 years! Yeah, and I did the math, and if everyone in this country paid the Medicare Part B, Supplemental, and Part D costs, that would cover $3.2 trillion per year. Do the math. It's not that hard.
(4) Get expectations fulfilled: Seriously? Got news for you, most people's current expectations are that we're going to have to die after going bankrupt if anything serious happens to us. I hope to God we can do better than that.
As Wonkette says, "You can't just shout "American exceptionalism!" without ever actually being exceptional. Even if means pulling a muscle or two, we should at least try to fix our broken health care system."
4
I think he makes terrific points as I simply don't believe our political class will ever have the willpower or ability to drive such a painful and controversial process. I would rather see us move to catastrophic coverage for all - cancer, trauma, etc. This could be income based - higher income folks have a higher threshold; low threshold for low income.
Private insurance or pay your own way below the threshold.
There is a perfect path to a full Medicare, with almost no fuss whatsoever.
There is no reason a 'Medicare Advantage' extension cannot be applied to the entire society. Medicare Advantage is currently the option of choice of those over 65 who qualify for Medicare.
In this option, for which there is a monthly premium by, recipients select a PPO type plan from a fairly large set of them offered by competing private insurers. Medicare sets the rates for coded medical care. There are out-of-pocket costs such as co-pays. Out-of pocket maximums, etc. Exactly like your PPO now.
Extending this to all members of society merely means adjusting the premiums to fit the clientele; those under 65 will pay higher premiums. Private insurers will not lose their place, but they will no longer call the shots perhaps. Some people will qualify for low premiums -- depending on how a BIPARTISAN Congress determines them.
This is a description of how it can work, and I am sure there are even better ideas, which will emerge over time. The point is: we can have a much, much, much better system -- and it has nothing to do with the media's perverted sense of 'socialism'.
3
Big changes often require periods of adaptability. The question is : Should we uproot what we have and do something new or continue as is? Because we pay more and don't get as good outcomes we should be open to change. There's nothing more important to the health of the nation than the health of its people.Efficiency in healthcare could be a big boon to society at large. It also frees private businesses of financing healthcare, which should be to the benefit of businesses that want to grow.Medicare for all is appealing because it would provide a standard level of care for all citizens. I suppose if someone wanted more they could purchase something from an insurance company. It could be good.
1
When I think of Medicare for All, I'm thinking of a move towards equitable access to health insurance and the government correcting the market failures in the health care industry, like drug prices. Legislation passed at the state and Federal level should be designed to address flaws in the ACA. It's hard to see the US going to a British style system where everything is socialized, where doctors are public employees and the hospitals are state run. Or a Canadian style single payer system. However, the Netherlands and Switzerland have systems similar to Obamacare, which appears to be the most feasible framework American health insurance policy should use.
1
Wait a minute, A single payer system is just that. It would not provide the care. Doctors and hospitals would not be governmental employees.
1
This article is limited ... to Bernie Sanders' MFA proposal and Canada's and the U.K.'s health programs.
But comprehensive medical coverage for every citizen exists in many other countries (I know you know this, Mr. Brooks) and few are single-payer. In Germany, all citizens and visitors get coverage. A friend who lives there worked for Cigna. My point is private insurers are everywhere; it is only in the USA that they are unregulated. A CEO of a government regulated, private insurance company in Sweden is compensated for his or her performance in delivering health care to Swedes. A CEO for a health care company in the USA is compensated for his or her ability to deliver consistent and increasing shareholder value. Hence their compensation packages. Hence their loyalties to their customers - the citizens of the country in which they operate. So a few points to add there.
1
Let's start with some basics. First, relatively few other countries have true single payer - most simply have universal coverage. In other words a patchwork of government insurance and private plans. And in particular, most people who can afford it buy private insurance for better coverage in places like Japan and Germany.
Second, no country in the world has the type of de facto open borders that we do. On the low end of the estimates, we have 10 million illegal immigrants (that's over 3% of the population). If we don't move to a merit based system like all the countries with universal coverage we'll bankrupt ourselves paying for everyone else's citizens to get free healthcare.
Third, there's no guarantee this will improve healthcare. Physicians and nurses, much like other professions such as chefs or personal trainers, are not all equally skilled. The NYU Langone's and Mt Sinai's of the world will have waiting lists stretching into the months not weeks to see their phyicians. So yes, you're appointment at Woodhaven will be free, but for many people their care will be worse.
Fourth, the government is bad at spending money. All the projected cost savings over time, ignore the US military which despite having tons and tons of money thrown at it continues to see its supremacy decline while private contractors are the ones who benefit. The profit motive of private insurers may still be better than the utter lack of motivation displayed by the MTA's employees...
3
I think Americans are increasingly persuaded that access to affordable health care is the right of every citizen and that health care should not be a for-profit industry. Having said that, I think Mr Brooks rightly points to the biggest obstacle to Medicare for all, that being employer provided health insurance that so many Americans have. You can explain to people how it's not free; trouble is, it feels free, But the millions of Americans who don't have employer provided health insurance are just a serious illness away from financial ruin. Every day many of us choose between paying bills and filling needed prescriptions. Americans are suffering and dying because they can't afford the treatments they need. Nobody in Britain or Canada has to choose between paying the electric bill and going to the pharmacy to fill an urgent prescription. Nobody in Britain or Canada worries that bad news from the doctor could result in bankruptcy. You may think Medicare for all is an impossible dream, but our current system has failed us.
2
I'd wish someone would talk about the actual costs of Medicare to the recipients because the cost of Medicare is NOT free to the recipients. Very basic health care services are the only ones covered free under Part A of Medicare paid for as part of payroll tax surcharge. For hospital coverage and more expanded coverage Social Security automatically deducts about $150 per month from your retirement checks. Then if you don't want to be saddled with the 20% of your covered medical expenses you need to buy a Medicgap policy to cover the uncovered 20%. The costs range from $150 per month to $300 per month depending on carrier, etc.
Then we come to drugs, or Part D. These are private plans you must buy. Those costs are all over the board and range from $20-60 per month depending deductible, drugs covered, etc. These plans do not make the drugs free, but give a reduced insurance company rate. So out of pocket premiums are about $6,000 a year. This does not include medical services not covered, including dental, drugs, vision hearing, etc. The average Social Security check is about $1,500 per month and if your wife is 66 she gets 50% additional if her social security benefit would be less than 1/2 of yours. This is then $27,000 per year from Social Security. So out of $27,000 from Social Security you pay about $12,000 for "free" Medicare premiums not including uncovered expense for dental, drugs, vision, etc. $15,000 for all other living expenses-rent, food, etc.
3
David - this column illustrates, in bold relief, that you are nothing but a "bought and paid for" shill for the health insurance companies.
As if private insurance companies are saints who are surely not trying to make as much money as possible off the backs of all of us.
You should be ashamed. This column is as bad, no it's not. It's WORSE than your shilling and defense of the Iraq invasion. May a horde of angry patients descend on you and yours.
2
I respect David Brooks, but he seems to be saying our healthcare system is such a disastrous mess that there is simply no way to fix it. That seems contrary to his usual message of community, connectedness and hope. Sad!
Thumbs down
2
David Brooks has got his. And that's all that matters in Brooksworld.
3
David Brooks' arguement:
The dog ate my homework.
Excuses, excuses......
2
The author of this article clearly doesn’t attack dreams if it’s too difficult
1
The only thing making it impossible are the nattering nabobs of negativity like Mr. Brooks, who once again provides us with a typical right-wing tactic - short on ideas, long on rhetoric and fear-mongering.
Mr. Brooks - you are boring.
3
Oh David. What are we going to do with you???
2
Digest this information: it costs les than $60 to have a baby in Finland
https://www.cbsnews.com/news/why-finland-is-consistently-ranked-one-of-the-best-places-in-the-world-to-be-a-mom/
2
We ask for this.....they give us That.
Mr. Brooks....it saddens me to read that you have all but capitulated to the Congressional Swindlers.
We, the american people, were pitched..."affordable health care".....and we bought it .... hook line and sinker.
But what Congress delivered.............was nothing of the sort........the deceiptfully named ACA law is nothing more than a Govt Sanctioned Monopoly for Health INSURANCE....
Theres' no mention of actual "health care" in the law.
We got played. (again).
In fact, ACA, so says the Supreme Court, is, in reality little more than a Bill Of Revenue!! Dont believe me....read the law....every financial consideration in the law is administered by ... the Internal REVENUE Service!!
I am fed up with this archaic "Medicare for All" propaganda nonsense. Its not "progressive" ... its RE-gressive, a desparate attempt for out-of-touch Democrats to cling to the fond memories of a bygone era.....circa 1968.
Let us start in the 60’s and 70’s, 1 in 10 American would get cancer now the numbers are 1 in 5 and just maybe medical for all will get the government to get off its butt and revamp the food industry, the water we drink, and the products we fill our landfills with since they won’t be willing to fork over all those tax dollars. We transition to Medicare for all with the uninsured going first and Congress last
1
Spoken by someone who has company paid healthcare. Try getting fired in your 50s and no healthcare and no Medocare. Brooks, typical health plan, just die.
2
David,
Healthcare in America is BIG business, indeed. Everyone involved has learned to suck as much monies from the trough as possible, Insurance Companies, Hospitals, Physician, Pharmaceuticals, and Medical Devices. The result is that America spends more on healthcare than other Nation in the world with worse outcomes. These are the facts.
With the realization of the above paragraph Mr Obama and Congress wrote a law, the Affordable Care Act, this was an excellent beginning while keeping the Health Insurance Companies. Once Americans got over the Republican sponsored sound bytes, they realized that it worked. So what do the Republicans do with this beginning, tear it practically to shreds. The Republican party are the representatives of BIG business, they don't what to pay for anyone to have healthcare.
Medicare is an established policy and works extremely well. I know, I use it. The transition is extremely difficult because of the Health Insurance Companies and Hospitals, two extremely powerful groups with control of "our" money. So I see the problem, but the answer is more elusive. We could lower the participation age of Medicare to 55 to start, while we return some teeth and sanity to the ACA. This could be a workable beginning.
1
Conservatives want to remove from the Constitution that part that says “promote the general Welfare.” They hate it – it’s socialism (what were the founding fathers thinking?). America is not like other countries; we’re special – the “Chosen People,” remember? We are not a team, but a random collection of independent individuals. We’re a meritocracy; we run on self-reliance. Pull together? Wouldn’t hear of it. Give everyone an equal opportunity? It’s not the American way.
We like Darwin; we like the jungle. We function best without a government.
Now, I’m sure that in David Brooks’ ivory tower there is excellent health coverage. But many Americans don’t live there – and Republicans are hell bent on taking away what coverage they do have.
Brooks states the blatantly obvious: “The American people would have to transition.” Yes, and it ain’t gonna be pretty or painless, but it has to be done. America is in the grips of many institutions and traditions that simply don’t work anymore within a 2019 reality.
Upcoming columns planned by Brooks are: “Why We Can’t Afford To Do Anything About Climate Change,” “Income Inequality Is Good For America,” "Infrastructure – who Needs it?” and “God Meant For Time to Stand Still (Why Calendars are a Sin).”
“The easiest way to get to a single-payer system would probably be to go back to 1776 and undo that whole American Revolution thing.” No David – not undo it, but fulfill it in a way it has never been done.
4
You assert that 70% of Americans who get their health insurance through their employers are happy with their coverage. Let me conjecture here that that is so because they know no better. It would be interesting to ask people who have had an exposure to other health care systems. In my case, having lived and worked in the USA, Canada, the UK, Spain, France and Sweden, the health coverage that I have got, from several employers in the USA, has always been more expensive and far worse than what I got in those countries.
1
The answer is gradually. Like a car backing up slowly, gently reduce the medicare eligibility age in 3-5 year increments, for example: lower it to 60, then to 58, then to 55, then to 50 etc.... Keep private and employer insurance alive and well and gradually transition the population to Medicare over time. Americans will get used to it. Like us Canadians, they'll soon realize it's not the end of the world and they can still supplement with private insurance for those who choose it and can afford to.
1
It is possible and inevitable. The first step was the American Healthcare Act. We spend too much on healthcare and there are disturbing statistics that our quality of care is declining. Americans want guaranteed, affordable, quality healthcare. Politics and "ism's" and outdated attitudes are obstacles to accomplishing this.
1
With all due respect Mr. Brooks, your opinion betrays a lack of concern and empathy for the 30 million plus Americans (according to the Gallup Healthways Poll) who don’t have any health care insurance.
What about their experience?
Any transition to a single-payer health care system could begin by extending converge to these Americans.
2
This opinion is a shallow puddle.
Most Medicare now comes in the form of Medicare Advantage plans, which are operated by private insurance companies. These plans are very attractive generally - as good or better than most employer-based coverage. Seems to me that this is a good starting point for a transition to Medicare for all, but David Brooks has apparently never read about these plans.
We could also take the transition in bite-size chunks, e.g., starting by making Medicare available to those 55 and over, then 45, and so on and so forth.
Could there be Medicare available to all, and commercial insurance overlays to provide additional benefits to those who want and can afford it? I think so.
Could there be an ability to opt out, and keep your private insurance while receiving an offsetting tax credit? I think so.
Yes, this is very complicated, and yes, it would be tough. But David is really just looking for the "no" argument. He seems to read a lot, but he didn't do much of it in this case, and he lacks imagination too.
1
I have been covered by Medicare as my primary insurer and Blue Cross Blue Shield as secondary insurer since 2004 when I became 65. Most Medicare recipients that I know are also covered by a private insurer that wraps around the Medicare coverage to pick up the deductibles and co-pays. Why do you say that private insurance would have to end with Medicare coverage for all? Why can't it continue and be a supplement to Medicare even if on a smaller scale? Medicare could scale back its benefits leaving more incentive for an individual to enroll with a private insurer.
Yes, government sucks and people don't like health care managed by the government.
So take your government hands out my Medicare!
Instead of focusing on Canada and England, what about looking at Germany? It is a multi-payer system that has shown to have lower costs than ours, everyone is required to have health insurance and you can choose between over 100 private nonprofit insurers. Insurance plans are not tied to employers which also would make our business more cost competitive.
2
How about...
We start by lowering Medicare eligibility to age 50. This is challenging but possible because private would probably be happy to let go of this demographic, as this is when more costly health problems begin to surface.
Then, we guarantee that those under 30 can remain on their parents' insurance. Again, this is a largely healthy group who will not incur a great deal of cost.
For those 30-49, some type of ACA system would work. This is largely a healthy demographic that is at their prime earning years.
For those who don't fit into these demographics (those under 30 who don't have parents or who don't have parents on private insurance), we can mandate that states provide a way to cover them and offer either block grants or other types of federal subsidies.
I know, single-payer and Medicare-for-All sounds simpler and more attractive to many, but we are not starting post-Bubonic Plague or post-nuclear war. We have an existing system, and trying to completely undo it will probably not be possible politically.
Politicians want to get reelected, and they rarely will put their careers on the line to support changes unless they are fairly confident that they won't get thrown out of office for doing so.
Wow David your column is just in time for the economist quote of the day:
Scratch a pessimist and you find often a defender of privilege.”
William Beveridge
293
@Rhporter I agree with you but we should not dismiss Brooks lightly. The view that people who are comfortable on their employer based plans (in many cases having no earthly idea how much their plans actually cost) are going to support Medicare for all when all the Republican dirty tricks are unleashed are deluding themselves. Did anyone see the idiocy of "death panels"? Of course not. The reality if Democrats overreach we are not going to see the dishonest Republican bus that is going to run us over. Why not start with fixing the problems with the ACA--something people actually support--and creating a "public option", something Republicans will have difficulty demonizing (but they will, believe me) and move a bit slowly. Lets not forget that the Democratic majority in the house is built on conservative areas that turned Democrat for the first time--like in Orange County, California. Lets get these voters comfortable with competence in government before we start asking them to "trust us."
17
Look at all of the ad hominem attacks Mr. Brooks. 25 million people are employed in health-related jobs. The fact is that a lot of people benefit from a large health care system--one person's expense is another person's income. This is obvious to accounting and finance folks like me. You can say the same thing about the military/industrial complex in the U.S. Whenever you change the allocation of the pie, some will get more and others will get less. But the idealists, like little children, cover their ears and won't listen.
Each year lower the age of Medicare eligibility by one year until we have Medicare for All. It's gradual, incremental, and doable.
I had to check to see if this column was written by “Grumpy Cat” who’s motto is “just give up”.
3
Oh David, you are an intelligent thoughtful man who has to pretend to be everyone’s alternative, moderate
Republican voice. PBS, NPR, NYT .... I guess it’s a living.
1
At implementation, everyone from Mexico and Central America would show up at the border with a child in hand and claim asylum. Wouldn't you?
Well, there is no healthcare solution if a current model is used, or modified. Medicare for all is a metaphor, and a dated metaphor.
Without any doubt, the country can afford to provide basic healthcare to all citizens. Without any doubt, powerful interests want nothing of the sort (partial list: republicans who fear that the browns and blacks will benefit, insurance companies that provide zero value but profit immensely, drug companies).
Add that this toxic soup, a citizenry given to hysteria, over-reaction sans sense of perspective, and the tendency to dismiss objective evidence in favor of superstition. Throw in the brains fogged by legal and illegal drugs, social media, and Fox. We could not collectively tie our shoelaces.
Solutions are not simple, but they exist.
One starts with envisioning the removal of insurance firms from the equation.
Second, one deals with issues that are best explained as an analogy: the free hip replacements for 90 year olds who also get free Viagra.
The last six months of life that suck up $300K, is unsustainable; the notion of palliative care among "know nothing biblists" is a non starter.
Then one considers "pay a fee" to see a doc, in an environment where the doc gets to practice medicine than focusing on gaming the system of insurance and medicare. Make money people spend on improving health - tax deductible.
There. A start, if not the finish. Can be done. Like, totally.
How could you transition? Well, like Canada did. Take a look.
3
When the hospital charges your insurance company $49 for an ace bandage, you know it’s a dirty racket!
2
What happened to American Exceptionalism, Dave?
1
This is just nonsense.
Other rich countries do it. Are Americans just EXCEPTIONALLY stupid?
Sure it would require some changes throughout the whole health-care system. But, this system is notoriously inefficient. It should be changed.
4
Coming soon to this space - David Brooks health care plan.
2
I am starting to believe the NYT is just putting up straw dog columnists, so that the paper can print reasonable modern positions, without having to take responsibility for those positions. It makes it easier to continue getting advertising dollars.
It is frankly, bizarre, that this is the level of discourse. And further bizarre, that the country with the greatest concentration of wealth in global history cannot feed, house, or keep healthy a huge percentage of its citizens. The United States may be one of the greatest criminal enterprises, ever. The great con. Who’s happy now?
2
The British model is perfect, but only in theory. It never worked because no government was and is willing to invest sufficient funds. Consequently the British health service is one of the worst on earth. Not to mention the idiotic tradition that a so called consultant (a medic specializing in one field) is to be adressed as "Mister" and would never reveal the result of his investigation to you but only to your General Practitioner as if you were an idiot. The French and German health systems are near perfect. The US haven't got a chance to ever get there. Not to mention the criminal fees American doctors (and lawyers) charge even for trivial matters.
I have some sympathy for the US predicament -- and no, not in the usual Canadian way. My uncle by marriage was president of the American Medical Association in the 1950s, and by extension my family bears some responsibility for the US failure to adopt universal medicare when it should have been politically feasible. So if, like Prime Minister Trudeau, I were addicted to apologies, I would get out my kneepads and bow to the south. But, you know, my experience with Medicare hasn't been too bad. I can remember when we switched from private to public in the 1960s, and I can't recall any pangs of regret for my private insurer -- actually in those days, a non-profit. I'm inclined that even you, David, would not find the cultural leap to single payer too much of a gap, or a gasp. And I like visiting my general practitioner with the knowledge that money does not come between us. Now that's a special relationship!
2
We need to rethink this. Medicare only covers hospital stays. Supplemental insurance plans cover everything else. As a senior I have a choice of multiple insurance plans. They all include covered wellness checks which are important to staying healthy.
If I'm starting to have a problem I can go to a doctor and often get help so I never have to go to the hospital. That help can include flu shots, pneumonia shots, and shingles shots for starters. I also get regularly checked for a myriad of potential health issues that can be dealt with before I would ever need a hospital. Good primary care decreases the need for hospitalization.
I pay about $250 a month for my plan that covers most co-pays and deductibles. Another $75 or so a month gets me dental and Rx coverage. Of course there are other options, but this is what I chose.
Medicare, plus supplemental plans like I have would cost the rich less, would still keep insurance companies and employees in business, would encourage individual responsibility and provide choice.
Please stop referring Medicare for all as if it will solve all our health needs. It won't. Do explore supplemental care that comes along with Medicare.
3
The plausible route from the Affordable Care Act to Medicare for all was the Public Option, which the Republicans and their toady Joe Lieberman were quick to torpedo.
It is not necessary to replace private insurance overnight. Such a transition would indeed be wrenching.
1
@Jasr
The problem with the public option is that the people who would sign up for it would be those who are sick and poor. If you have good employer provided coverage and aren't saddled with huge co-pays or deductibles why would you go for the public option? This would be a boon for the private insurers funded by all of us taxpayers. Again, privatizing the profits and socializing the risk.
Medicare for all would have to be better structured, planned, administered, and executed at a higher level than the majority of public schools. Otherwise you end up with private insurance filling in the gaps for those who can afford it. Just like private schools.
1
David Brooks MAY be correct that Medicare for All is an impossible dream, but that is because of the undue political influence of the pharmaceutical and insurance industries…see today's NYT piece on the oppression of the majority in the US.
https://www.nytimes.com/2019/03/05/opinion/oppression-majority.html.
But please stop bringing up the same old tropes that a single payer system will necessarily bring about long wait times and will drive physicians out of business. It's not an inevitable result of the system, but of how it is financed. We pay almost twice as much of our GDP for health care as do Canada and Britain and get poorer outcomes. Imagine what Canada could do if they spent what we do, and they already do pretty well.
I'd be fine with paying what we do now if everyone could be adequately covered, there was no private insurance profiteering and drug prices were the same as in Canada and Europe, although our healthcare spending WOULD drop significantly with a single payer system. But, without a revolutionary change to our election financing system, I don't see a path to Medicare for All any time soon…and I am a physician who has been pushing for this for years.
2
What Brooks describes is only one version of universal health-care. There are many different ways to get there. I like the phased in model, where 1st anyone 50 and over can opt into medicare. Also, add a single-payer option to Obamacare, like there should have been in the 1st place. This will apply to all states. Then revisit the questions and go from there. Saying this is what it will be and then set up all the supposed consequences is insincere.
So many things wrong with this analysis (from the NYTimes resident health care policy expert). Had Brooks pose a series of questions and concerns, maybe this would have been an interesting read. Now, it’s just a closed-minded, head-the-sand, sky-is-falling diatribe.
3
This may be the most entitled opinion piece I have ever read. Clearly, you don’t have a clue. People are dying because they can’t afford their healthcare. People who have insurance can’t afford their healthcare. People in the gig economy don’t have health care. Could you possibly sound more clueless? I don’t think so.
5
We have medicare for all.I truly do not understand why the US is fighting against it.Everyone who needs medical attention, surgeries, procedures, here just gets it free out of pocket...yes we pay taxes but isn't that what taxes are for....funding the good of the many....If you do not have your medicare card when you get to hospital it's just...no worries...we'll look up your registration number and direct bill....a few questions...you're in....I can't imagine a country that excludes those most needy...I have a friend here whose son needed surgery...First surgery as a child...free.Then they moved to the US and later on he needed a second...it was thousands of dollars..the health of everyone should be a government's responsibility.
3
Let’s set up a pilot program in few blue states. Let it be funded by taxing the citizens of these states. Let it run for 5-6 years and see results. Then we will deside if we really want it.
1
So, basically your bright idea is to keep spending 17% of GDP in an inefficient system that does not cover everybody, and produces sub-par results compared to others in countries that have a longer life expectancy.
VERY conservative...
3
Mr. Brooks: Typical Republican gibberish. We can provide gigantic, budget busting tax cuts for corporations, wealthy folks like you, and plutocrats like your pals the Koch Brothers, but for the American people, sorry no can do. Maybe the Republican Party should rename itself the Can't Do Party: can't do healthcare, can't do immigration, can't do child care, can't do gun control, can't do free public tuition, can't do nothin'.
And their motto should be: Tough Luck America.
4
Republicans:
1. Medicare - “the impossible dream” (socialism)
2. Social Security - “the impossible dream” (socialism)
3. Medicaid - “the impossible dream” (socialism)
4. Civil rights - “the impossible dream” (races can’t mix)
Universal health care - added to the list.
2
As usual, we can only make changes when David Brooks and conservatives say it's okay.
They really, really, REALLY, like things the way they are.
Sigh
3
So, a pundit who has told us over and over that we must be ready to embrace "creative disruption" in the economy as a force for good, now tells us that disrupting the medical industry would be disastrous. He claims that we would have to undo "that whole American Revolution thing" in order to pivot away from the oppressively bureaucratic, numbingly complicated, hideously expensive and yet obscenely profitable hot mess that is U.S. healthcare. What a distinct lack of faith in America this corporate lickspittle viewpoint represents.
We're the US of A. When we finally get around to it, we put on our big peoples' panties and we can do moon shots, pass civil rights legislation and bring electricity to rural America. We need to stop questioning our ability to have a health care system that meets the needs of our population and just start figuring out how to implement it. We're better than this, Mr. Brooks, and we DO deserve nice things and since we're already paying more for our present system than every other industrial economy in the world then yeah, we can afford it.
3
Let's just stay with a broken system instead of doing the hard work to transition to a better one. I am surprised Brooks is so quick to quit.
How like the "stay the course" advocacy for "president" W in 2004.
I see Brooks omits that fact that US "health" insurers are for profit (they weren't 45 years ago) that's a huge waste of resources he's implicitly supporting.
Typical familiar Repub narrative of it would be hard to transition, insurance companies would lose employees, etc, etc. Then he goes off the deep end saying we’d need to scrap Congress to make this work? Really?
This is yet another opinion piece by David Brooks where he puts up a strawman and obliterates what is essentially a good idea by focusing on the potential negative aspects of the implementation, rather than applauding the direction of the idea and offering constructive ways to implement it. No doubt before Medicare For All could be implemented it would go through many policy and practical iterations. But the startling truth is that over the top healthcare costs in the US and the lack of healthcare for many people who need it but can’t afford it Is a sad story in the world’s wealthiest nation and an ugly embarrassment. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-s-spends-disproportionate-amount-health. Something urgently needs to change to correct this sorry state.
1
Regrettably, your facts are wrong. Medicare collects troves of data on treatment costs including direct costs, overhead, capital expense, executive salaries, insurance, education of students, and differences in regional cost of living, according to Stephen Brill in his seminal Time expose. Providers complain about Medicare rates; but they do reimburse actual cost.
Secondly, hospitals charge almost 400% of Medicare rates, and insurance reimburses on average 70% of that. So hospitals price-gouge patients while they are naked on gurneys. (To add injury to injury, hospitals now sue patients for deductibles which are nearing $1,500 for employer plans. Nearly half of low-income families in WA now have legal problems with medical debt.)
Finally, people are happiest with Medicare 77% to 61%.
The rhetoric of the healthcare industry is finely-honed and practiced to prevent us from trying to change the system. They spend more on lobbying than any other industry. They bamboozle us. If you would like to write columns on this issue, more research will be needed to counter their false claims.
https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx
https://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html
1
Hey, you want to know what the satisfaction rate is for seniors on Medicare? 84%. [http://medicaretoday.org/wp-content/uploads/2016/07/8.21.18-Senior-Satisfaction-Survey-Fact-Sheet.pdf]
A logical way to move towards a single payer system would be to simply offer medicare coverage for purchase to everyone eighteen and older. David Brooks cannot see a way towards universal healthcare because he's a paleoconservative with quasi-religious beliefs about how government works.
1
While some who call themselves "conservatives" might prefer that sick and disabled citizens who can't fully pay their way just vanish to pay for the tax cut of the Republican Party financiers, that is not what will happen. Without good health insurance, ill and injured working Americans often become poor and unemployed Americans. They stop paying taxes, families lose breadwinners and society picks up the cost of both healthcare and welfare for them and their dependents. . There is no doubt that giving all Americans good healthcare, would extend their ability to work; make them more productive; Keep families together; Avoid bankruptcies, and actually do more to make America great than slogans on hats. The ACA, (Obamacare), should have been named the keep Americans Working Act, because that is exactly what it accomplishes in the long run.
Great nations do great things and Medicare for all would be a great thing.
4
@rich
Yes healthcare is a good investment that largely pays for itself in terms of the increased taxes healthy people pay. Unfortunately, the Republican party does not value this kind of investment in its people, or as David Brooks says, "these purported savings ... down the line."
https://www.vox.com/2015/1/12/7531707/medicaid-expansion-tax-revenues
@rich Not great things, Do the" Right" Thing.
Americans' ability to address great challenges defies Mr' Brooks's reasons why "it can't be done." Efforts during and after World War II show what can be done with strong-willed leadership. The same is true of landing on the moon and with pulling the country out of the deep 2008 recession.
People who are happy with employer-provided insurance are not happy when they lose their jobs in a fickle economy and don't find replacement insurance at reasonable cost. Health coverage should be portable, affordable, and accessible. Employer-provided insurance is not portable; private insurance is often un-affordable; private insurance coverage for people over a certain age or with certain medical conditions may be neither affordable nor accessible. In our society, book-ended by aging baby boomers whose jobs may be disappearing on one side, and "millennials" who often change jobs or are involved in a "gig" economy on the other, achieving the desired result of portable, affordable, and accessible health insurance coverage in today's world for oneself and one's family is pretty hard. Let's not even the startlingly increasing costs of pharmaceuticals.
I think Mr. Brooks addresses concerns for a static society, not for a rapidly changing society.
1
My family and I spent four years in Copenhagen recently, paid into the Danish tax system and received the benefits of their health care system. Some observations based on our experience:
The system is controlled by a gatekeeper: a family doctor who decides what healthcare is required and whether a specialist is needed. The gatekeepers are generally very competent and efficient, but you should not expect more than about 10 minutes of their time during an office visit
In our experience, the wait time to see a specialist was not excessive. A couple of friends had detached retinas that required emergency surgery and this happened immediately. Knee and hip replacements do not happen immediately, but again, the wait was not overly long.
We had a number of eye-opening experiences that illustrated the different approaches to medicine in US and Denmark. My wife needed a procedure that in the US would require general anesthesia, presence of multiple doctors and nurses, and would cost $11,000. In Denmark, the doctor did the same procedure on an out-patient basis in her office for around $150. I attribute this to the risk-averse nature of US medicine, coupled with the fear of lawsuits
The Danish medical records system is fully digital, and we were constantly impressed by how well it worked. Nonetheless, Denmark doesn’t have the same obsession with privacy that we have in the US
On the whole, we were very pleased with the medical care we received in Denmark.
2
If only we had the resources of the following nations .......
Austria
Bahrain
Belgium
Brunei
Canada
Cyprus
Denmark
Finland
France
Germany
Greece
Hong Kong
Iceland
Ireland
Israel
Italy
Japan
Kuwait
Luxembourg
Netherlands
New Zealand
Norway
Portugal
Singapore
Solvenia
South Korea
Spain
Sweden
Switzerland
United Arab Emirates
United Kingdom and;
Australia.
..... we might be able to afford this luxury.
384
@Ian MacFarlane
Actually, the healthcare systems in virtually all of the countries you've listed in no way resemble what Canada and the UK have. What Mr. Brooks, perhaps somewhat disingenuously, is saying is that "Medicare for All" isn't going to work and, though I heartily favor "universal health care" ala Germany, I am inclined to agree with him. Until one knows the difference between these things, and can make an informed statement regarding them, I would hazard one is better making none at all.
23
@Ian MacFarlane
and in other countries not on your list, there is still regulation. Especially pharmaceutical costs. i.e. The gov't of Turkey subsidizes pharmaceuticals and cost at the pharmacy is incredibly low.
11
@Glenn Baldwin
Our nation is arguably the wealthiest in the world. Why we cannot afford healthcare for all, while we can afford the by far largest military budget on the planet, speaks of a planned disconnect which, for millenia, has kept armed men in power.
As you note, one may be uninformed, but not without the ability to reason.
36
David,
Your argument that having to deal with the transition to Medicare for All would make the change impossible — “you can’t take away what I have now!” — is undercut by the fact that millions of us who are 65 or older have managed the transition very easily and are pretty happy with the result. Consider also that employer-sponsored insurance is no more certain than a person’s current job (making it an inherently unstable benefit) and that a main reason a person might be unemployable is a chronic health issue, so I can easily lose my health coverage along with my job just when I need the coverage most. Add that this unreliable private system may cost 40% MORE than a single-payer public system, and one could start to wonder why anyone who is not profiting from it would defend the current system.
1
Right on, regarding single payer. But there are other ways to get our failed health care system to work without going to "Medicare for All." Among them is the German system as discussed in an op-ed piece in this newspaper by Jamie Daw entitled: A Better Path to Universal Health Care. And she is a Canadian.
How do we do it? Just rip off the bandaids.
2
Decades ago, at my welcoming assembly to Brooklyn Tech, the principal, who served as a Navy engineer building airfields on wartime Pacific islands, gave a short speech, which ended this way:
"Like the Seabees, a Tech student's motto is....Can do."
Just because David Brooks can't, doesn't mean we can't.
1
Gee, I wonder how other countries got from here to there. Perhaps when their health care systems became grossly unaffordable they figured a way. Perhaps if someone proposed “Medicare for none” we might see what political will really looked like. The medical industry has suckled at the teat of American prosperity for far too long. Time it be weaned.
So Mr. Brooks, your chief concern is transitional logistics, re. Single Payer? I think your conservative, pro-capitalist no-matter-what bias is showing. First of all, higher taxes doesn’t mean simply hand bureaucrats money. It means you are paying more taxes that pay for medicare costs, and LOWER your healthcare bill by a wider margin than any tax increase. Is that so hard to grasp? Also to apply the term “monopoly” to the government is disingenuous. Also, employer-provided healthcare research you cite (70% “happiness rate) applies to the plans themselves, not happiness with the system. Why?- Because “benefits” are used as leverage against offering better salaries. And by the way, one wonders if the respondents of this study were certain of their anonymity in providing answers. And these respondents talked about “satisfaction,” not “happiness,” Mr. Brooks. And sorry if I don’t cry over the destruction of the insurance biz as we currently know it.
Yes, lower healthcare costs would affect certain industries. That’s OK if the vast majority wins. Re.KFF survey stating “only 37% of Americans support” Single Payer. Really? So why does the most recent KFF report state: "56 percent of the public favor a national health plan, sometimes called Medicare-for-all…” Oh and somehow we’re now unpatriotic if we vote for single payer - thereby [“undoing”] "that whole American Revolution thing.” What? Simply because we’re looking to emulate Britain? Please.
1
David, first I don't know who these 70% of people who are satisfied with their health plan. Honestly, I can't remember the last time I worked somewhere and NOT heard people express dissatisfaction with the craptastic coverage and increasing costs offered to them. The new plan at my current employer is pathetic and the only course was to supplement the ONLY paltry option with a medical savings account.
The transition would probably have to start with a public option. That way if you're rich and can afford to buy Cadillac plans you can. Once people see a more affordable way (Medicare operates on a 3% overhead while private insurers struggle to get their operating costs under 20%) people might start to change their thinking.
That is if they can stop themselves long enough not to be swayed by inaccurate use of the term socialism.
Interestingly, I never hear anyone question where the money is going to come from for the next pork barrel pentagon expenditure.
What a con job.
The ugly little thread running through so many comments on this topic is that, at the end of the day, most people simply don't care that there are so many Americans that can not afford proper health care. In short, they're OK with letting others (as one put it here) "bleed to death at the curb". Transition is a problem? Deal with it, America. "Our history makes it difficult/impossible to transition? Baloney. David Brooks makes me wonder what has happened with "conservative ideals" and I'd consider a nation being able to pull up its breeches, recognize that its no longer the 18th century and pay the price for its social indolence over the last 200 years. Its bad enough that our infrastructure, mortality rate and educational system is made to look like Toonerville next to France, Germany, and Singapore for heavens sake. We've become a nation of lazy entitled indolents and its time to address the most basic need of any truly compassionate nation: proper health care for ALL of our citizens. Getting it at work? Great. Stay employed, my friend. NOW how much "choice" do you REALLY have as a human being?
Another example of Republican't thinking.
1
It is an impossible dream as long as the insurance companies are in charge - and they are, because the are major donors to the campaign funds of both parties
Obama gave them what the wanted, record profits, 'cause he knew that otherwise they would kill his projects - remember Harry and Louise ?
Click here to see how the insurers made out under Obamacare
https://www.economist.com/sites/default/files/imagecache/640-width/images/print-edition/20151205_FNC666_0.png
Notice how their pre-tax profits increased from $ 15 Billion to $ 25 Billion, from 2009 to 2015 !
They nearly doubled in a mere 6 years
1
Brooks relies on an AHIP (Americas Health Insurance Plans) survey in his absurd claim that "70 percent" of Americans with private insurance are "happy" with their coverage:
https://www.ahip.org/wp-content/uploads/2018/02/AHIP_LGP_ValueOfESIResearch_Print_2.5.18.pdf
Using an industry sponsored survey in a Medicare-For-All hit piece by Brooks is not surprising.
The pro-corporate propaganda spewing from this "news"paper on a daily basis is disgusting.
1
There is not adequate space here to refute all the errors of fact and insinuation in this column. As a Canadian who has lived lengthy periods in both systems I can definitely say that this column perpetuates the myths that the United States medical insurance companies nurture.
Americans are the losers as they seem blind to the billions in the system that could be spent on health care but are not. Those billions end up in the pockets of insurance company shareholders.
1
You're not the first person I've heard suggest that all but a few rich Americans would be much better off here if we had lost the Revolutionary War to the Redcoats. We'd be Canada, a much smarter, happier, and healthier country than the U.S.
1
Have some faith Mr. Brooks. We can't put a man on moon either. Nor can we defeat the Nazis. We can't build an international highway system. I could on and on and on about the things we Americans can't do.
1
Your Money or Your Life.
I am a health care industry and insurance company investor, and unlike doctors and health care workers who care for people, I do not. I care for profit and the CEOs of all of the companies in which I invest, work for me the stock holder.
Our goal is to make as much money as we can off human illness and suffering, while providing service in a manner that keeps us in business and within the law as our attorneys interpret it.
Profit drives our policies and practice, not what is best for patients and the nation.
The old time highway robbers used to say "Your money or your life" and many of them were caught and hung. But isn't it great........ we can take all of your money, and sometimes even your life, and yet remain respected pillars of the community.
Our nation has socialized military, socialized police, socialized legislatures and socialized court systems, because if those institutions were turned over to capitalists it would subject America to great harm and expense perpetrated by people like me. For profit health care is no different.
It is illogical to allow profit to be part of any system we must use to avoid suffering and death, because like the Mafia, business will use the inherent leverage to extort a price most cannot afford, but all must still pay.
4
@rich
I can't decide if you are masking your truth behind a facade of an investor or if you are, in fact, an investor. If you are the former, your sardonic wit works well. Swift would likely nod at the success of your mask. I think your choice of the short, lower case name suggests this reading of your comment is likely true.
If you are, however, the investor you hold yourself out to be, who has profited from the very system you rightfully condemn so you can spend out your years on an upper middle class island in Florida, then you, like too many of us, are merely afflicted by the rot at the core of the American soul.
In either case, your point is well taken.
I don't know where you are getting your data on reimbursements, but my employer provided retiree insurance only rarely reimbures any more than Medicare, certainly not anywhere near the difference between 87 and 145 percent.
The following is from a 2017 edition of the New York Daily News. It describes the third-world conditions you seem content with, Mr. Brooks.
"A fairground turned into a huge makeshift hospital offering free medical, dental and vision to thousands of desperate patients in Virginia, to deal with the U.S. healthcare crisis. People traveled miles and camped overnight to be seen by doctors who used barns, trucks and animal stalls to carry out treatments and examinations."
Oddly enough, I've never seen anything comparable in Canada.
A side note. I was having night sweats. Went to my doctor that morning, and he diagnosed atrial fibrillation. He booked an appointment with a heart specialist that very day.
2
Finally, a well thought-out column on Medicare for all.
Another fact that David didn't mention is that more and more doctors are refusing to accept Medicare due to the low reimbursement rates. Doctors either make due with younger patients or alternatively go concierge. Finding a doctor that accepts Medicare can be difficult as it just doesn't pay enough.
1
Figuring out how to get from here to there is not the first requirement. The most important thing is to see the necessity of getting there. Where there is a will, there is a way. Necessity is the mother of finding the way. We would not have put a man on the moon and returned him within the decade if Pres. Kennedy had listened to the scientist who said it couldn't be done.
Its particularly impossible because our bipartisan political class and their 1% puppet masters want to import many more 10's or 100's of millions of no English, 3rd grade education equivalency immigrants into the US which will transform the whole of the USA into a 3rd world like "low-wage" economy in which very few will make enough income to pay taxes - put money in the national treasury necessary to pay for such an expensive government benefit. And you can forget about some Marxist like OC taxing the billionaires in the resulting oligarchy to get the cash. Because there's no reason to believe that they'll be any less able to hide their loot overseas in future - when we have the totally "open borders" world that the democrats, republicans and and our assorted 1% elites want so they don't have to obey the laws and regulations of any society or nation state.
"Americans are more decentralized, diverse and individualistic than people in the nations with single-payer systems."
Read the book "Excellent Sheep" on how American education has become, in effect, an intellectual and academic conformity/docility contest, and a how this is the *real* agenda of we call "meritocracy," and b) this agenda has successfully molded, or at least reinforced, the ethos of the upper class and any subordinate swaths of the population that class and its educational system have successfully molded for employment purposes, which is to say-- cumulatively 99% of the population, minus the few who have successfully resisted this form of socialization. In other words, we are, for all the feistiness, self-assertiveness, and of course competitiveness seemingly built into the American character, it's in a context of extreme authoritarianism and intellectual and cultural conformism.
I say, don't let insurance companies or any other interested parties hold unkversal affordable healthcare hostage to commercial principles norms and values. Whatever steps are necessary to de-commercialize healthcare and render it a true "profession" (calling, not profit-driven business) in the authentic sense of the term, must be taken, if America is to catch up with counterparts vastly more civilized in this respect. Market has become too much of a religion here, and healthcare is where to start correcting this; education next, then other so-called "professions" (now businesses).
2
What good is private insurance if you can't use it because of the high deductibles? If you can't afford the premiums for insurance then where do you go when catastrophic illness strikes? How many senior citizens are unhappy with their medicare? Mr. Brooks come look at the real America? As more and more Americans are priced out of the healthcare market, medicare for all might be the only solution.
3
Let’s face it. The reason Obamacare hasn’t lived up to its potential is because it was sabotaged by republicans since its inception. The terror shared by the GOP and the medical industrial complex was simply that - if given a fair chance - the ACA might have succeeded. That it still clings to life is testimony that with a little tweaking we might not be having this Medicare for all conversation right now. But since we are, conservatives are already locked & loaded, hammering the evils of “socialism” into the national conversation every chance they get. That the battle lines are already drawn is informative and we shouldn’t make any mistake about what the right is fighting so hard against: poor people having adequate medical insurance.
2
The U.S. literally wastes 6% of our GDP each year by paying more for healthcare than is necessary. Our peers spend 10% of their GDP and achieve health outcomes at least as good as we achieve with our outlay of 16% of GDP. Given that U.S. GDP is roughly $20 trillion per year, the cost of all our inefficiency and price gouging therefore amounts to $1.2 trillion each and every year. A trillion dollars is too large to wrap your head around, but putting it on a per capita basis reveals that we waste $3,636 annually for every man, woman, and child. That amount of money devoted to satisfying other wants and needs would go a long way towards improving our stagnant standard of living, but particularly so for American families earning the median income (approximately $60,000) or less. So yes, reforming the system will be hard because a myriad of vested interests has a financial stake in perpetuating all the waste and inefficiency (one man’s cost is another man’s income). Still, the stakes are so high that we should at least make the effort rather than throwing up our hands in despair.
1
The U.S. will never have health care or health insurance for all until we have governmental administered care or highly regulated insurance providers. The for profit free-enterprise system can't work unless providers can exclude or limit their losses. Why does it take us so long to figure this out when the other western democracies and Japan did decades before?
Now, we must accept our failing system or change to a proven, accepted model from elsewhere. There are no easy magic wand solutions that don't involve arguments over funding. Let's get to work!
1
As an American living in Canada I have seen the best and the worst of medical care in both countries and, believe me, it's much better in Canada. Do not listen to the scare mongers, those who tell the "truth" about all the people supposedly dieing while waiting for surgery or the over 2month wait for an appointment with a GP. Some of these untruths may have credence in very small towns located far from hosptials, but this is true everywhere. I have never waited longer than a few days for an appointment with my family physician and often can see him within a day or even a few hours of my call. Getting to see a specialist may take longer, but situations are evaluated and emergencies are cared for immediately. Unlike my family and friends in the U.S. I do not have to be concerned about paying for care should I have a heart attack or a major accident or develop cancer. Yes, our taxes in Canada are higher than in the U.S., but we do not have to fear bankruptcy-by-healthcare or do we have to choose whether to pay for dinner for our family vs, seeing a doctor when we are ill or have an injury!
3
Insurers don’t provide healthcare they deliver two services enabling healthcare delivery-financial protection from financial risk uncertainty-distributing costs between participants. Large businesses costs are predictable, and they need little or no financial protection. Universal cost data is predictable, and the U.S. Treasury doesn’t need protection. Administration is a process soon to replace humans with technology, whether a public or private function. Some suggest free market private insurance is efficient due to competition. Mergers, acquisitions and regulatory quasi-monopoly eliminated competition. Currently, large businesses can eliminate insurer costs giving them a competitive advantage over smaller businesses. Start up and small businesses can’t afford to offer healthcare benefits and middle markets can’t afford the efficiencies of self- insurance giving larger companies a recruiting and cost advantage. Business provided healthcare limits employee mobility between employers or entrepreneurship. Removing healthcare cost from business increases their global competitiveness. What about societal costs of people without healthcare coverage? Lack of preventative care, unnecessary emergency room costs, lost productivity, financial uncertainty resulting in bankruptcy and other desperation leading to criminal activity, drug use, active shooters and a multitude of anger or fear responses are all costs. Cost to society will be far less with Universal Healthcare.
I have to believe that many people commenting here are not on Medicare, and consequently have no idea what they are proposing. They seem to think it is free to the covered, with no premiums, deductibles, co-pays, etc. That is just wrong. I pay $200 PER MONTH in a premium automatically deducted from my Social Security check. I also have deductibles and co-pays for everything. Like many, many people on Medicare I also purchase a Medicare Advantage plan to cover what Medicare does not---like vision and dental. If you decimate private coverage, we will lose our Advantage plans. Medicare for All is really nothing more than Medicaid for All.....everyone will be reduced to having the lowest, slowest, worst care. If you continue to mis-characterize MFA as free to the users, you are going to have to do a lot of explaining to people who currently are out from under Obamacare's mandate and are happy with the coverage they choose to have or not have. This is just Obamacare on steroids, and we will all end up paying a lot more for a lot less.
3
@Nancy
Americans have a fantasy about what health care would be like under the government. They would get the same high qualify state of the art care they are receiving now -- when they want it -- and without having to go bankrupt.
The problem is they never conceive of any consequences beyond the demise of the for-profit insurance companies.
They don't think about cost containment (always rationing in every single system). They don't think abut losing specialists or tests. They don't think about politicians interfering in their health care for political gain. Only bad insurance companies behave this way in their ideal scenario.
Never mind whether our current system can accommodate tens of millions more enrollees. Remember that Obamacare system disaster? And that was just a simple front end system.
What dooms this "Medicare for all" utopian rallying cry is a total disregard of the consequences. It's as though none exists. That's nonsensical thinking, and certainly no substitute for a clear-eyed assessment.
This is entirely too important to "go for it" and worry later.
David is right, "Medicare for All" is going to be a tough sell. Most insured Americans, not of retirement age purchase their health care through their employer with pretax dollars. They have access to good coverage at a reasonable cost and tend to be happy with it. The crisis in American health care that president Obama attempted to address with Obamacare was for the Individual market. Hypothetically, what would happen if all Americans were placed in the same insurance pool? Require Insurance companies to provide the same product at the same price that they do for group purchase, to all customers. Then allow individuals, like group buyers, to purchase their coverage with pretax dollar. Following that, develop a formula for determining reasonable affordability providing taxpayer subsidy, making that insurance affordable to all low income individuals.
1
There are many issues with this piece by Brooks. Firstly, many people are happy with their insurance, because most people don't have devastating illnesses occur. When this happens, and you find out that you are not covered, you need a transplant or intensive care or extra medications, that is when you find out that the cheap insurance you had was not so good.
Concern about higher taxes to pay, well the overall cost of medical care should be lower, because of less profit in insurance, negotiating better prices for drugs and other services, less money spent on appeals. If you are no longer getting insurance through the employer, then you should receive an equivalent increase in your wage, which should more than offset an increase in taxes.
The entire health care payment system, in which procedures are reimbursed at a higher rate, incentivizes more procedures, which wastes much money. Reimbursement should based on maintaining the health of the doctor's patients, not on their illnesses.
Oversight and budgets need to be maintained. Further, if education is not so expensive, then doctors will not start in so much debt, and they should be very comfortable with less income. I don't think we need to start the country all over again to realize what most industrial countries on this planet have figured out.
Well David, I hope you are enjoying YOUR Medicare as much as I am. That being said let's look at the 70% who are getting their insurance through their employers & are happy with it. Why wouldn't they be happy with it if it is already paid for? Why not poll the population that pays for their own insurance. I was paying almost $1,000/month at age 63 before medicare. I had no problem with the care or coverage, but the actual affordability? These costs are really beyond affordability.
2
A not for profit public option should be considered rather than Medicare for all. Individual insurance payments are very high if not received through employment or other group insurance. The healthcare industry is doing very well on the backs of doctor/patient.
1
The notion that the rates charged by Medicare today would extend to any services provided by "Medicare For All" in the future is a laughable assumption. As anyone who understands the current health care delivery system knows, the higher rates charged by private insurers compensate for the artificially low rates charged by the current Medicare fee structures. Anyone who is calculating savings predicated on the assumption that all future insurance costs would be comparable to current Medicare reimbursement rates is going to wildly overestimate the savings from such a plan.
Good Grief.
So you are saying that a country as rich and ingenious as America can't do what has been done in virtually all western European democracies and Canada.
Did those countries magically 'appear' with Medicare...or did they all face similar 'barriers' to developing and deploying Medicare? Do you imply that the USA doesn't actually get an advantage by studying how many different societies have already managed to pull it off?
The real problem, David, is a lack of imagination and a level of greed in the Republican Party that is, frankly, to put it in terms they underestand..."unAmerican" and "unChristian".
Maybe look at it this way...INVEST in your human Capital to maximize productivity and profits. There...that sounds more your speed.
2
The Medicare for All movement has been around a while and has been mostly ignored by the elites. That the pundit class is now aggressively attacking it is a sign of the movement's gathering momentum to replace our insane sick care system with something that isn't nightmarish for most involved.
2
I gotta say, David, you’ve done a fabulous job of knocking down that straw man and kicking him to smithereens. Were you really unable to come up with any way to gradually transition from one system to another, say, by lowering the enrollment age for Medicare in stages rather than all at once?Or by introducing a public option to Obamacare and expanding it over time? Or we could start with a public option and see how it goes, and decide later what steps to take. And you don’t seem inclined to take into account the tremendous reduction in administrative costs in a unified system. Instead you decide we would have to move to a parliamentary system of government. (Maybe that was a joke, I don’t know.)
You start your column by saying how good single payer would be, and then throw up your hands in despair because there’s just no way to do it. C’mon! It’s not that hard.
2
David, I love reading your opinions even if I don’t agree on your viewpoints. There was so much negativity here and so much wa-wa, I couldn’t finish this one.
Stay positive.
1
If the managing editor of this paper reads comments by readers, I wonder what he thinks of David Brooks and his fit in the OpEd Page?
Honestly, I have not seen many articles where more than 20 percent of the commenters had ANYTHING positive to say about the piece.
This one is an excellent example of how out of touch with domestic and international reality this man is. 70 percent of Americans are supportive of Medicare for all. Our congresspeople are all in a Medicare equivalent plan. A huge majority of people who reach 65 give up their private insurance provided by their employers and enrol in Medicare (it would be nice if Brooks or NYT provides the percentage that do that - but I guess that is what we expect of papers like The Guardian of the UK).
I am sorry to say but both the paper and Brooks are way behind the times.
1
"Transition." Mr. Brooks uses the word throughout the essay but seems to define it as "immediately adopt." Gradually raise the enrollment age? Have you heard about that transition? This is a straw man argument if I ever heard one.
I also don't get the anti-American theme. It's going to be hard, so why bother. With that attitude we'd have a monarch on our currency.
Usually Mr. Brooks is worth reading, but this essay was absolute hogwash. And that's not even getting into the elitist aspect of his stance.
Short story: I can't get a full time job because my employers don't want to shell out for health insurance. So I'm stuck with multiple part-time jobs. And I'm one of the lucky ones. At least I have multiple part-time jobs and education and skills. I also have tons of student debt and no savings what-so-ever. Retirement will be the day I die.
Mr. Brooks writes, "No plausible route from here to there."
To that I say, "Go [censored]."
It would put the Sacklers & Teva Pharma out of business?
Medicare for all? Yes, impossible. Just like abolishing slavery, a minimal wage and 5-day workweek, mandatory universal public education, putting a man on the moon, a transcontinental railroad, eliminating polio, sending pictures through empty space around the globe, a conservative columnist at the New York Times. . . . . All impossible dreams.
3
David: The fact that you dedicated a column to try to refute “Medicare for All” is telling - your anxiety is showing!
Now, isn't that odd.....?
Problems in this country can always be solved..... except and unless we are talking about anything that would help real, live human beings who are on the bottom rungs of the Brook's ladder.
The super-uber wealthy were feeling poorly, so Mitch and Trumpence gave them almost 2 TRILLION DOLLARS in tax cuts - thereby weakening all institutions.
And when the military was pouting because it was left out, why, we jumped right to and gave them BILLIONS more than they even wanted! And, I suspect that there will be more this year, too, because India is blushing because its military is "antique" and, God Forbid, that they tax their billionaires!
So, we will push that military budget up past A TRILLION A YEAR!
And then there is that ONE TRILLION in interest on money we have 'borrowed' over the decades - that is finally catching up with us......
I see.
So NOW you are saying there is no money for medical care for those on the bottom rungs of the ladder that YOU built.
No money for medical care, none for the environment, none for food, zip for housing, nada for education......
David, this is low, even for you.
By the way..... how much did you make off that "TAX CUT"?
Warren Buffett was open and honest: He admitted that his Berkshire Hathaway made 29 BILLION DOLLARS.
How much did you make?
Is that why you are howling about anyone else in this country getting help..... for medical care.....?
Shame.
2
I quit reading after the usual dimwit claim that Canada and England both have single-payer health insurance systems, AKA “Medicare for All.”
It’s pretty simple, okay? They both have “universal coverage,” systems, which means in practice that both countries have taken steps to get pretty much everybody covered in one way or another.
A “single-payer,” system is one in which a single entity—generally speaking, government—collects the money needed to run the system, and pays all the providers of care. Most of these providers are private people or companies, contracted to provide the services.
A “socialized medicine,” system is one in which government levies taxes, builds all the hospitals and clinics, hires all the docs and nurses and so on, and regulates care.
Canada has one. England has the other. Both are actually, “mixed systems,” which means that people can go outside the general network to buy private coverage and/or supplemental plans. Both come with very high taxes, limits on services—and GENERALLY, better care than we get in this country.
Who cares?
1. Obama are is in principle a universal system.
2. It is politically impossible to get a single payer system in this country within the next twenty years.
3. None of these systems are free. No, cutting “waste fraud and abuse,” would not pay for them.
4. Most lefties radically deny costs and limits. Not big on facts about other countries, either.
5. Righties just scream incomprehensibly.
6. Kff.org and the Upshot
Mr. Brooks information on wait times in Canada comes from the Fraser Institute, which is a right wing think tank with opaque funding. Its reports on wait times have been thoroughly debunked. These reports are based on a voluntary six question survey filled out by about 20% of physicians reporting on their subjective assessment of how long their patients have to wait for an appointment. See this CBC report https://www.cbc.ca/news/health/fraser-institute-wait-time-survey-critique-1.3867927
There is obviously a bias in the self-selection of physicians who decide to fill in the Fraser report. (There is very rigorous reporting on wait times by the Canadian Institute for Health Information, where wait times for key procedures are measured against benchmarks.) Mr Brooks misreporting on the Canadian system is a consistent feature of US discussions about health care. My question for Mr. Brooks and the NYTIMES is: presumably you have research staff and fact-checkers - it would have taken perhaps five minutes to check the quality of the Fraser Institute report and find a more reliable report, why didn't you do so? I pay for a subscription to the NYTIMES because I want trustworthy information. On a final note, I might add personally that I get same day appointments with my family doctor and specialist appointments when needed in a matter of weeks (or the next day for a dermatologist to remove a suspicious wart).
1
It's too hard. Throw up our hands and admit we're losers.
1
Of course there is a path from here to there, 11 other countries found it and so there are bread crumbs to follow. Quit talking the right wing propaganda points David Brooks.
Quit whining that it is just tooo hard, like a teenager and stop using trigger sentences like we would have to go back and undo the American Revolution.
How come you do not ask how we can fund the military, which is the most expensive and bloated in the world. Yes the precious oligarchs would have give up stacking the deck in their favor and and be taxed above 10 million dollars a year. And regular people would pay a little more in taxes, but they would save over 3 trillion in ten years, since they would not be paying huge insurance and out of pocket fees and they would not live in terror of a serious illness wiping out their savings and losing their homes and they could change jobs if they wanted to and start their own businesses and our life expectancy would rise and match those of the 11 countries
You sit in your elite chair and with your great insurance and shake your head at us silly regular people wanting decent healthcare. And try to lecture us that, sorry the rigged system set up to benifit the wealty and big business is just impossible to change and so us rest of us should bow our heads and politly die and go bankrupt before our time because our demanding medicare for all would destroy the country that the revolutionary forfathers fought for. Thanks for the elite slap in the face buddy!
1
10/10 Brooks column. For consistency, not humanity or wisdom. Long time reader, long-time "HUH?"-asker here.
Yeah David, it's great that you're a nationalist and an expert on character and you seem to travel America talking to normal everyday peeps who prefer the random kindness of others to, I dunno, a 21st Century Safety Net. What do you call it, 100 points of.... NO, Weavers, that's it. The Weavers will take care of me when I can't pay my rent, or I can just go to a nearby church for housing, medical care, and food.
So, a nationalist columnist who believes this is the greatest nation on earth says NAH, I know other civilized countries manage to prevent medical bankruptcies and "Go Fund Me" campaigns for diabetes maintenance drugs for their citizens, but WE CAN'T GET THERE FROM HERE.
Greatest nation in the world, yeah. Should all U.S. citizens deserve "first world" status? NO. Healthcare is for the wealthy only, and anything that forces me to ask my colleague Paul Krugman how the government might prosper while serving its citizens is garbage. You mention future disruption, when people are dying right now in large numbers from substandard care –- just the people who are conveniently off your radar, perhaps you haven't run into them at random diners or your bootstrapping motivational seminars because they have passed on.
This column is indeed a lazy shill job. We might as well have read some Ivanka tweets, she blows some pretty smoke clouds too.
1
Essential Reading from the BBC
10 charts that show why the NHS is in trouble
David, all those worries you have about Transition are unfounded and apocalyptic.
Most of those 350,000 insurance workers will easily transition into jobs with the Universal Health Care program. How come you never worried about all those millions of workers being unemployed by the free market?
Those doctors and their supporting staff will still be working in their own offices and their incomes won't fall because delivery of health care will still be private and not government. But, they will be saving a ton of time and money spent on collecting insurance payments from private health insurance companies. You didn't worry about college debt before but anyway, those debts can be forgiven or at least become interest-free!
Members of Parliamentary system and US Congress are both elected except for the undemocratic electoral college.
FYI, Universal Health Care system does not eliminate private insurance but reduce its size.
Individuals will still be able to buy private insurance for luxuries like private room instead of a ward with four patients or some such things or for medical care care not provided in the system.
Health Insurance Premiums will be replaced by Universal Health Care Premiums but they will be much lower. You got it wrong about taxes are upfront and savings are down the line. Actually it is the opposite. Savings are upfront (lower universal health care premiums) but with guaranteed coverage.
Are you happy now?
You can pay for it by taxing the employers who are already paying for their employees' health insurance. This "hides" the tax from individuals and makes it much more feasible politically. Companies with only a few employees might be exempt from the tax, and the per-employee tax could scale up with the size of the enterprise. We've handed big companies such outrageous giveaways for years that it's time they paid a little back.
Other countries that have government provided health care have a perfectly functioning private health insurance market as well.
Medicare for All doesn't replace anything. It's just an option. Private plans will have to adjust and compete. Competition is good.
Obviously, hospitals have to be reimbursed 100% of costs and medical staff should continue to receive roughly the same salaries they have now.
One thing this article left out is supplemental insurance, which Medicare recipients have now. That covers the remaining allowable portion of medical and hospital billing. A separate policy covers outpatient medication.
Dental and vision are generally not covered and hearing is almost never covered. There would have to be provision for these, as we know that all three are essential to overall health.
Dentists often pick up on systemic illnesses that are not yet particularly symptomatic, when they are most treatable. Untreated visual and hearing losses can lead to falls and to blindness.
Universal coverage faced transition problems in other countries where it is now well established. We need to study what they did and choose what's best for Americans.
I had decent insurance as a teacher. Then I turned 65 and went on Medicare. All my providers are the SAME, doctors the SAME, hospital access is the SAME. A slow progression of change to make Medicare-for-all is necessary - say coverage starts at 55 within 3 years, then 45 within the next 3. Etc. People are currently trapped in their jobs just to have insurance, they are bankrupted due to lack of insurance or fake substandard insurance. The actual U.S. costs of insurance far exceed any rates of those "socialist " high tax nations." Why? If one includes: deductibles, 20% co-pay, outrageous and inflated drug costs, and the insurance companies policies designed to deny coverage our rates far exceed other nations. Private insurance is a skimming scam with skimmers at every level taking and giving nothing in return. Plus, here is a point rarely mentioned - The government totally subsidizes the insurance companies. How? Insurance companies "cover" us in the healthy golden years: birth - 64. When people are older and costs really kick in who pays? The government. The insurance companies dodge real costs - they only rake in profits.
In Medicare the basics are covered. Dental and eye is a supplemental and if people want their private insurance supplements they can buy it like in: New Zealand, Aussie, Europe, Japan, Korea... all the civilized countries. It works.
"About 70 percent of these people say they are happy with their coverage. "
Ask people after they are told they are now going to get as salary what their employer was paying for their health care. In many cases that can amount to 30% of salary. Ask people earning $60K a year if they'd rather keep their current plan or if, instead, they would prefer to earn an extra $20k a year and have to pay somewhat hire taxes.
I don't think you'll get 70 percent of people choosing the former.
1
This is another bad-faith argument from David Brooks. Like many people with employer-provided, private health insurance, I'm happy with the care I receive but I'm certainly not "happy with" my insurance company or plan. I have no particularly fond feelings towards a company with completely arbitrary rules about when and where I can receive care, whether or not it will reimburse me for the same medication from my local CVS or Walgreens versus a faceless and obtuse mail-order pharmacy. Health insurance is an intermediate economic good; a means to an end. No one wants health insurance--what they want is health care.
1
I had dental emergencies in Wellington, New Zealand and Sydney. In both cases, I got same day appointments with downtown dentists, a 20 minute consult (as professional as any in the US), X-rays and prescription medicines. Since I was an Overseas Visitor with no recourse to the national health systems, I paid the maximum rack rate: a total of USD 85 in NZ and USD 105 in Sydney. Clearly, these are not prices which can support a high end lifestyle for the providers, but what law in nature says that providers are entitled to prices leading to incomes totalling 18% of a country's GDP?
2
David, have you asked yourself how "medicare for all" came to be in other places, such as the UK and Canada? They, too, had to transition from a private to a public system. "Transition" IS the "plausible route.". You don't have to do it all at once! In Canada, it took a quarter century; major legislation had to be passed in 1957, 1966, and 1984 to move things forward. Indeed, you don't have to do it all EVER. There are still health insurance companies in Canada selling private health insurance to individuals and group insurance to companies that want to offer it as a benefit. They cover things the health care system does not cover (dentistry and drugs are the big ticket items here in Ontario). The transition in the States will be long and complex and uncomfortable, but it most certainly can happen--and it needs to!
1
As many of the comments show, this is an intellectually lazy article that doesn't begin to examine the subject.
Its only purpose seems to be to defend the status quo and the many vested interests that profit from it.
2
David,
Read HR 767, it's all there.
David Brooks is a highly respected journalist. That he would write a piece like this...... reinforcing such abject ignorance..... is nothing short of tragic.
To cite but one of many, many examples: he writes that many jobs in the health insurance industry would be lost. QUESTION: Did we continue making automobiles by hand, because “many jobs would be lost” if we transitioned to assembly lines? Did we continue picking corn and cotton by hand because “many jobs would be lost” if we automated these functions?
Mr. Brooks, THIS COLUMN IS BENEATH YOU. YOU ARE BETTER THAN THIS.
2
Shame on America not having affordable healthcare for all. I've had cancer in the USA and in France. I'll take France. Much better care and follow up. In the US, I had "great" insurance and they paid for most of my treatments but when it was done, they dropped me! Luckily I was moving to France anyway so when it happened again (in the US, they said I was cured, haha), France took care of everything and were so professional and caring. All I can say is how lucky I moved to France! By the way we do pay into the system, it isn't totally free unless you can't afford it. They even take care of foreigners who fall ill here. It's continually rated the number one healthcare in the world. Having compared both, I agree, it's better here in France. Oh and I can chose any doctor and hospital I want. I don't have to chose a doctor off a list which is what I had to do in the US.
2
@getGar - A friend of mine was living and working in Slovenia about 10 years ago when she was diagnosed with cancer. As a non-citizen, she had to pay out of pocket for cancer surgery and several months of radiation treatments. Total cost: $450. (Not a typo).
And she's still cancer-free 10 years later. She also said the doctors and nurses were much more caring, and the care was better, than she'd had the last time she was hospitalized in an American hospital.
I have gained great affection for David Brooks. I don't know why he wrote this. Maybe he's trying to get in Trump's cult of personality
Come on David, let's not pretend you wouldn't have been a Loyalist.
Your low opinion of the United States and Americans is duly noted.
So - do you think you faked the moon landings?
It always amuses me when conservatives like Brooks say its not possible for the US, the wealthiest nation on earth, to do something that every other major industrialized nation has accomplished.
Something tells me if Mr Brooks, and his lack of faith in America's ability to accomplish large goals, were leading the US during WW2, we'd be speaking German right now, and we certainly would've never landed on the moon.
Just run it like the Civil Service model.
You get a pick list of insurers with a range of coverage and costs.
Then give the qualified poor an adjusted fee schedule.
A minimal co-pay is essential. What the military found with "free" healthcare was folks would just go to the hospital & sit all day.
:)
David writes: “If America were a blank slate, Medicare for all would be a plausible policy, but we are not a blank slate. At this point, the easiest way to get to a single-payer system would probably be to go back to 1776 and undo that whole American Revolution thing.”
The UK started theirs in the 1940’s and Canada in the 1960’s. Obviously they had something previously and didn’t start from a blank slate.
Here are two quotes from President John F. Kennedy. They touch on different subjects. But the sentiment of these two messages- we as Americans can tackle and overcome hard things, is an important aspect of the “American way."
“Our problems are man-made — therefore, they can be solved by man. And man can be as big as he wants. No problem of human destiny is beyond human beings. Man's reason and spirit have often solved the seemingly unsolvable — and we believe they can do it again."
“We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win, and the others, too.”
3
Let's be clear. You're saying there is no way for the majority of the American People (its poorest citizens) not to die in a state of medically induced poverty, and the accompanying side effects, because we cannot agree to a shift in how the money we are already spending for healthcare is to be collected and allocated.
I'm sure that private insurance CEOs and shareholders are relieved that their piece of the pie remains untouched.
You can treat all of the people some of the time or you can treat some of the people all of the time, but you can't treat all of the people all of the time unless we can agree on whether or not it is moral to value human life in terms of ability to pay market rate.
If money equals life, only the wealthy get to live. How long will that calculus stand?
2
If median wait time between seeing a GP and a specialist in Canada is 8.7 weeks, why do the Canadians prefer it to the American system ? and 9 months for an orthopedic surgeon ?
I simply do not believe they do.
"Medicare for all" is a great system if you don't already have insurance.
It's awful if you already do have insurance.
And where are you going to find anyone willing to go to medical school in this new world ?
Mr. Broks, we are not talking about adjusting. We are talking about losing benefits, paying more, and experiencing multi-year chaos.
Thanks anyway.
@G - 10,000 Americans a day turn 65 and go on Medicare. Where's the great upheaval that's supposed to cause? Most people who go on Medicare like it better than their employer or private coverage. Unlike those other coverages, under Medicare you can see any doctor and use any hospital you want, instead of having a limited network of allowable doctors and hospitals.
When will someone (HHS, Congress, Bezos/Buffett/Dimon, NYT, Big Blue, anyone) finally conduct a definitive study of the healthcare systems in westernized countries to see what works, how, at what cost compared to ours, & how our approach to healthcare might have to change? How many years has this been kicking around w/o answers except that we increasingly feel we can & should have something better. (Those happy with their existing private insurance still don't say they are happy with the cost of it. I do think there is fear of change.) This is a cost of gov't influenced by big money from healthcare & big pharma. IMHO, Republicans never gave “better, cheaper, & more coverage” any real consideration once they realized they could not do it & still make mounds of money.
Other developed countries with far less wealth & resources have good, affordable healthcare & pharma. Are any clamoring to move to what we have? There is absolutely no reason we cannot have the same healthcare. And, in a revamped system concerns about existing private health insurance will largely disappear as people & employers, see that at least the same level of care can be provided at less overall cost. Businesses should jump at the chance to get out of the health insurance business.
We need a new model for healthcare whose primary goal is healthcare. We can certainly do better than Medicare-for-all at least until Medicare will prevent bankruptcies from medical expenses.
3
This sad little piece reinforces my worst impressions of David Brooks. He admits the MFA is good, in fact far superior to what Americans now have. But its beyond our reach...because its too difficult to implement. I suppose that a core tenet of small 'c' conservatism is that government should not attempt radical, rapid, experimental change. I get that, though I don't agree. But he seems to forget that many millions of Americans have no insurance or inadequate insurance and millions more live in fear of medical bankruptcy. And we're not suppose to transition to a better system because its hard? Are the French so much smarter than us?
3
Mr. Brooks is probably correct in his assessment of the prospects of Medicare for all. That said, it's a pity that most Americans with private insurance don't take into account that a significant portion of their health insurance premium funds emergency room care for indigent patients who lack health insurance. That so many americans are uninsured is one of the reasons why the rest of us pay so much. Higher private insurance premiums or higher taxes to fund single payer: one wonders, is there much difference?
The more I read about “Medicare for all” proposals, the less I think any of these people, including David, understand how Medicare is administered. There are actually TWO types of Medicare:
1. Original Medicare, Parts A & B, which include any physician, hospital or other medical provider that accepts Medicare. Hospital deductible is currently $1,364, not annually - but every 60 days! Hospitalized on day 61? Pay another $1,364.00.
Doctors, tests, out-patient services, etc. are covered at 80%, less annual deductible. This minimum premium is $135.50/mo. Premium goes up significantly at higher income levels. Most people buy a supplemental private insurance plan to pay hospital deductible and the 20% Medicare doesn’t pay. Also, they must purchase an RX drug plan, Part D, with deductibles up to $415. Average Pt D premium is ~ $36/mo., plus deductible and co-pays. Supplemental policies are costly, depending on age and location. At age 70, my supplemental policy is $185/mo.
2. Medicare Advantage - this is MANAGED care, usually an HMO or PPO (more $). Private insurance company manages ALL your Medicare benefits and provides supplemental and RX drug coverage. Lower premiums. Yep. Good deal so long as you don’t develop serious/chronic illness. Hospital co-pays are often $265-$300/day for 1st 6-9 days. Co-pays for physicians, imaging, chemo (20%), medical supplies (20%), etc, etc.
Be careful what you wish for. This is NOT truly “single payer”.
2
The proposed status of current Medicare beneficiaries will be the key factor if a Medicare-for-all type system has a chance of being enacted. To put it bluntly, current Medicare beneficiaries will have to be bought-off. One way to garner the support of current Medicare beneficiaries would be to grant them a special deduction that could be applied to their gross income for Federal income tax purposes. The deduction could be the total amount paid for Medicare tax in all years that they were not receiving Medicare benefits.
This special deduction could be used to reduce taxable adjusted gross income. It could be applied in whole or in part in any tax year and any unused portion could be carried over. This would cause an increase in the Federal deficit. However, the fiscal impact would diminish over the course of a few years, since there will not be any new individuals who had paid Medicare tax but not obtained Medicare benefits.
It would be very easy for current Medicare beneficiaries to estimate how much they would gain from the special deduction. The 55 million current Medicare beneficiaries are arguably the most powerful voting block in America.
There is a question as to whether the proponents of a Medicare-for-all type system would be savvy enough to make it worthwhile for many of the 55 million current Medicare beneficiaries to mobilize for Medicare-for-all. If they did it would be difficult to block such a movement..."
https://seekingalpha.com/article/4111577
@Lance Brofman - What's wrong with continuing traditional Medicare for those 65+ and the severely disabled? Then everyone else could be in a new Medicare which could be paid for by taxes, or by allowing people to buy into Medicare by paying premiums to that program instead of to an insurance company? I suppose you may be right if you assume that some people - Republicans - might object to allowing other people to go on Medicare, but I'm old, I've been on Medicare for many years, and I'm eager to see other, younger people also have a chance to have universal healthcare like the wonderful Medicare I've benefitted from.
I rarely disagree with your conclusions, David, but this time I must. Bring on all the ‘down sides’ you describe. Just give us single payer. It doesn’t have to be perfect from day one. Legislation never is. If the Brits and the Canadians, and much of the rest of Europe can bumble into healthcare systems that generally agreed to serve more people better than ours, we should take a shot at it. Yes, our legislative system leaves a lot to be desired, but that’s an issue to resolve on another day
2
Calm down, David! The world will not end if the U.S. finally begins to address the burgeoning crisis in our health care system. And we will not all faint away at the idea of some big changes to the way we look at health care. Change can be good, actually, if we go at it calmly and without raising red herrings and Armaggedon.
Medicare patients all pay Medicare premiums, David. And co-pays, unless you also buy a supplemental plan from a private insurance company. So all who use Medicare pay on a contemporary basis for part of the care received, and they pay lots more--three times the normal premium and loss of any Part D drug cost subsidy--if they are not poor. Progressive system. No handouts to the rich.
We can begin by permitting people gradually to access Medicare before age 65. No one will have to give up their employer-based health insurance if they don't want to. Diddle what remains of Obamacare to shore it up, and devise ways to meld VA, Medicare, and Obamacare. Etcetera, etcetera.
The goal is to serve people. No one in America should be without health care.
We went to the moon, David. We can do this. Just take a big breath.
2
Medicare for all is feasible. The problem is that all the proposals are really Medicaid for all, but without the requirement that patients use their own funds first before relying on the general population. Under Medicare, hospitalization is covered, beginning at age 65, having been somewhat paid for by 45 years of employment taxes. Doctors and drugs are paid for through additional payments. Medicare has been, to a large extent, paid for (as a group) by those who use it.
This represents a failure of imagination and analysis. Medicare for all does not have to mean ONLY Medicare for all. Other countries have hybrid systems in which basic coverage is supplemented by private insurance plans that can be purchased by those who want additional coverage. Remember the public option? We can move toward a hybrid system that allows people to obtain Medicare coverage at lower ages and makes sure that there is basic coverage for all. It's really not an impossible dream.
2
**The insurance companies would have to transition. Lots of people work for and serve this industry.**
Yes, and lots of people are gang members, robbers, and thieves. The insurance industry is one of the biggest rip-offs on the planet. We should excise the whole thing, and good riddance.
2
One of David's solutions to health care costs is tada! The Marketplace. How the hell am I to make informed decisions on a medical provider when I can't even find a decent house painter? When my wife was told by our insurer that she couldn't keep her oncologist she went down the list and picked the first who's name sounded Jewish (we aren't Jewish).
It's not an impossible dream. First you have to dream then go after it. One must have hope for the future so dream it, then chip away at it layer by layer.
Australia has a medical care system that would probably work well in the USA as it is a mixed user pays/ and free public health care system. Australia has a Senate whereas Canada has a Parliament.
The most basic oath in medicine is, "First, do no harm." This should apply to any of the politicians fiddling with the US health care "system." Their oath should be, "If you're going to screw up, screw up small." Or, maybe: "Nibble, don't gulp." For sure: "The devil's in the details."
I'm an enrolled American Indian covered by Indian Health Services--it pretty much is Medicare for All (all tribal members). It's great for me the few times I've taken advantage of it (got some cavities filled, got contact lens prescription, all free for me). I want everyone to have something like it, but if the consequences are economical then the U.S. needs to do the total opposite of what our tribal governments are doing. With all due respect to my people, bluntly, our reservations suck-- the free health care, free food, free housing, free "education" are just not worth forgoing a middle-class lifestyle. I've never met a truly middle-class res family, and I've met a lot.
62
@Dale
Having lived on the Navaho Nation I can say for certain that free healthcare (or education or housing) is not at the root of dysfunction on the rez. Just think how much worse it would be with bad teeth, no eyeglasses, and no schools.
26
This post reads like it was ghost written by an health insurance executive. For someone who makes a living writing about "morals," its incredible that you are so nonchalant about fixing a crappy system that in many respects favors the wealthy and leaves the lower and middle classes to fend for themselves. This kind of "I'm not going to offer any solutions, just criticize those posed by others" is why I have no respect for you.
3
Capitalism wrapped in the flag, wrapped in the Bible, wrapped in the free market. We can't possibly take care of everyone's health needs and make gobs of money at the same time. One has to go.
Get rich or get lost.
Definition of rich-
- two bedroom apt in down-scale apt. block- 1500.00/month
- health insurance if not provided by employer- 1000.00/ month
with 5,0000.00 deductible
- carepayment 300.00/month with insurance
- food 600.00/month
- phone/ internet 150.00/month
- misc. 200/ month
total to live and get back and forth to work- $3,450.00/month:
that's 45 thousand/year after taxes.
These numbers are for southern New Hampshire
So really you need 60 grand and thats with no retirement factored in. Or vacations or education expences.
1
The path to "medicare for all" begins with "medicare for some"--that is, by granting a finite additional segment the option to buy in to Medicare. Whether it's those over 55, those over 50, or some other bright line, allowing Medicare buy-in makes it a math problem, not a social experiment. People can keep their own insurance if they don't want to buy in; the risk pool will actually be strengthened by adding younger, healthier members; insurance companies will not be put out of business; doctors and hospitals will see a small effect, not a huge one. Why not try?
4
Nowhere in Mr. Brooks' piece is there any mention of this fact: under the Medicare For All scheme, PATIENTS GET TO KEEP THEIR DOCTORS. Please, please, please: Stop the scare tactics and tell the truth about Medicare for all: we squish out most of the waste, everyone is covered, everyone gets to select a doctor(s), no co-pay or co-insurance. Everyone will be affected by the change, some more than others, but everyone will be better off once we get used to the system. And, btw, it is not persuasive to argue that because a handful of Brits or Canadians complaint about their health care schemes, those systems must be horrible. First, it's illogical to make the argument based on such a small sample size; second, go to a hospital in Chicago, Philly, Boston, or NYC; I am sure you will find lots of dissatisfaction.
2
@Maron A. Fenico - I think we all know why David Brooks hasn't been chosen to figure out a way to Medicare for All. He starts out by saying it's impossible. We do NOT have to immediately scrap the current system. We could start with a public option, where people could choose to buy into Medicare by paying premiums to Medicare instead of to an insurance company. And we don't have to stick to the current Medicare reimbursement rates.
As for the horrible, difficult adjustment from whatever people have now to Medicare - every single day, 10.000 Americans retire and go on Medicare, and most think it's far better than their employer or private insurance. Under Medicare, people can see any doctor and use any hospital they choose, unlike in most employer or private plans, which have a limited network.
And before Brooks and other opponents talk about wait times in other countries, maybe they should check out wait times in the US. They all act as if there are NO wait times. My husband waited 4 months for hip replacement in the US, while the Canadian government's figures show that the average wait time for hip replacement in Canada is 90 days.
@Maron A. Fenico- Who decides what doctors are paid for each patient and procedure? Do all doctors get the same government set fee? It that fee the same in Scarsdale as it is in rural Virginia?
I think that we can all agree on this: We need universal healthcare coverage. We cannot have people with no coverage walk into an emergency room and receive outrageously expensive and inefficient care. And indeed ALL care delivered to uninsured patients in the emergency room IS outrageously expensive and inefficient. This situation leads to bankruptcies of both patients and hospitals.
Everyone must be covered and this includes the "undocumented."
Private insurance companies are price gauging and including huge profits for themselves and their executives. But they are not the only ones. There are drug companies, medical device manufacturers, malpractice attorneys, nursing homes that house the terminally comatose at public expense, and various hospitals and medical providers that figure out how to "play the system." Just switching to a single payer system does not even address these other inefficiencies.
One patient who uses crack cocaine, gets pregnant, gets no prenatal care and has a baby with severe birth defects costs the system a fortune. This counts toward a "high cost, poor outcome" assessment of our health care system, but actually is a social problem that has nothing to do with the health care system.
Universal health care coverage? A public option? Yes. But shouting "Medicare for all" onto the airwaves only divides us, gets everyone angry at each other, and will lead to no legislation that has a chance of passing and to the reelection of Donald Trump.
3
The article makes one big assumption. That Medicare for all or a single payer health care system actually works.
The central tenant of a single payer health care system, is not that its government controlled. Only that it is wholly funded, by and through the central government. Be a single state such as California or all the United States.
In general, health care providers could operate like today, as private or governmental entities, with funding coming through the state or federal government.
Great you might say, but the core provision of government funding is also the great uncertainty. The government would need to raise taxes and sometimes charge fees for patient care and services to cover the cost of providing that same health care.
And there is practically no political system in the world that can guarantee that the government can cover this cost in the long term.
Either taxes would sky rocket for the wealthy and most of the middle class. Or the health care provided would drop to a lower level, on average than we have today. Fewer hospital beds, fewer doctors available to treat patients, and longer wait times overall. For screenings, tests, treatment and after care.
Or most likely, a combination of both.
And the wealthy would skip the lines, by paying out of pocket for gold plated health care and treatment anyway.
So you would end up with a two tier medical system, even more lopsided than today, one for the 1% and another for the rest. Is this what we want?
1
So now some Canadians tired of waiting times that have "hit an all-time high" are paying cash or buying private insurance coverage to cover their visits to US facilities.
https://www.huffpost.com/entry/canadian-medical-tourism_n_5949b405e4b0db570d3778ff
https://www.cbc.ca/news/health/canadian-insurance-to-cover-care-at-mayo-clinic-1.1113896
There are alternatives we should consider. The Swiss model, for example. In Switzerland there are no free federal health care services. However everyone is mandated to have health insurance (Oh, the Horror!!). Part of the system involves promoting personal responsibility, while providing a fairly equal health care model across the entire nation. Health insurance pays the costs of medical treatment and hospitalization, which the individual is responsible for a modest annual deductable. You can also purchase "private" health insurance to supplement the basic insurance. I encourage people to read a Fortune article about the Swiss system here:
http://fortune.com/2017/09/26/health-care-bill-obamacare-repeal-switzerland/
The Swiss model in my mind would be a good way to go - it is still essentially privately administered, however the population is no longer a captive of unknown costs, outrageous premiums and deductables. It's a combination or private, subsidized public and totally private systems. This is where the ACA tried to take us, but was unsuccesful .
Another requirement in Switzerland is that health insurers must be not for profit - excess funds to into a reserve.
We can have a better system if there is political will - and we do not have to have a totally government run program. However, due to the stranglehold big Pharma, and for profit hospitals and insurers have on the GOP, it is unlikely to happen to the detriment of all citizens.
2
Just because it would be difficult does not mean one should give up. I think the first step would be to overhaul the medical education system. The US system takes too long and is too expensive. The future of modern medicine is going to have a whole lot more mid-level practitioners (NPs and PAs), as a universal health care system can't pay current physician wages for all the physicians needed. Healthcare will also have to be much more holistic- focusing on preventative care beginning from birth. Currently, our medical system is incentivized for specialist care due to our payer system. Once the public sees the true bill for good health, preventative medicine will garner the attention it needs (and that includes dental and nutritional health). Hopefully, the new microscope on public health would enable drastic reforms of our farm subsidies and food assistance programs that make carbs and sugar so much cheaper than fruits and proteins.
Efficiency of delivery will have to be addressed: think traveling clinics to each school district to administer pediatric checkups, vaccines, dental cleanings etc.
Mr. Brooks is correct, the system will need a top to bottom overhaul, but we've got to start somewhere and sometime.
1
What is wrong with a system of compulsory insurance coupled with rigorous regulation of the charges of insurance companies as in France, Switzerland or Germany? Single payer may be hard to transition in the United States but not a well regulated compulsory insurance scheme. Only the insurance companies would object.
Brooks' statement of wait times is grossly exaggerated. When urgent, I can see my GP in 24 hours.
1
@Armand de Mestral - We're supposed to think all you Canadians, plus Europeans, etc., are dying like flies because of "wait times" and "rationing" and "poor quality care." Considering that people in every one of those countries live on average 2 to 6 years longer than Americans, it's hard to make that case stick.
Devil is definitely in the details for transitioning from our current model to Medicare for All. There are a few details missed in this column, though I know column space is limited:
* increasing the number of medical schools. We haven't had any real increases in our capacity to educate new doctors in decades. This needs to change.
* changing our medical malpractice model. If we actually went to a system like the NHS in the UK, it would make sense for the government to also be the insurer of record.
* changing our pharmaceutical and medical device model. Bluntly, we're still paying too much.
One thing that should be pointed out about the Mercatus Center study is that it appears to ignore that some of that money would come from state and local governments to cover their current employees and retirees getting healthcare. That's not a negligible figure.
A final note: Bernie Sanders did mention multiple ways to slowly phase in Medicare for All to minimize disruption, such as gradually lowering the age of eligibility for seniors and raising the age of eligibility for children and young adults. That would give plenty of transition time for private insurers to either figure out other models or shift to different forms of insurance.
1
The hard cruel fact is that 70% of the public wants single payer healthcare. It's going to happen whether Mr. Brooks understands how it will be paid for or not. There are lots of very smart people in the country who have studied the problem and have worked out the details. Obviously, it's now up to the Democrats to campaign for and implement one of those plans. Drug and insurance companies are going to take a hit but so did horse buggy makers. That's the price of bettering our national health outcomes while decreasing our healthcare costs. And while we're there, we can join the rest of the first world countries.
3
David buried the lede with this sentence.
"In 2010, Republicans scored an enormous electoral victory because voters feared that the government was taking over their health care, even though Obamacare really didn’t."
Obamacare passed and the sun came up the next day. It has survived a terrible glitch filled opening. It has survived every Republican attempt to kill it. Amazingly no hordes of death panel Doctors appeared to throw granny out the window. Let history be our guide and get us a better system.
3
This is typical Spanish. My neighbor, at her yearly revision at her private doctor did a blood test and checked off the box for an extra test, one that detects tumors. Came back positive. Immediately, as all Spanish people do in this situation she made an appointment at the public neighborhood GP, because she knew she was going to need more tests, body scans etc. Turns out, she had a tumor on her pancreas, about 3 inches long. In 2 weeks she was on the operating table, at the public hospital with the team of surgeons, and specialists. It was a serious operation, over 6 hours. She stayed at the public hospital almost a week recovering. No one in Spain would give up their public health coverage. Its not as good as it was 10 years ago but still amazingly good, especially compared to the US. Here, people go to private doctors for dentists and small things.. All the cancer, organ transplants, hip replacements... all are done at the public hospital, very using often cutting edge technology and might I add the best doctors, often are in the public hospitals. Where there is a will, there is a way. There is no one in Europe that wants the American system. Time for more informed arguments. How many ads does the NYT get from pharmaceutical companies and hospitals? I would invite the NYT to travel to all the European countries and do a serious investigation about longevity, coverage, well-being and happiness.
2
As for Canadians going to Palm Springs for health care it would be wealthy patients. The vast majority of us see our GP within a couple of days. My son was born at 27 weeks and got lengthy extensive care -- he is our $1,000,000 baby who is now 37. I have a chronic disease where I had to wait 6 weeks to see a specialist. I have seen him on a regular basis with all the necessary care for 25 years. I have a growing list of friends who need or got joint replacements having had to wait 9-18 months depending on the severity of their condition. Those who have $100,000 are the ones going to Palm Springs I imagine. To get immediate care for non-life threatening issues would be cost prohibitive. Most of us understand that. I never worry about getting the health care I need, as noted above. It does not cross my mind that I would go bankrupt from health issues and I feel good that my fellow humans get care regardless of their economic status. Dr.'a are highly paid although not obscenely. Taxes are high but we also have other social goods that contribute to making a mostly supportive society ( well paid, highly trained teachers resulting in an excellent education system, 12-18 months of shared maternity/paternity leave...). I believe the US does not have to give up its innovative, entrepreneurial spirit in order to have a rational approach to creating a set of common social goods of which health care for all certainly must be a priority.
2
Americans probably don't deserve a Medicare for All system or the kind of systems that exist in other countries. Nor do they deserve the other things we see in other advanced countries. They are too wedded to their illusions about free markets, self reliance, and the like. What a primitive country.
6
Medicare for all is too much to ask for - how about "Medicare for over 50"
Its an option you can buy into - for a reasonable and sliding scale - covers kids up to 26 - fills the gap for older folks who get "aged out" of the work force, or who want/need to retire early/try something new and are too young for Medicare. No prexisting condition limitations of course.
this would allow folks to keep their health care through their employer if they have it and for those that have lost it (layoffs etc) buy something else thats comprehensive (not one of those ridiculous high deducitble plans that covers NOTHING) AND AFFORDABLE. LETS DO THIS!!!
Its a reasonable compromise!
1
Apparently it much harder to repair our broken and corrupt healthcare system than slashing tax cuts for american billionaires so we have to chose the easy way to feed the beast.
Great, the ugliness of our system prevails, what else is new.
1
David Brooks is probably not last on my list of go-to health policy experts, but he's down there pretty far
3
This is absurd.
David ignores the existing language in Medicare for All proposals that outlines exactly the just transition and protections for already-insured patients and healthcare industry employees that he feigns concern for.
Not to mention all the other industrialized countries that have already made this transition - and whose populaces have been reaping the *empirically verifiable* benefits for decades.
Every. Single. Point. He makes. Is already addressed, if he cares to actually read the legislation he seeks to critique.
Basic journalistic integrity, folks. For millions of people, this legislation is, without exaggeration, a lifesaver, and David can't even be bothered to read it. Enough equivocating, let's get this done.
3
Another dishonest attack on a good idea by Republican Commentariat member Brooks. Compare apples and oranges? Check! What is the time frame for “onerous” in getting an appointment to see a doctor in the US? Switching to a stated wait time to see a specialist, not just any doctor, in Canada without comparing it to that in the US is meaningless. Leave out the influence on opinion poll responses of right-wing disinformation campaigns? Check! It is only natural that people making billions of dollars a year in profits off the current medical system would invest in propaganda against single-payer. Change is hard, so let’s not? Check! If everyone used right-wingers’ logic, we would still be living in caves. Apparently, for Republicans nothing worth having is ever worth working for, except winning political power at any cost to the country, of course.
3
Soemehow “Socialism” takes on a lovely gleam of acceptance and coziness for most Americans — when it is applied to their Social Security and Medicare. I notice that Republicans never go near putting those words together. Fear of getting kicked in the teeth (and lower) perhaps?
Social Security and Medicare have a great successful track record for the vast majority of people for decades! If you don’t like, them turn back your checks each month and buy your own health insurance— a sure way for average people to go bankrupt in old age.
I say it again and most people need to keep it in mind:SOCIAL SECURITY AND MEDICARE ARE FORMS OF SOCIALISM.
If you want to keep them you had better vote and vote Democratic.
4
Still using a rotary phone and listening to music on reel-to-reel tapes, are you, Mr. Brooks?
Argue for your limitations, and they're yours.
3
If President Trump can add two trillion dollars to our debt with tax breaks given to people and entities that do not need tax breaks, then we can afford to have a national health insurance program that guarantees healthcare without bankrupting you Mr. Brooks.
5
Thank you, David, for once again slavishly re-phrasing the latest Republican talking points.
1
David...we don't have a choice. Costs under the current system will continue to escalate until they bankrupt us. The simplest way to change peoples minds would be to eliminate the tax deduction employers and employees get for their health insurance premiums. They allow it to seem as if it is something they get for free. But they are being paid for by taxpayers...all of us. Once people started paying taxes on the value of their employer paid health insurance, they wouldn't like it so much.
The amount of waste and greed in the current system is economically foolish...a misallocation of resources to profit and waste that don't contribute to peoples actual health. And it is morally indefensible.
What the change will require is education of employers and the public, and fearless leadership on the part of politicians. But it's not impossible, just because the path is not obvious. And your piece, which seems to be in the spirit of...it's just too difficult so let's just bag it, is not helpful. You wouldn't take this position if you were at a less lucrative job, or had to pay the actual cost of your health insurance, rather than have it paid for by the New York Times, ie. through my subscription dollars!
Virtually every other advanced democracy has solved this problem. Mr. Brooks' argument boils down to, "We'll never be able to unscramble this egg." That's not good enough.
“The Sanders plan would increase federal spending by about $32.6 trillion over its first 10 years, according to a Mercatus Center study that Blahous led. Compare that with the Congressional Budget Office’s projection for the entire 2019 fiscal year budget, $4.4 trillion.”
David, David, David...you are too transparent. You use a guy who is known for hating Social Security and Medicare to the point of writing at least two books about it. He was not recommended for reaffirmation on the SS commission by democrats because he inflates numbers in order to make his case. It’s a bit insulting that you think that your readers wouldn’t check the guy out before believing you.
The fact is, all the other countries transitioned and they made out OK. Yes, it would be complicated in the beginning but as time goes on, our children, grandchildren and so forth will benefit from a program just as they will with Social Security and Medicare. If all the brilliant minds in our country got so easily discouraged like you, Blahous, et al, wed have never amounted to anything as a country. Not withstanding the crazy person in the Oval, we can do this. With a real commitment, we can do this.
1
Transition is always fraught with difficulties, setbacks, errors, and displacements. However, Mr. Brooks lives in fear of the future, and steadfastly ignores ( denies? ) the present, in which the costs, outcomes and real rationing ( no care, you die, bankruptcy you die, etc) which exists. These verifiable and unchallengeable facts show that American citizens to lag far behind other western industrialized societies, who with single payer, socialized, Medicare for all, ( you name the approach) healthcare, have provided their citizenry with medical care as a right , not a priveledge. Unlike pubic safety ( police, fire, coast guard, national defense, FEMA, etc,) public education, transportation, retirement dignity, our heath care remains in the hands of a private for profit middleman, the insurance industry, which stands between the real “ providers, “ and the patients, adding a bloating and forever profit seeking buffer of big pharma, insurance execs, coverage deniers and rationers. Mr Brooks, you and Diane Feinstein are all smugly convinced of what is not possible, and are in fact problems yourselves. Have people of your generation ever heard of Franklin D. Roosevelt? Frank Hosticka NYC
1
Nothing in social contract theory supports someone else paying your bills. Freedom, yes, security, yes, taxing others to get things you want so you don’t have to pay—NO!
It seems that Mr. Brooks needs to fact-check some of his assertions. For instance, the average wait time in Canada between a general practitioner and an orthopedic surgeon is six to seven weeks, not nine months (Fraser Institute Report 2017). Wait times vary from province to province, but the longest reported wait time was in New Brunswick at 4.7 months. The average time in the US to see any doctor is 3.4 weeks with the longest wait being in Boston being 7.42 weeks (Forbes) and the average wait time to see any specialist is nearly 6 months. Not being an economist, I would hate to get into those particulars, but I suspect that those are inflated as well.
@Tamara Eric - My husband had to wait 4 months for hip replacement here in the US. I found a Canadian government website that listed wait times for every major surgery for each hospital, plus a country-average. Average wait time in Canada for hip replacement? 90 days. Notice how everyone in the US who's opposed to MFA pretends there are no wait times in the US.
Mr Brooks is why we can't have nice things.
5
What a bizarrely structured opinion piece.
A morally listless laundry list of right liberal objections - divorced from the most remote hint of suffering, need, or 'real life' pressures - enclosed by violent political imagery: abrupt defenestration at the start, revolution at the end.
Never mind Mr. Brooks' personal psychology. Let's go big picture: think about what this reveals about the the terrors underlying outwardly calm and reasonable, intellectualized reasons change is impossible.
In this - the public intellectual version of THEY'RE COMING FOR YOUR HAMBURGERS!!! - the hysteria only seeps in at the edges.
2
Fight WWII? Done. You're welcome.
Fight global Communism? Yep.
Space Race? That's one small step for man...
Global real-time communication system? Can do.
Multi-front multi-decade war on terror? We got this.
Provide healthcare for our people? Shucks, that's too hard and too expensive.
1
Wow! Holy partisan politics! Especially the patriotic finale.
Nonsense, Mr. Brooks. A hybrid system, akin to the one implemented in Germany, is quite feasible, either as a transitional mechanism or as the ultimate solution to providing affordable health care for virtually everyone in the U.S.
As for keeping costs down, a system that does not have to generate shareholder profits and pay fat seven and eight figure executive compensation packages can provide healthcare to many Americans with the resources that are now skimmed off the top to enrich a handful of wealthy individuals and corporations.
You ‘conservatives’ never cease to amaze. We have over 300 million guns in public hands and an epidemic of gun violence; other nations limit gun ownership and, by strange coincidence, have a tiny fraction of the deaths and injuries from gunfire that we do. But ‘conservatives’ tell us gun control won’t work. Or tell us the problem is we don’t have enough guns — perhaps the most tragically comical nonsense one could imagine, passing as ‘conservative policy.’
Other nations have rational healthcare systems, with considerable government involvement. Their health outcomes surpass our own, and they spend less than half of what we do on healthcare costs — about 7% to 9% of GDP versus a whopping 17% in the U.S. But no, healthcare for all can’t be done, trust us, we’re the practical business minded guys, and we’re certain it can’t be done.
Except we all know it IS done; and it works better than what we’re doing. Do you take us all for idiots?
Worthless commentary here. You start with the premise that healthcare for all, single-payer systems, are desirable. Then you spend the entire column telling us why it cannot be done. Wouldn't it be better to instead focus on how we can achieve this goal? Seriously dude, do your words help anyone?
The free market works. (...so we need Capitalism.) And we need to provide health care for all. (...so we need Socialism.)
Together, these statement imply we need a system that includes both. Is this possible? For the deeper thinkers, here‘s a proposal for a two tier system that marries both approaches.
http://web.cecs.pdx.edu/~harry/reform/HealthcareReform.pdf
So David, what's your alternative?
1
Please Mr Brooks! Fearmongering is a club we need to put down. This op-ed is disingenuous propaganda just like all the talk of infanticide and hordes of immigrants. Let's have a little faith in the American public to adapt, innovate and overcome.
The only way forward is the long view. It always has been. The time for band-aids is over.
Just read the argument made in the NYT https://www.nytimes.com/2019/02/20/opinion/health-care-germany.html
by Jamie Daw
Very well put: Germany is an example of how you could transition to a multipayer system that still has everyone covered. No need to make all these insurance companies jobless, but yes it would require work on their part.
It sounds like David Brooks doesn’t believe in evolution.
1
Here's Brooks with his good old GOP can't do attitude. We can't transition to a better health care system like the rest of the civilized world. Just can't, it's hard.
See also, opponents to the moon shot who said Kennedy was a fool to spend so much on space. The America First society and Neville Chamberlain playing down the threat of Hitler and suggesting we need not fight or accept refugees. Those who imprisoned Galileo, not wanting to accept change in their view of the world.
And of course Brooks and his buddies, today, denying basic science and suggesting we should not do what is needed on climate.
No thanks to the can't doers. We don't need their naysaying. Never did.
1
“I’ve just never understood how we get from here to there...” is either a declaration of willful ignorance or a bad-faith argument. And neither is a good argument for sticking with a broken, outrageously expensive and unfair healthcare insurance system. As others have mentioned, other nations have made the transition from private to universal public healthcare insurance. Does Mr. Brooks believe Americans are less capable or just stupid?
Do any nyt opinion writers read the comments of their readers? Most often in the case of Brooks the readers logic and experience in the real world far surpass Brooks. He is often so idiological that it strains common sense.
David when you hit 65 maybe you will get it.
1
Oh, David, David, David! Have some imagination! In fact, we do need to go back to 1776, not to "undo that whole American Revolution thing," but this time get it right.
3
Most of the NYT Picks are pro-Brooks' argument. Nearly all Readers Picks are critical of him and his short sighted take. Our system needs dramatic change and continues apace to destroy lives. Recent stories from NPR, the Chicago Times and ABC are all heart breaking. If Brooks proposes no change he needs to explain how to deal with these problems and all of the others created by our system. If he is numb to them I have no use for his thoughts.
1
Everyone covered for less. That's already happening in the rest of the industrialized world. Yeah. We're exceptional. A spineless Brooks article..
I have no idea why David Brooks thinks he can discuss health care policies and make comparisons with other countries. He picks Canada as a standard of good natiional health care. Yet Commonwealth Fund, a well-respected health care policy think tank, ranks Canada as one of the worst health care systems for industrialized countries. For health care access, Canada ranks next to last with only the USA system being worse. Using Canada as a comparative country is a typical ploy by conservatives to scare people regarding national health care systems. Look at all the industrialized countries which have inclusive national health care systems. They are inclusive and cost a lot less. Perhaps the New York Times should have Paul Krugman and David Brooks hold a debate regarding health care systems and the USA. Maybe Brooks would learn something. This column just shows his ignorance.
hhhmmmmm....scribbling apologist for all things GOP for the past 35 years is against universal healthcare. Is anybody shocked?
Let's recall he was for the Bush/Cheney Mess in Mesopotamia.
Batting average: .168
1
What Dave the Knave forgot to mention, your premiums go away. Dude is just a shill for the "right wing" or "conservatives" or whatever they call themselves these days.
The old saying, a little learning is a dangerous thing, applies to Brooks : there are only 3 true single payer systems, GB, Taiwan, and the US VA; here the govt owns the hospitals and pays the staff, including doctors. The rest of the 17 countries that have national health operate thru subcontractors/private insurance companies on at least 2 levels: a primary level of basic coverage for everyone ( highly regulated and non-profit ) , and secondary levels which are for profit and are subscribed to by people that want more than just the basic coverage; the Netherlands for instance has several additional optional levels of coverage. Of course MCFA could be implemented, not like throwing a switch as Brooks implies, but by a transitioned approach. The Swiss in the mid nineties were exactly where the US is today, and they did it; another educational reference for Brooks...a 60 mins program that aired some years ago called ' Getting Sick Around the World '. The waiting times in Canada is just Republican propaganda...yes they have a triage system where emergencies get first first priority, but fixing your shoulder for a better golf swing, forget it.
How do I know this...worked overseas for 30 yrs, including 8 countries with national health coverage which our family of 5 always used even though we had private insurance thru our US employer. By the way waiting times for the 30M plus Americans who don't have health insurance, in infinite .
Mr. Brooks doesn’t shy away from trying to untangle huge, complicated social and cultural problems and often offers sensible guidance in the search for solutions. Why now the whine of “ ...buts it’s gonna be h a a a r d.......” on another one?
Re:worker displacement/job loss, I think wouldn’t be merciful to liberate those who toil in the bowels of the industry, figuring out how to erect obstacles to coverage, and help them find alternative fields in which to exercise their God-given talents
America has the best healthcare system in the world for a country of its size and diversity. The Canadian and U.K. systems are deeply flawed and most of their citizens know it.
In addition to long wait times in both Canada and the U.K., the U.K. NHS is severely under-funded, which is why they are still running Windows XP on their hospital computers and were vulnerable to a cyberattacked from North Korea.
https://www.nytimes.com/2017/10/27/world/europe/uk-ransomware-hack-north-korea.html
Furthermore, more than 10,000 nurses have quit NHS following the Brexit referendum and now Britain is looking to the US healthcare system for a solution to their impending crisis.
https://www.nytimes.com/2018/01/16/opinion/nhs-britain-crisis.html
Spoken like a frightened Republican. BTW, in Canada specialists tend to make more than specialists in the States - in certain specialties, much more. But of course, that would actually mean some research and less knee-jerk conservatism.
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N.H.S. Overwhelmed in Britain, Leaving Patients to Wait
NY Times
January 3, 2018
Maybe we ought to think this through.
Even though Mr Brooks manages from time to time to write a decent column, his old unyielding and obtuse conservative nature that had him cheering on the Iraq war, prevails here. The amount of nonsense he can come up with about healthcare, a subject that he seems to know as much about as he did about weapons of mass destruction, is pretty astonishing.
First you take health insurance off the stock exchange. Health insurance does not belong in any type of gambling situation and that is what the stock market is. High stakes legal gambling.
Then you check the zeroes in the over-paid, over-compensated CEO's of those companies and reduce it to a number that actually reflects that they are in the health industry not the loan sharking market.
With those savings alone you'd have a good start at single-payer. It is the inaccuracies that get flouted that have sunk any kind of health care reform in this country. If the ACA had been supported by those who proclaim how pro-life they are we would have a better system already and transitioning to single-payer from there would have been smoother. But, no, we had to give the bull-horn to all the naysayers and down play the facts.
Your so good at dissecting the issues that maybe next time you can tell us why the Pentagon doesn't know how much anything costs. Maybe you can start with the F-35 bomber.
The main purpose of this article is to provide a mouthpiece for "studies" from the Mercatus Center and the Fraser Institute, 2 Koch brothers funded "think tanks". The rest is gloss.
This is how the 0.01% propagandize.
I didn't realize David Brooks had such a low opinion of America's potential. But then, Brooks's pontificating is not based on infallible logic: he is one of the guys who advocated for the Iraq War, after all.
Wow!! Well, your cogent argument and presentation of alternatives has really convinced me ; convinced me that you are a pasty old white man (like me) and that the younger generations who are ready to burn everything down and start all over have a really valid point. Yes, change (improvement) would be difficult and uncomfortable for some people over the short term, but it would take the USA out of the second or third tier of countries who provide for their citizens. It would be well worth it. David, just get out of the way. We are ready for health care along the lines of Western-Europe and the rest of the Developed World. (Communist Denmark, Sweden, England, France and on and on).
Ah....the wretched excess of conservative opinion!!!!
Medicare for all is impossible, eh? So....how is it that it is QUITE possible for Canadians, Japanese, British and every other advanced industrialized society?
Once again, another brick in the load of the republican war on fact!
Well, David, there you go again, as Reagan would crow when he heard what he believed was a fallacious statement, as is your rich boy negative comments on Medicare for All;life is an adjustment, the demise of democracy under your boy trump is an adjustment to overcome;stop your wimping;The ACA was the most effective plan EVER. FIRST,it eliminated the PR joke of paying more or being disqualified for coverage by health ins. greed executives;SECOND, if you or ANY GOP actually read the ACA,you would know it offered aid for those wanting to go to Med School,so it was a high school junior who read & discovered this to set him on a path to his dream;those who don't READ remain IGNORANT,hence the IGNORANT BASE OF FOX FAUX NEWS;THIRD,the master of deceit McConnell called the ACA a failure,a disaster,unconstitutional because the greedy 1% didn't want to pay the tiny tax required of them to aid the poor's coverage&lied about death panels which was free counseling if, at 90 your diagnosed with cancer,you get to speak to a professional if chemo is your best choice;FOURTH, GOP Orthodoxy demands climate change denial&NO TAXES for the 1%,if you don't spew that,no Koch bought elections&"donations" to enrich yourself;FIFTH,Rand Paul went to Canada for his surgery,they must be doing it right there as a Canadian co worker said their doctors are held to a higher standard&she took her cancer diagnosed mother back to Canada for treatment where she live 5 more years yet US doctors gave her 6 months
Zero chance of happening
@Mike DeMaio.
Wrong.
You are a man of lowered expectations
Wow Mr. Brooks, such a laudable goal and you have so many objections. Look, if we Americans could put a pathological liar/sociopath/stable genius in the White House, we Americans can achieve Medicare for all.
Billons and billions in Medicare Fraud....and the only solution the DNC Corporate Board of Directors can come up with is.....More of the Same??
We all got snookered by that Affordable Care Act....that has nothing Affordable, nor does it have any Care in it.
Its a Bill of Revenue.....written in its entirety in the Senate(that's blatantly un-constitutional by the way........even for you "living document" types).
Its time to scrap the Military-Industrial-Welfare Complex approach.........its the 21st Century............and you all think that the final answer is still some John Maynard Keynes system cooked up in the 1930s...........
David,
You make the assumption that providers, insurers and drug manufacturers and distributors will be separate for-profit businesses.
A socialist medical system will be run by the government. providers, hospitals, insurers, drug manufacturers and distributors will all work as government employees.
Barring governmental corruption and assuming state-of-the-art administration, only the users of the state health delivery system will "profit."
But, such a "metamorphosis" of the healthcare system is, at present, only a "gleam in humanity's eye."
@george witt - Out of the 33 industrialized countries with universal healthcare, only the UK as a system like our VA, where government owns and runs the hospitals and clinics and directly employs all the medical personnel. The rest have privately owned and run hospitals and clinics and the doctors are self-employed.
I don't think Mr Brooks is saying Medicare For All is something we shouldn't do, he's saying it's something he thinks we CAN'T do, at least not right now, and that it is such an extreme jump from where we are that we risk alienating a significant number of voters if this becomes the central issue of the Democratic campaign. I am all on board with health care in the US needing dramatic changes, improved coverage, lower costs; I even support the socialist notion that health care should be a right, and that no right should be taxed or monetized.
But there is something in the US that needs a dramatic change, and it is far more important than health care: The current resident of the White House. Everything else pales in comparison. I am willing to forego any changes whatsoever to our health care system if this assures that Trump is defeated in 2020. Conversely, I am opposed to any policy that gives him any leverage for re-election.
Having said that, and with the hopeful assumption that he is a 1 term president, I have to agree with Mr Brooks that turning this particular ocean liner in the middle of the sea --- moving in one fell swoop from our current system to Medicare For All --- is not realistic. It is realistic, however, to explore a public option, lowering the Medicare enrollment age and, for pete's sake, allowing Medicare to negotiate drug prices.
There's no reason we can't start turning the wheel and get this ship going in a different direction.
Oh, David. Who is saying "the transition" would be immediate? You? Can you not possibly imagine a longer, gradual and responsible roll-out, and with for-profit healthcare remaining for those who want it and can afford it? I guess your pessimism about "transitions" extends to alternate energy as well?
So when was American not able to achieve something that seemed impossible in America (but not in Canada or the UK?)? Man on the moon, internet, automobile, iphone, computers etc. etc. etc. We were able to adapt with every change, we will adapt with change that allows all to be covered under a medicare for all or similar plan. Just think, no American citizen having to worry about being cared for when ill--now isn't that a huge plus for our nation???
My understanding of the Canadian system is that it is a ration system subject to physician discretion. So you are shifting one prioritization methodology with a different one. Then, wealthy Canadians probably could pay for additional healthcare domestically or elsewhere, like the U.S.
So Medicare for all is not necessarily the solution can be a single payor as the basic health care system but it will disappoint people when they realize the wait time etc. Look at what has been happening to the VA
Besides, even Medicare has supplementals like the Part B and Part D etc..
While basic healthcare should be universal, additional services shouldn't be. After all, we all want to live as comfortably as possible for the longest time. Alas, Econ 101 states wants are unlimited and resources not.
Instead, maybe uniformity of services is more important. You give a basic set of services to everyone. But depending on the scarcity and speciality, it should be optional. True, the rich got to have the best healthcare they can afford, is it fair? Depending who is asking and who is receiving. People complain about the costliness of gene therapy but unless the technique is so simple, it will cost. There is no way you can dodge it. Say if your loved one needs a $2M cure, that is the healthcare pot is $2M less for your neighbor's loved ones. Martin Shkrei thought he could raise an old drug 5000% overnight because insurance will pay for it; alas, insurance is really for everyone's pocket
Millions of people who liked their employee health insurance have turned 65 and transitioned to Medicare. Is there a steady chorus from them that they are angry? How hard would a Medicare option be? Tell each person with employee health insurance they can switch if they want and simply ask their company to send the money that would go to the insurance company to instead sent it to Medicare.
Every other Western democracy manages to do what you say is impossible. And many quasi-democratic states and a few decidedly undemocratic states manage it too. So what kind of cramped imagination is really responsible for this? Or is it just more influential big money players gouging the suffering before treating them?
Not with MFA, they don’t. Systems vary cinsiderably.
Here's how we make Medicare-for-All real in the U.S.: we make it a goal. We say, "We are going to figure this out, because it is something that would make health care accessible to people who don't have any or struggle to pay for it." We make it a goal because, as thinking, feeling people, we understand that people who don't have the money to pay for health care aren't deserving of poor health care, death or bankruptcy because of it. We do it because in a developed, wealthy country, the idea of having people holding fundraisers for their child's chemo treatments is unacceptable. We do it because we know that even if our health care is top-notch, it's awful for many people, even working people, who struggle to pay growing out-of-pocket costs for ordinary care. We do it because we know we're not the only people in this country, there are more than 325 million people out there that don't happen to be us, and are having their own experience, which might not anywhere near as secure and lovely as our own. If it were a goal, we would find a way to manage it, just like we do everything else. The reason we don't is people who feel just fine about their own circumstances, many of whom have platforms like these, can afford to muse, "Oh, but it can't be done." Yes. It. Can.
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David Brooks usually offers insightful and thoughtful columns, but this one, sadly, comes up short. First, while he acknowledges that Canada and other industrialized countries would not trade their healthcare system for our system, he makes the mistaken assumption that the majority are satisfied with their healthcare. He bases that on the fact that the majority have healthcare through their employers and are "satisfied" with it. The truth is that few are satisfied, they are just afraid and are clinging to what they have left.
We have seen the erosion of benefits over the last 25 years: higher prescription costs, larger co-pays, rejection of services by third party insurance managers, and employee cost sharing plans. We (consumers and employers) are paying a lot more for less. Our healthcare system is leaking capital. As a nation we pay nearly twice what other nations pay and we have poorer health outcomes. We need to address that. What parties are reaping these benefits and at what cost to consumers? A "medicare for all" plan needs to get a handle on the cost spiral that has consumed our healthcare system. Our current system has failed to do this.
But the saddest part of Brooks' column is in the title, "The Impossible Dream: there's no plausible route from here to there." This, I fear, is a loss of spirit; a loss of nerve. The story of this country is the story of finding plausible routes through tough terrain.
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Transition to single payer health care is possible if done slowly enough for people and institutions to adapt. Start by offering a public option. I believe it would slowly catch on, and companies that now subsidize health insurance for their employees would still be paying the bill, not taxpayers.
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Every negative or reason to say no to Single Payer that Brooks cites can be reconstrued as an opportunity for creative adaptation, using new strategies to meet requirements of a Single Payer system in a modern democratic republic, which the United States should aim to be but is not yet ("a more perfect union").. Further, Brooks ignores the crucial distinction between government-run and government-financed. Subsidizing health care with public funds is a mandatory "cost of doing business" in a modern industrial democracy.
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The Medical Industrial Complex will not die a quiet death. Big Pharma, Medical Device companies, the AMA, for-profit hospital chains and the insurance lobby will spend millions to keep their gravy train going. Our corporate Congress will not fold easily. The K Street Lobby is too lucrative a job for our members when they get off the Hill. Just saying.....
And there needs to be a reality check for everyone in how our taxes will have to pay for this. A VAT in addition to higher taxes for everyone? We need to quit hiding in the weeds about this....
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You missed one big transition. How are the pharma execs going to transition from making multi-millions a year by charging $6000 for a $20 pill to making just a comfortable salary? How are the hospital execs going to make the same transition by scrapping their coding systems that allow them to charge $120,000 for sewing up a cat bite? That is the big transition. All others pale in comparison.
@Gaby It's a big transition. If you expect ordinary people to feel sorry for them, well, that's an even bigger transition. Don't hold your breath. These companies have been holding human beings hostage for decades. It's time they were brought down.
"We’d take the money we’re spending on private health insurance and private health care, and we’d shift it over to the federal government through higher taxes in some form."
Misleading is the best word to describe David's statement. It's actually better viewed or explained as an accounting maneuver.
The cost of employer-provided healthcare insurance, the part borne by the company is an expensible, deducted from the company's revenue in the process of determining net income. To the employee it is an unseen and, to him or her, untaxed monetary benefit. Depending on the employer's methods of providing this insurance, the employee's contribution for the premium is often exempted from his income in determining his taxable income. The employees share can range from $25.00 to several hundred dollars per pay period, an inconsequential amount if taxed on the low end, not so much on the latter. Any increase in total employee taxes will not be as onerous as it sounds.
As well, if we are talking about Medicare as those of us who are receiving it, private insurance is still part of the picture, in the form of supplemental insurance for Part B, the charges for office and clinic visits.
An essential part of Medicare for All is the ability to negotiate with PHARMA and device makers to limit those impacts on medical care cost.
Yes, there well may be some increase in taxes, but nothing like those hair-on-fire opponents claim. The peace of mind that comes with insurance is worth it.
@Glen We don't want "insurance." Insurance is a scam, a constant fear for the consumer "did I do the paperwork right? Will they deny this on a whim?"
We want health care. Insurance needs to die the death.
@Terrils - Tehre's no way to have health care without insurance, even if the insurance is Medicare, unless you think everyone should get only the amount of healthcare they can afford to pay for out of pocket.
The Americans who get their health insurance through employers don't know who's paying for it. Insurance companies make this work by gouging the self-employed and others who aren't employees. Employees pay reasonable rates because they are a large group.Independents are each on their own with no bargaining power. You won't find many independents who think their health insurance is fine. Employees wouldn't be so happy if they had to pay the real cost.
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Mr. B is broadly correct about the clean slate concept but needs to return to maybe 1956 or so, not 1776. The British or Canadian medical landscape will not template into America.
As a note, his reference to Canadian wait times, a much referenced boogeyman in America, needs major context and qualification, and he should compare vital statistics between the two countries for some interesting contrasts.
It's easy to list the many reasons a health care for all system would be hard to implement. This column is one of many examples.
What no one, including the author of this column, seems able to do is list the reasons why health care in our country is more expensive and less effective than health care in other countries. And why the cost of health care in the US continues to increase with no end in sight.
Until we are willing to talk about why health care costs so much in our country, I think we are wasting our time talking about solutions, by any name, to a problem we don't understand. We need to understand what really drives the cost of health care first.
I'm afraid that this is nonsense. This is straw man and not a serious policy analysis. Any move to a federal system of universal health care coverage would, of course, be a transition. Here are a couple of possibilities:
For example, one might begin by covering children and young people aged 26 or less, who would retain their coverage going forward as they aged. This would be relatively inexpensive in the beginning as young people are generally healthy, and many are on Medicaid, CHIP or on their parents' policies.
Or, one might begin with the federal government phasing in coverage of the 10 essential health benefits, and then build the system out from that.
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I am 74 YO and have paid medicare tax since its inception in 1965. Is the proposal by the democrats to allow someone who is just becoming eligible to start on the same footing as myself and others who have paid well over $200K in taxes over the years? Haven't seen anything specific about that.
Mr. Brooks, think about what you are saying. Yes, many other countries have done it. Yes other countries spend far less of health care. Yes other countries have significantly better health outcomes. But none of this is achievable for the US because we "can't" make the transition. What do we call a business that can't make the transition to a better way of operating--bankrupt. What do we call a country stuck in an old demonstrably inferior rut--a former power now in decline.
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@PJM
Think and Mr Brooks in the same sentence? How odd!
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Once again David Brooks thinks the possible is impossible. He writes "If America were a blank slate, Medicare for All would be a plausible policy, but we are not a blank slate" -- as if all 1st world countries with universal healthcare were blank slates when they made the change.
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Mr Brooks simple truth is that, as has been made abundantly clear, americans, at least the current crop, are not terribly bright and are addicted to greed.
My company pays about 2800 per month for my family of four. Don't give it to me, give it to a government agency that administers health care. It is not mine to use as I wish. It is not mine to negotiate. When it all gets sorted out, it seems far too obvious that the costs will fall and the payment of employer will begin to go down. (Try, if you can, to keep in mind that in any other country that has a single payer system, the costs tend to be roughly half of the american system and the outcomes in every measure are better.)
About those lost jobs in the insurance business. They are one of the purest form of capitalist, so they certainly would understand and accept the need to find other employment.
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Private insurers currently have a large and growing role in Medicare through the Medicare Advantage program. Private insurers could continue to have a role in Medicare as it expands to cover younger people as well.
$717 billion 2019 'defense' budget'? No problem. $750 for TARP? No problem. Taking care of the health needs of our people? Er - can't afford it.
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@Wild Bill
Talking sense and numbers to neocons is like.....
You name it :-)
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We live in interesting times and we must be careful of the lies we think we know about but don't. Medicare for all isn't just a great policy it's cheaper to pay in taxes than it is to be paying premiums and uncovered costs so a group of investors get to enjoy a payday at our expense.
We're told to hates taxes and love premiums by the same folk who scream USA USA USA with menace in their eyes.
Medicare and a well regulated supplemental insurance industry would cover our needs and give the insurance industry time to find another business model. The way things are going now Mexico offers better healthcare to their citizen than we do for ourselves.
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Medicare has a monthly premium (deducted from your social security check) and has deductibles roughly a 80/20 split.You can buy a supplemental policy from a private insurance company. Medicare for all would not be free and insurance companies can make plenty of dough selling supplemental policies.
I am tired of hearing intelligent, knowledgeable people describe Medicare as a single payer system. It is not. A variety of private sector options, or self pay are required to cover the 20% of approved charges NOT covered by Medicare. Physicians may charge more than the approved reimbursement for particular procedures or treatments and thus patients and their insurance plans may be required to pay the difference. Come on Mr. Brooks, you know better.
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You written more thoughtful pieces Mr. Brooks. Great thinking - lets stick with what we have, because changing it will be too painful. First, it won't be anymore painful than the misery of the political stalemate and distraction we suffer by not resolving an issue which the ENTIRETY of the civilized world has resolved. Second, I would love to meet the 70% of employed American's who say they are "happy" with their coverage. I have run large and small businesses and you have to be joking that people are "happy." Sure, with all the scare tactics from conservatives to attack the Obama care plan (which, ironically, you reference as possibly not so bad), I am not surprised people answer surveys showing on a scale of 1 to 10 that they are "happy" with their plan because they have been taught to fear change. Here's the joke: employers regularly switch plans, push costs to employees, plans routinely change coverage or eliminate access to doctors and medications, but employees are happy! Here's the truth - nobody is happy. Some are more dissatisfied, all are concerned if they are covered. Happy is the wrong word. Overly fearful of change is accurate.
As for the monopoly argument, who comparison shops with private health care insurance? Companies make a decision on coverage and employees get only the options offered - which is what the government will do. It is not a functioning market based system. Just, more efficient (87% vs. 145% of costs) as you admit.
The alarm raised about waiting for, say, 8.7 weeks (what exactly is 0.7 week?) to see a specialist is, well, alarming, until one considers what the current system looks like as well. Speaking for myself, in February I contacted my GP to arrange a full-blown, old-guy physical; the earliest appointment I could get was early June. I have been seeing an eye specialist annually for more than a decade to ensure a disease hasn't progressed; they contact me six months in advance of their next available appointment to arrange that, and if I am non-responsive to, say, a call from them left on my answering machine, I go to the back of the line.
No doubt there would be many challenges in transitioning to a single-payer system. But let's not deceive ourselves about the realities of the current environment in the meantime.
I think the fretting over how we get from here to there obscures the fact that all of the actual plans being proposed don't really suggest completely blowing up our health care system.
Amy Klobuchar, for all her faults, has it right when she says what we should first be looking at is to restore the ACA to what it always should have been before the Democrats removed the public option from the bill while negotiating with the (BAD FAITH) Republican Party for votes that never materialized.
Give people the choice. If you truly believe in economic freedom let us also be free to chose a public option with lower costs that can negotiate on behalf of consumers (voters) and would put pressure on the oligopoly of health insurance companies we currently have that sell us all health coverage at criminal prices.
Whether or not that eventually moves us towards a state run monopoly on health care remains to be seen but if we're intellectually consistent (right, conservatives?) than the market will determine that when and if most people move to the public option.
Brooks simple addresses an either-or here: it's either the system we have now or else Medicare for all. There are many other discussions taking place about blended solutions, such as a public option. Private insurance does NOT have to go away for those privileged enough to afford it, or buy it as a supplemental package much as wealthier Medicare-age users do now. They have BOTH their Medicare and supplemental packages to offset the things that a single-payer system either won't cover or will kick them to the back of the line for. So if someone wanted a hip replacement but it wasn't going to be covered, for example, they'd still have the option to either pay for it or have a supplemental policy (or policies) to offset costs. My point being it does NOT have to be either-or.
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@Kemal Pamuk
Even if it is either/or, so what?
Will you have tears for Healtcare Insurance Company Index loosing 70 percent of its value? Phama index loosing 30 percent?
There are other things we could save our tears for. If you want I can name some.
Bernie 2020.
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