Many people in California who qualify for Medicare have made the choice to receive medical care under Medicare Advantage programs (such as Blue Shield) or through Kaiser medical system programs. Would these options continue to exist under Medicare for All?
The current system of Employer paid medical insurance is archaic in the least. It does not cover half the population. It is not a uniform system. Change in employment status or even a change of job causes havoc in receiving health services needed.
The problem with the current privately administered health insurance system is that there is no certainty that it will pay for medical care needed. So, having health insurance is no guaranty. Another problem is that there are so many different types of insurance policies with different co-payments, different caps, different coverages that the insured is at the mercy of the insurance companies. Another sad and hazardous condition is that many health insurance policies could be money pits with no real protection.
A Single Payer system with assured minimum coverage for most illnesses is a necessity. Private insurance does not provide that because of its inherent nature of maximum profit seeking as its objective. There can be private insurance facility but that is only to provide coverages for above and beyond the basic minimum universal health.
It is inhuman to subject the population to the expensive and uncertain and uneven health care access.
4
A single payer system is what we have in medicare. This allows one payer, the government. However, the actual system is private.You chose the doctor, hospital etc. Thats the system right now for millions. The difference is that costs are controlled and no restrictions on care and no profit to large multi billion Insurance companies. The administrative costs go from 18% with private to 3% with single.
64% of our care is already government paid-Yes we are mostly single payer already. The employers pay for about 49% of the population. They pay 1.2 trillion to insurance companies. They pay 250 billion to the government in taxes. They could have their taxes increase 4X and still be way ahead if no Insurance payments required.
see letusbeawarefolks.blogspot .com -can we afford a single payer system for details as to why we can and should.
9
A single payer system is obviously cheaper than the one we've got. Countries that havae single payer systems pay condiderably less than we do (like half) for health care. The reason is obvious. They've eliminated the health insurance beauracries and the hospital beauracracies that do battle with the insurance beuracries every day. So how can we loose? I sometimes read - 'but what about people who like their health care insurer. What does this mean? Does your health care insurer have a nice smile? & actually, while the health insurer has a 'network' of doctors & hospitals it covers, a single payer insurance would give you access tool doctors & hospitals - any health providers who want to ge paid. Of course, there would be (elective) procedures not covered by single payer - like plastic surgery. So people who wanted it would pay for it. End of story.
8
@Jenifer Wolf It is good to keep seeing the same doctors for your problems; they get to know your body.
2
Yes. That’s one advantage of Medicare for All: every doctor is in network, no matter what job you take or what your employer chooses to offer.
One way would be to carve out special situations that would reduce real costs over time.
EXAMPLE; Providing free family planning and birth control. Read Jamala Burke Harris MD: adverse childhood events (ACEs) cause mental and physical illness in children and even in adults years later. An unplanned child throws a family into chaos: then they can't protect and nurture a child. PREVENT MENTAL AND PHYSICAL ILLNESS by supporting families in making good choices.
SAVE lots of taxpayer money on Obstetrics, Neonatal care, pediatric care, child protective services, special education, psychiatry, and criminal justice. Birth Control is the very cheapest way to help families choose wisely.
Decrease government expenses and you have more money to spend on other health care.
EXAMPLE seat belts have saved lots of money and lots of lives.
EXAMPLE Gun control: gunshot wounds suck up health care dollars. Gunshot deaths suck up police and justice dollars.
Fewer gunshot wounds and deaths would save a LOT of money.
Surely we can figure out how to prevent illness and injury so we can use the expensive medical dollars to spend somewhere else.
3
'Medicare for All' would change the face of America.
Our overall heath status would rise to a level more commensurate with our potential as a nation.
It would put a new face on the equivalencies we should expect as we age. No longer should we age frought with fear of living in a world that sees the elderly, the weak, the injured, the ill, the poor amongst us as a burden to social norms.
All of us aging into our final years would be responsibly cared for and what in the world is wrong with that?
9
@merc Can't wait for a piecemeal approach. The health insurance industry has leached off the American people long enough.
4
The one thing we do not need is a rigid single payer only system. Every other advanced country has a hybrid system with a basic plan and with options including private insurance and even opt out provisions for the wealthy.
3
@John Goudge Medicare has a single payer but you choose the docs and hospitals. It already is a government-private arrangement. Difference?No expensive middle man who needs to make profits.
2
@John Goudge: Canada, your next door neighbour has a "rigid" single-payer system and it 1.) costs much less per capita, 2.) has better healthcare outcomes and 3.) covers every legal resident.
And, the wealthy can always "opt out" and buy their way to the head of the line.
3
eliminating the insurance companies takes 30 percent of the costs out of the system. all they get paid for is denying care, and they get paid a lot for that. with their high salaries gone and more care earlier available for people there would be better outcomes for less cost
14
@Concerned Citizen - You're mixing up private insurance and private healthcare. No one is proposing a VA-like system.
1
@Concerned Citizen One third -- not "most" -- Medicare patients are on Medicare Advantage. How many other misstatements are in your post? You are entitled to your own opinion, but you are not entitled to your own facts.
@Concerned Citizen
I don't know from where you pulled your statistic that MOST medicare patients today on Medicare Advantage. That is UNTRUE. Only 34% of US Medicare patients use Medicare Advantage and the percentage varies from 1% to 56% (Alaska, Minnesota) in different states (Kaiser Family Foundation). Medical Care is almost completely Private anyway. We are not advocating the Care Providers to be government sourced. Only the Payer (Single) is government administered and even that is for the basic universal health care. Private Insurers can provide elective, convenience oriented, luxury services. Single Payer may also be allowed to compete in this market.
1
U.S. healthcare annual spending costs PER CAPITA (2016) were $9,892 compared to UK 4,192; Canada 4,753; Germany 5,551; Norway 6,647. We now spend nearly twice as much PER CAPITA as these major developed nations with successful national healthcare programs and our healthcare outcomes are worse than theirs.
The “PER CAPITA” is important. It means we, as a nation, are already spending enough to provide national healthcare FOR EVERYONE equivalent to the nations listed. If our healthcare was as efficient as the UK, we could actually provide their level of healthcare for about 600 million citizens! The question, then, is who, precisely, is paying these costs and to what extent?
Huge cost projections that do not account for current & projected costs AND who is/will pay for them are not too useful. Considering existing spending, it seems such they likely assume the continued excessive profiteering of what-the market-will-bear private insurance which regularly enlarges the pie so all participants can have a bigger piece … except the customers to whom these higher costs are shifted each year. But a national plan should significantly cut such profiteering & administrative costs (for physicians, too). However, let private insurance continue; people will gradually shift to a nationwide plan with less costs & equivalent, or likely better, care.
Last, Medicare is less than satisfactory when private plans are needed as supplements & you can still go bankrupt due to medical bills.
11
@Len You raise a central point that is getting overlooked. The price structure for health care in the United States is one of exorbitant profit. Countries with national health systems would go broke in a year if they agreed to the prices demanded for drugs, services, devices, supplies in the US. These national insurance systems are not models of efficiency - but they are not paying extortion level costs, so they are affordable. As documented in the book "An American Sickness", interlocking profit extraction is almost at a racketeering level.
8
@Concerned Citizen
Ultimately, it is you & I who pay, in premiums, deductibles, pharma co-pays, smaller paychecks due to employers’ paying for insurance premiums, & taxes (incl. state & local). We need to see exactly how we are already paying more than enough for a national plan. This will inevitably lead to the other side of the equation, what are we paying for, where is the money going, what are we getting for paying around twice as much PER CAPITA as other developed nations?
Similar data from countries that fund their national programs through taxes, also paid by citizens, is relevant since it would show the tax rate needed to fund their healthcare program(s) & we would see what they pay for what they get.
All of this has to be translated into language most people can understand not just if you have a Ph.D. in healthcare economics. Then we can understand just how bad, and profit-oriented, our healthcare system is and make informed decisions for the future.
No one will be happy with a less responsive healthcare system, but none are perfect. Claims about a system not yet in place are a bit premature unless there is actual systemic evidence. For now, Medicare, even with its significant deficiencies, is probably the best example of a national program & most people give it positive marks.
2
@Concerned Citizen - The average employer who offers insurance spends $12,000 per employee per year. If they were relieved of that expense, then they should add $12,000 to their employees' pay.
1
I'm sure the same uncertainty about costs to taxpayers, Republican threats of doctor shortages, longer wait times, etc. swirled around the creation of the original Medicare program President Lyndon Johnson and Congressional Democrats gave us in 1965 but they did not waiver in their commitment to helping retired American workers and their families get the healthcare they needed in their declining years. The sky did not fall. Instead, our parents and grandparents lived longer, suffered less and worried less because they could show the doctors and hospitals their Medicare card. Democrats of today need to read that political history, proclaim it and stand proudly on the achievements and principles of their party. For all its flaws, the Democratic Party is still the party of working people when it counts, and healthcare counts the most.
3
Amongst the new proposals would there be "gap insurance"? That insurance pays the difference between what current medicare pays for a medical charge and the total charge. If implemented that could be a private insurance remnant.
1
In an ideal world, we would go straight to Medicare-for-all. Realistically, adding Medicare as a public option is a likelier compromise at this time.
Hint to the CBO: Medicare premiums are calculated on a sliding scale, and younger working people are likely on the average to have bigger incomes than retirees. The cost to the government may not be as bad as all that, especially if part of that $10,000/employee/year is converted to a special tax. Employers shouldn't be too distressed by that, given that they just got a mega tax cut.
4
@Concerned Citizen The TAXES that pay for Medicare are a percentage of income matched by employers (if any), currently 1.4% each. As for private group insurance subsidized by employers for their employees, the employee who earns $20K pays exactly the same dollar amount toward the total premium that the employee who earns $200K pays. We can debate whether either of these approaches is "fair" but I think the percentage-of-income tax is more realistic. Low-wage working people are barely covering their basic living expenses and insurance is just insurance, not medical care.
Higher cost for you than you think, especially if you now have group insurance and pay a small contribution. Why?
What is the average annual cost of a benefit rich plan (very rich) under Medicare for All? Maybe $10,000 per year. That's per person. You pay that in increased taxes, not likely to be passed off onto Jeff Bezos. Plus your taxes will be increased to pay the cost for others, including those elderly on current Medicare and those on modest incomes. The poor are already on Medicaid, so no change there, thanks goodness.
Taxes? Quite a lot more, and more than we can imagine. Really. You get to carry the load for a whole bunch of folks.
Get rid of insurance companies? That is a one time tick down of 10-12 percent, and we're assuming that there is no cost for the government to administer it, which is an assumption for the delusional.
5
@dEd
What you will pay depends on your wealth.
The Haves will pay more as a progressive tax.
Too sad that many Haves don't want that to happen.
3
@Ed
How does your $10 K figure with what the person is ALREADY paying for HC.
Most people don't have a clue.
Hint- Its on your Annual W-2.
That's what you're paying in lost wages!
5
@Ed God forbid that we help others, after all, "I'm all right Jack". I have nursed in both the American and Canadian systems (currently living in Canada as a retired nurse) and can say, yes, we pay higher taxes; no, I don't resent helping my fellow countrymen (many elderly, who worked hard all their lives and some who fought for our freedom in WWII); and yes, it is a relief to have no fear of bankruptcy to pay for medical bill. The Canadian system is far from perfect, but given a choice, it is the one I wish to have.
7
We have s healthcare system now that is subnormal for developed countries, by any measure you choose. The level of uninsured? Life expectancy? Infant mortality? We are, however a clear number one in expenditures on health care.
It's perfectly clear that too much is being spent on drugs and services. Our system has no effective means to control costs. Meanwhile, the insurance companies are doing very well, along with their employees, administrators, and shareholders. The insurance companies do absolutely nothing but reward their dependents, process paperwork, and advertise.
The government, by that I mean the National government, can process paperwork, pay reasonable salaries to it's employees, control costs effectively and, if done right. provide high quality healthcare to everyone.
What do insurance companies do that the national government can't do better?
There may be a role for private business in supplemental insurance plans and plans like Medicare Advantage for people who want to pay for extra care not offered by national insurance.
The only rational opposition to a National Health System is from people who are making a huge amount of money off the current system. Ordinary employees fo insurance companies can easily transfer to the National service and continue their work for the people and not the profiteers.
8
@Concerned Citizen - Republicans were behind Medicare Advantage. It was simply a way for more profit to be squeezed out of the system. Initially Medicare Advantage plans paid insurers 15% more than regular Medicare paid for the same services. The ACA put a stop to that, but our insurance agent tells me he gets a $700 bonus for every senior he signs up for a MA plan. Those extra payments come right out of our Medicare dollars.
1
If you buy a product from a company that supplies Health Insurance to their employees, the cost of the product is increased to pay for their Health Insurance. Also Your Income Taxes are increased, since the company can deduct their Health Insurance cost.and lower their Taxes. So basically just about anything that you purchase is helping to pay someone’s Health Insurance.
My Medicaid Part D Insurance generally reduces the cost of any medical procedure by 70%. That’s wonderful but how do they do it? I look at the Large Corporations that own hospitals along with the Medical Insurance Corporations and all are profitable. Could it be there is collusion between the two suppliers to set the costs?
The great inventions of the Internet and the Cloud have improved the productivity of every manufacturing, bookkeeping and medical procedure which resulted in eliminating jobs and reduced costs. Its about time to take a hard look at the Health Insurance Industry to determine if it is past it’s time.
6
Take a gander at the following two excerpts from the report, and tell me what the report is seeking to do.
"The cost of a single-payer system is not as unpredictable as that of terrorism insurance"
"Medicare for all is likely to have a high price, and many Democrats would prefer to postpone contending with the politics of such a number until there is a plausible path forward."
My opinion is simply that it seeds the notion that the overall cost is higher than what our "benefactor" Big Insurance charges, which is laughable, and seeks to contend that Democrats are only concerned with implementation instead of the loss of the billions of dollars in "contributions" (bribes) they solicit and receive, from Big Insurance.
Oh, and the "terrorism insurance" blurb, well that's thrown in so the masses will transfer the mostly inordinate, and government stoked fear of terrorism, onto Medicare for All, equating Medicare for All as something dangerous to our wellbeing and welfare.
The art of perception management has been so carefully honed by our corporate owned government, and it's media mouthpieces, most people simply cannot see through the chaff.
Following is the whole truth, see excerpt and link -
"Medicare for All could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents."
https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all
13
There absolutely will be a doctor shortage. We already have one and that is before taking into account the fact that the current generation of doctors is burning out and leaving medicine faster than prior generations plus the boomer generation that is aging. The types of physicians we will need will skew heavily to those paid the least while also being asked to bear some of the highest administrative burdens: GPs, Renal, ID, etc. There have been many public attacks on physicians while the APP lobby increases in strength and we continue to define their roles of these additional providers. They will help plug holes and many are very skilled but at the end of the day we still need more physicians. Physicians still take a long time to train and graduate 100-250k in debt on average. Medical schools are trying to increase slots but residency slots cannot be created as easily-there are only so many patients at any one hospital and you need each trainee to see enough that they get a sense for what they are doing. No one really seems to have been discussing any meaningful plan for this, however, and it is going to be a very big problem.
7
@Concerned Citizen I am not sure what world you live in, but apparently not one in which physicians do, especially those under 40.
Most doctors, you say, are in the 1%, all in the upper 2%. Huh? Tell that to residents and fellows making $70,000/year (or thereabouts).
A $300,000 debt will NOT be paid off in 5 years by someone making, say, $250,000/year before taxes, before malpractice insurance and debt insurance, before various "pay-ins" many doctors make, before money put away for retirement -- and before rent/mortgage, food, the basics of life.
Comparisons with salaries paid doctors in other countries are complicated, especially countries where the government pays for doctors' education and provides excellent, affordable health care to all (including doctors -- health insurance costs American doctors what it costs the rest of us), among many other taxpayer-funded benefits not available to Americans.
Who are all these foreign nationals of whom you speak, taking spots in medical schools from more qualified Americans (bribing people to get them, no less!)?
I don't know a single physician who wouldn't love to have more physicians in the U.S. They are all overworked and concerned about patients being deprived of timely care.
Finally, you do not even pretend to address Erin's point about residency slots.
3
Why is that only "supporters of a single-payer plan note that . . . there could be substantial reductions in the other ways individuals and employers pay for health care"? Any meaningful analysis of the cost must address aggregate healthcare expenditures. If we end up paying more, is there a commensurate benefit to society from the improved health of our population? Does the allocation of the cost reduce or exacerbate wealth inequality?
@taykadip - The average family spends $28,000 on health insurance, counting premiums and deductibles but excluding co-pays. Those costs, or most of them, would go away and instead would be paid by taxes. If someone has employer insurance, the average employer spends $12,000 per employee and takes that amount right off the top of what the employee would otherwise be paid. Anyone who pretends that we'd all still be paying as much out of pocket for our health care doesn't understand the system or is being dishonest.
1
A decision is needed now on what form insurance for all will take. This decision should be deployed immediately. It would go a long way toward unifying this country and giving our people a sense of accomplishment and hunger for more much needed change. How about an immigration policy that works? I would love to see this nation tackle a few big issues together! We all know what we can do when we are united in purpose......
1
Although we are probably the wealthiest country in the world, that wealth is not spread evenly throughout all of our our citizens. In my opinion, it's ludicrous for wealthy millionaires and billionaires to have their health-care paid by our government. There are, however, many millions and millions of Americans who work hard but are not even close to being wealthy, and many of these are POOR. These are the Americans who should have their health-care paid for by our government.
4
You don’t want a means-tested program. Really, you want a universal one. Universal programs are simple, easy to understand, and hard to misrepresent. Social security and Medicare. Means-tested programs are never generous and forever on the chopping block. Medicaid, SNAP, TANF.
It’s ok that the wealthy receive government services. They pay for them, after all. If you exclude them, they have no incentive to make the system comprehensive and convenient.
There are 180 million private health insurance policies covering 240 million Americans. Polls show people are overall (80%, WaPo) satisfied with their insurance policies. These companies employ 3.5 million people and 70% of Americans with an investment portfolio hold one or more of these companies.
If average hardworking Americans (not billionayres) have purchased a product with their own money that they want and this market is a fundamental building block of our economy what possible justification could there be for a government run system like Payapal is proposing (Federal government pays for everything-doctors to hospitals)?
Is it the 12 million Americans who have no insurance? You know they could buy it, subsidized on an exchange, if they wanted to. Is it disparities in health care? This is a "payer" system, it won't provide obstetricians to rural areas. It won't affect any of these problems, it'll simply give everyone the same bare bones coverage.
I practice in Canada. It isn't terrible, it works well for some, but every day a million Canadians are waiting for procedures they could get immediately here. Every month HealthCanada turns down new treatments based on cost that the FDA approves. Biden's 21st Century Cure Act is the antithesis of single payer medicine, it provides faster access to more expensive therapies.
Single payer medicine can not solve every problem. For every problem it solves it creates a new one. These utopian proposals are not reality.
6
@jkemp Yet it is the REALITY for every other advanced nation on earth. Even with all it's short comings any single payer system is millions of times better. Those millions being the number of Americans that have NO healthcare AT ALL and the millions more who go bankrupt or die way too early due to the profit driven current system. (p,s, and even if it was true that Canadians have to wait for needed service (it isn't) at least they are waiting for care they WILL GET, unlike millions here who die waiting for care that's NEVER coming.)
2
@jkemp - My husband waited 4 months for hip replacement here in the US. I checked out a Canadian government web site that listed wait times for every major surgery at every Canadian hospital, plus average wait times for the country for each surgery. Average wait time for hip replacement in Canada? 90 days.
The CBO report said the government-run program will need increased spending, but how much more, especially if the profit motives and obscene executive pay for insurance companies are excluded. On this note, another publication had compiled a list of the highest paid CEOs. 8th highest paid is a CEO for an insurance company that makes most of its money on Medicaid, which is all funded by tax payers. Our tax dollars paid for $26.1 million in compensation package for one CEO for one year. I am all for capitalism and having choices in health care, but when I see something lik this, Medicare for All starts to look pretty good. However, I do have a concern that we may end up with Medicaid for All with increased wait times and reduced access to care.
Btw - why isn't this article on the front page? This impacts our daily lives and well-being far more than the Mueller report.
10
One point that never gets mentioned is how people would freely move to jobs they like instead of staying in jobs they hate or have no affinity for just so they get health care benefits.
22
@Astat
It does get mentioned, though not as frequently as it should, so thank you.
I might add that this would be a strong boost to new entrepreneurs being able to start their own businesses without having to worry about medically-induced bankruptcy.
5
@Astat Good point. But wait, we already have that. HIPAA, otherwise known as the Health Insurance Portability and Accountability Act, already provides for this. Unfortunately, the administrative geniuses in Washington took this and destroyed its original intent when they decided to expand the 'privacy' part of the act and totally ignore the rest of the bill.
2
I am on Medicare. I did not sign up for Part D because it will not pay anything for one of the two prescriptions I take (and the other one is really cheap.)
And the have denied a claim for contrast-enhanced mammography. They only cover plain mammograms I guess. I will find out next month when I have another one.
Medicare only pays 10% of my physical therapy bills. I understand that’s going to change. I will believe it when I see it.
You really don’t have any recourse when they refuse to pay for something. If you think it’s going to solve your problems you’re crazy.
6
@Anne Beal I too am on Medicare and I love it. Been on it for 4 years now and still remember the relief I felt both mentally and financially by leaving my health insurance company.
11
@Anne Beal
there is a penalty if you do not sign up for Part D I think -you are supposed to sign up even if you take no medications.
I can’t wait till the government takes over health care they do such a great and efficient job running everything else, oh wait.
7
Ignorance is bliss. Part of what government dose is to provide services, that the private sector ignores because there is not a big enough profit. An example is New York Central Railroad walking away from train services between New York City and Albany, and Amtrack stepping in to continue to provide the daily service that so many people rely on for business and pleasure. With airline traffic becoming increasingly difficult, how many people are turning to the quicker and more reliable cross country service of Amtrak? Sadly, because we either cannot afford it, or Gov officials have no interest in it, maintaining the tracks Has become part of the infrastructure to do list.
3
@EAH - Medicare covers all the oldest and sickest Americans and does it for less than private insurance companies charge to cover their younger, healthier customers. The CBO says it would cost $20,500 for a senior to purchase a Medicare-equivalent policy on the private market. And fwiw, Medicare IS government run health insurance, and for most people on Medicare it's far superior to their previous private or employer plans.
"The paper notes that requiring patients to see a primary care doctor before a specialist; denying a treatment that is unusual; or requiring patients to try less expensive drugs before more expensive alternatives would all be possible under single-payer, and are limitations with such systems in other countries."
Readers may already know this but the NYT should be clear these things already happen with private health insurance, except perhaps for Cadillac-type plans, where people are already paying a lot more . The difference between most gov't healthcare systems and private insurance is their intent: the latter's goal as a business is profit. The more they delay or deny your care, the more likely you will be too sick to protest or die early, thereby saving them money. With gov't run programs, there is usually a more transparent way to appeal denials than the privates. I write this as an MD who has done appeals under both systems for patients.
This article should also go a bit more into how private insurance is incorporated in other countries. For example, private insurance in Canada allows more generous coverage of dental, eye, drug care provided you or your employer purchase it. But the majority of care is gov't provided. In some countries, I believe if docs opt out of the national healthcare system, they opt out entirely but few do so because it means losing a lot of patients. And that most patients in the UK for instance, even wealthy ones, still stick with the NHS.
16
@ms
I'm a physician too. I've dealt with both and I disagree. Insurance plans will turn down requests for care but I've found not only is the appeal process clearly spelled out in the denial letter but patients who go through the system, who have valid requests, usually succeed. I've seen many compassionate exceptions. Government run insurance plans' appeal processes are hopelessly complex and never make compassionate exceptions.
Furthermore don't ignore private reimbursement to doctors and hospitals is better. This means more choices, more convenience, and the ability to choose providers to a greater extent. Patients with private insurance frequently can go to other cities for more advanced options. People pay for these options and there's nothing wrong with that.
For the most part Canadians don't have these options. For complicated tertiary care loved ones it makes a huge difference.
2
@ms A point of important nuance to consider is that the majority of the 180 million with group coverage (workers and dependents) are in plans self-insured by their employer. Under these plans, savings on medical expenses go to the employer, not the insurance company The insurance company is typically paid a fixed fee per worker for administrative services only (ASO).
1
@jkemp - Anyone on Medicare (not Medicare Advantage) can see any doctor and use any hospital they want, unlike most private or employer plans, which use a narrow network of allowed doctors and hospitals. In other words, they have MORE choice.
As for costs not allowed: Our friend's "cadillac insurance" refused to pay for his oncologists #1 recommended chemo drug. It would only pay for the #2 choice. Our friend offered to pay the difference between the costs of the two drugs but the insurance company said it was the #2 drug or nothing. We'll never know if our friend would have survived if he'd had the drug his doctors had specifically selected to deal with his type of cancer.
One type of company can offer better medical insurance than either the Federal government, for-profit insurance companies or non-profit insurance companies. Which type of company is the most honest, most ethical and fairest to consumers? The answer is a mutual company owned by its clients, customers or policyholders. We have mutual savings banks owned by their depositors, who elect the boards of directors, and each depositor has one vote. We have mutual insurance companies owned by their policyholders, who elect the boards of directors, and each policyholder has one vote. A
mutual company would provide the best medical insurance.
2
Health care is simply not a proper area for using the market philosophy on individuals. There are no real choices when one is injured or ill. No one can decide that this is the wrong year to get cancer or suffer a heart attack and put off buying treatment until next year. No one can shop around for quality compared to price. People want to be cured.
The market philosophy, which is highly effective for truly commercial items is unworkable in health care for individuals. The private insurance system has failed. The US is the only advanced country in the world without some form of single payer and by every metric we have the worst health care at nearly twice the cost of everyone else. Single payer, Medicare for all in some form is the only system that can actually meet the needs and hold down costs.
26
@Jack Robinson I appreciate your comment. People love to push the market philosophy onto healthcare, until you point out that other countries with single-payer systems do it better and for less. I refuse to believe the U.S. can't replicate the quality and reduced-cost of other nations' healthcare systems. It's not a matter of "we can't", it's a matter of politicians not wanting to because the "healthcare industry" lines their pockets.
8
Expanding Medicare to people aged 60, say, might be a better way to start, and see how that goes.
4
@Ed
Incrementalism is not the way to go! It's just stalling time for the Health sector and its investors to plan another way to make money off Health.
Obamacare gave them 4 years to work the numbers with their actuaries.
Was there ever an incremental approach to the arms industry or going to 'war'?
23
The truth is, a single-payer system in this country would be too expensive... IF we kept paying for the same bloated, inefficient, and ineffective system we have now.
If we switched to single-payer (which we should), do you think that..
- Hospitals would continue building multi-million dollar development projects, buying expensive equipment, or paying execs $3mil salaries? Nope.
- Drug companies would be able to charge outrageous prices with no worry about price negotiation? Nope.
- Private insurance companies be able to require intractable paperwork to pay claims? Nope.
- Employers would have to pay for ever-increasing healthcare costs with no visible improvement in quality for their employees? No.
Single-payer is not a silver bullet, but it would force MASSIVE improvements in efficiency and a greater emphasis on prevention. Telemedicine would become much better and more available for non-urgent medical questions/concerns. The entire system would be more incentivized to actually keep people healthy and out of the system. Healthcare would cease being "big business." I say let's do it.
37
Wouldn’t it be nice to not be tied to your employer for medical with no fear of losing coverage if you need to change jobs, move, support family, etc.
Wouldn’t it be nice that the little main street employer would have a fairer playing field compared to the big businesses everywhere?
48
@Mathias - we're already not tied to employers for coverage - that's one of the nice things about the ACA. I used Obamacare for several years after it started to work as an independent. Since I was earning enough, I didn't get subsidized, but was able to shop for and get insurance - something that was a lot more difficult 20 years ago. And if I had any pre-existing conditions, I'd still have had access to coverage - something that was far far less likely as an individual 20 years ago.
4
@Mathias It would also be nice if your premiums were tied to income so that the percentage of income that goes toward medicare remained constant. For example a $1million income pays $100k and $100k income pays $10k for the same level of care. (Ten percent may not be the right number but for illustrative purposes its an easy number to use.)
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@Leninzen Oops - for "Medicare" above read medical Insurance.
1
Nearly all Medicaid patients across America are enrolled in HMOs which also manage 40 percent of Medicare. 800 HMOs have total responsibility to manage nearly 100 million Americans in Medicare Medicaid.
This public/private joint venture is a one of a kind medical management marvel that incorporates the best that government and private enterprise have to offer.
The same structure applied to Medicare for All is well worth considering.
Dr John Raffetto
AmbassadorCare.com
Washington DC
[email protected]
1
@Dr John Raffetto
Medicare managed care pays a subsidy to insurance companies on the theory that negotiating rates with limited provider networks and setting up a gatekeeper function to restrict patients from getting unnecessary care will reduce over all cost. It doesn't. Medicare HMOs cost more per patient than a similar population of fee-for-service (traditional Medicare) patients.
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@PWR
The Republican led government subsidy for HMOs in medicare was established on ideological grounds as an entry into privatizing the whole medicare system for the benefit of the 1%. Without the subsidy, HMOs would have to charge much higher premiums and enrollees would be forced to foot that bill instead of the taxpayers. Few people would opt for such a costly and restrictive program.
3
I think there's a lot of disingenuous talk about Medicare for All's costs. Currently, we spend $3.5 trillion, all-in, to pay for our healthcare in the US each year (about 18% of our GDP). By contrast, England spends about 8% of their GDP.
When people say "Medicare for All will increase federal spending by $32 trillion over 10 years," we need to compare that to what we'd otherwise be spending.
The Mercatus Center, a *libertarian* think tank, found that Medicare for All would actually save us $2 trillion over 10 years AND cover every American with comprehensive coverage. What's not to like?
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@Matt The estimated cost of $32-38 trillion is the net increase in healthcare costs, not the total cost for healthcare. All of it would be over and above what we pay for healthcare now. The increase is more than the U.S. currently collects in individual and corporate income taxes combined.
@Arundo Donax - can you document your statement?
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@Arundo Donax That's not true - the $32 trillion over 10 years ($3.2T/year) would be above what the government currently spends on Medicare, which is about $800M/year. That spending would replace private and out-of-pocket costs, which are currently about ~$2T.
The net effect would either be neutral or a net savings overall for the economy on health care expenditures. How else does Britain's NHS cover 100% of its population at half the cost per person as our system, which only covers 90%?
Take a look at: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html
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Medicare For All has become a catch phrase. Currently under Medicare a retiree must also buy supplemental insurance, prescription insurance, dental insurance, and vision insurance. Premiums for that coverage constitutes my largest monthly financial obligation. I pay more in premiums now than I did for my employer backed comprehensive insurance coverage just 3 years ago. Few seem to realize how limited Medicare really is. How about we talk about universal health care instead.
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@Jean Sims This is also our largest outlay now. Wasn't until we retired. It's not "free" in any way.
5
@Jean Sims Yes, but with Medicare, you're paying the full premium, while when you had employer-sponsored insurance, your employer was paying a big chunk of the cost.
The sticker price of private health insurance is about $700-$800/month for single people. Are your Medicare premiums that high?
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@Jean Sims. Thus, "buying in to Medicare" is a ridiculous idea given the tremendous out-of-pocket costs that will still have to be paid. Medicare itself as "insurance" is not that great. Many health providers refuse to accept Medicare patients because of the outlandish complexity of the paperwork involved. Add to that the outlandish profits made by companies selling single use medical supplies and devices clothed in enormous amounts of plastic.
3
How about starting like this. Pay workers directly what their employer pays for health insurance. Then with that and what they have to add in they can go and buy their own plans. Allow association health plans to keep costs down. Also allow a public option as in a medicare buy in. People can see what health insurance costs and pick their plan on the market value. It would not be long, once people see the real cost, before they are clamoring for Medicare for All".
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If we stopped rewarding the middle man and the financial loan industry we would keep costs down. It only works though if republicans stop sabotaging the commons with poison pills to increase costs and funnel money into their donors hands.
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I remember that a group of doctors, insurers, and others prepared, at least 40 years ago, ways in which we could transition from our then-present system to a government-run system. Isn't that careful report still relevant? I don't remember the name of the group or of its report, but my college students and I were much impressed by it at the time. Please investigate. Thanks.
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The private health care industry has had an entire generation to provide an efficient delivery system. They have failed in any measurable way. Why should the American public listen to supposed experts anymore?
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Of Americans not already on Medicare:
About two-thirds get health insurance from their employer. For them these proposals mean: (i) worse health care and (ii) higher taxes.
About a fifth are on Medicaid. For them these proposals mean: not much, maybe longer waiting times for the same healthcare.
The rest (about fourteen percent) would benefit from these proposals. They would get (i) free stuff and (ii) no new taxes.
Nobody ever won an election by giving fifteen percent of the under-60's free stuff.
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@Woofy
You forgot to mention the thousands of Americans profiting off health care delivery.
Who will compensate them for their ill-gotten wealth?
Those who take in money from Pharmaceutical companies that make life-saving asthma inhalers or insulin that are both unaffordable for many.
How much of this $$ is going into investors pockets?
We have slipped over the edge of human decency if we allow this to continue!!
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@Woofy
I hate my employer provided plan. It costs my husband and I $800 per month. I would prefer to look at buying into a Medicare-type plan.
2
Mae West once said, "The difference between paying for sex, and getting sex for free, is that paying for sex is a lot cheaper."
That's a lesson people should bear in mind when told that "Medicare For All" would cost the government a fortune.
The only people who want to preserve the existing American for-profit health insurance model are people who either work in the medico-insurance complex, or those who think they get coverage "for free" through their employer.
The truth is that very ordinary employee plans cost over $10,000/employee/year.
About 40 developed countries provide universal coverage -- covering all those so-called exorbitant costs -- while spending far less than the U.S. while delivering superior quality of care, life expectancy, etc.
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@Mark Gardiner
Great quote. When I saw it, I thought you were going to say that getting health insurance for free is going to turn out to be more expensive than paying for it.
What advocates for a universal government health insurance generally don't consider is the cost of breaking the current system and replacing it. After the law was in place for only a few years, we saw how disruptive it would have been to repeal the ACA. This change would be orders of magnitude more wrenching. There would be winners and losers, of course. We want to think only about those who come out ahead and disregard or demonize those who will suffer. Aside from evil insurance and pharmaceutical company executives, they might include doctors, other health professionals, employees of hospitals and insurance companies and current Medicare beneficiaries.
2
I don't want to know all the ways you could provide healthcare, I would just like the CBO's estimate of the two Medicare for All bills in Congress, one from Sanders (Senate) and one from Jayapal (House).
6
“Would patients see new and expensive treatments and drugs?” Do they now under our private for profit employer sponsored ERISA plans? Not so much. Better question, does the fact that 28 million Americans still don’t have health insurance indicate that we already “ration” care? Why, yes.
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What are our national values?
Most of the rest of the world values providing health care for their citizens at reasonable costs with better measurable outcomes than our profit-driven, corporatized mishmash.
We (at least the (R)egessives among us) here in the Land of The Free (old, white, rich men) value shoving endless gobs of money down the insatiable maw of our bloated Military Industrial Complex so that Chickenhawk presidents (see; Chickenhawk George) can make themselves feel manly by randomly invading, occupying and destroying smaller, weaker countries that have committed no offense against us.
MAGA!
5
@me
Only rich old white men. You have to possess all three characteristics to count.
Presumably an Caucasian male who is merely comfortable (perhaps even struggling during the first half of the month when rent is due) isn't in her categorization, so it can't be, strictly speaking, racist. Race isn't the determining factor here. And it isn't according to Hoyle ageism if plenty of old folks, of all races and genders, would be a-okay in her book.
What you need is a catchy label to tar folks who are, for some reason, prejudiced against wealthy, exploitative, militaristic wanna-be brutes who would rather fund bloody adventurism abroad than invest in a reasonable health care system at home. Anti-parasitist? Maybe she villainist?
So how come the rest of the industrial world provides universal coverage for far less, 1/2 or more less costly with better outcomes but we cannot. My guess is that each study assumes the same type of networks, cost containment schemes, inefficient billing, etc, that prevent us from having an effective way to deliver healthcare. Since we are changing the way healthcare is paid for we might employ some old fashioned pragmatism and refashion our system in a way that decreases costs while improving health for all.
7
@Dave, because they don't allow drugs advertised on TV, they don't allow dialysis providers to charge 100% more than what we charge at the VA. These are only 2 small ways that they make more $$$$. I have many more being a front line nurse.
14
@Calleen de Oliveira, how about eliminating insurance company profits and all the administrative costs involved in insurance billing, insurance paperwork, and doctors' offices processing insurance and negotiating with insurance companies--just for starters?
6
So far, so good. A comprehensive assessment is exactly what is needed to convince Americans a "for-all" will actually work. All options need to be on the table.
Quite frankly, I'm not taking the word of anyone after Obamacare. I want to know exactly how it will work and what the consequences will be. And there will be consequences. It's for all Americans to decide whether they believe the benefits outweigh them.
I would also like to see a pilot conducted, a proof of concept if you will, before we jump into anything.
3
@AACNY
I think Medicare is your "proof of concept." Or you can look at single payer plans in other countries. The question is what will happen to the bloat in pharma and to the insurance companies. They are the ones that stand to be decimated. My own opinion is that that money is better spent on hospitals, medical professionals and their education, and other medical systems. Pharma needs to be reined in and insurance companies should just be cut out.
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"Medicare for All" detractors fear "longer wait times." That's "fear mongering." We are producing a glut of physicians in the US. This despite the American Association of Medical Colleges surveys showing shortages now and in the future. Does anyone believe that the American Association of Medical Colleges would ever produce a survey that predicted a over-supply? "Medicare for All" detractors fear demand from "10,000 Baby Boomers turning 65 every single day" will overwhelm the Medicare program. They conveniently fail to mention that 6,000 people drop out of Medicare "every single day."
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@me How do you know this? These are some pretty hasty conclusions you're jumping to.
1
@me
I an on Medicare and have no concerns about rationing or any of the fear mongering selfishness.
Health care must be disconnected from employment to free our labor force.
Profiting off health care delivery must be abolished to the extent that is happening here.
And we will have a state-of -the-art national health system just like our weapon industry.
8
@me current Medicare is only major medical coverage, nothing for prescriptions, office visits, lab test, vision checks, dental. If retirees want that coverage they have to buy additional insurance. So universal health care would be tremendously helpful to those over 65.
There is not a "Free Market" in medical care and that a huge problem. For most of us there is little in the way of "Choice" because of the limited number of medical care providers in any given area. Frankly, the issue of single payer is overblown while the issues of access and cost go unaddressed.
Yes, the wealthiest can shop around, even take "medical vacations" to have procedures performed for less money in far-away places with great specialists. That includes wealthy foreigners who come to the USA for special procedures that they cannot get at home.
The vast majority are limited to our current geography and the network of providers provided by our employers insurance package.
We are also subject to a pricing system that is inscrutable with little, if any, opportunity to comparison shop or question the cost.
Since I am covered by the V.A. but my wife is not I get to see a difference between a complete system that is unified and the "free market."
Unfortunately, there is no simple or simplistic solution to a system that is essential but also based in greed. Those two are incompatible but that is what we have. Rebuilding it will have serious consequences for all. Simplicity is not possible now regardless of how appealing it sounds.
3
A significant correction..."Supporters of a single-payer plan note that, even though government spending would increase, there could (sic) be substantial reductions in the other ways individuals and employers pay for health care now through premiums, out-of-pocket spending and state taxes."
There absolutely would be reductions in the ways individuals and employers pay for health care now. In the Sanders plan All those other expenses would be Gone for individuals. There would only be a very progressive rate income tax. I think there should be a business tax as well, also very progressively oriented to not damage very small, low profit mom and pop businesses. The shift off of business has to be accounted for in some way besides a windfall profit. But in the long run this will be good for business. Less hassle, less cost.
Where when and how the money comes to pay for this is Very important to discuss up front. As is clarity on what people Won't have to keep paying. Avoiding a nonsense "you can keep your doctor" misstep is important. Even though the reality of 'you can keep your doctor' in the past is next to nonexistent.
5
The whole purpose of CBO is to provide a budget number. I get there are permutations. They should have priced a single scenario from the middle of the pack for reference.
1
I qualify for traditional Medicare in 2022 when I turn 65 so any drastic changes are unlikely to affect me, however it will affect my two children hopefully for the better. If left unchanged healthcare will be out of reach for most Americans in the coming decades just when my children will need it the most.
There many that oppose healthcare reform but the system is unsustainable and will not be remedied by burying your head in the sand.
18
I am a retired physician and I am now on Medicare and thankful for it. We need a Single Payer system in this country, that is obvious. I have been waiting for this report and am disappointed because they punted, no firm answers. A lot like the Mueller Report. It's obvious that trump obstructed justice but Mueller left it up to Congress and this report says the same thing. It's too bad they didn't do as good a job as the PERI analysis that showed that single payer is doable and can be payed for. Even the Mercatus study showed savings. Having the government handle the payments will only make our lives less disruptive and more stable. It's not like what we have now is orderly.
44
Too often, the reaction seems to be, "If I don't need it, we can't afford it."
As a physician for 36 years and a Medicare patient for five, I am convinced universal/single payer is the best solution and a worthy goal.
Perhaps it would help to think of "Medicare for All" in a more general sense, while acknowledging that there are lots of details to work out.
The details do not mean it can't be done and, besides, the goal of universal coverage is still desirable on a humane basis in a civilized society.
Everything can be worked out over time...gradual phasing in, transitioning to public>private insurance, uncoupling the employer linkage, organizing the finances and cost control, assessing need for taxes to replace premiums no longer being paid, etc.
It may take 5 or 10 years to get it right, or more, but single payer and universal coverage are still achievable endpoints, if we can just listen to the signal, not the noise.
"Devil in the Details" does not have to mean "Dealbreakers in the Details."
As for "government interference," I'll take that any day over an insurance company or "pharmacy benefit manager" pretending to be helpful and driving the corporate profit motive.
As far as rationing is concerned, what's wrong with replacing our current economic profiling with evidence-based distribution of limited resources?
The discussion always comes back to right vs. privilege....and that is why we are in gridlock.
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@Pasdelieurhonequenous As Greta Thunberg recently said, we need cathedral thinking!
4
@Pasdelieurhonequenous
Thank you for writing!
You understand what it means to see someone deprived of Care because of Money.
4
I am on Medicare , and also pay extra for a medi-gap insurance plan that pays some co pays and also have a prescription drug plan with a private insurer, that sets prices
( which are becoming ever larger--Thank you George W Bush for legislating that NO ONE can bargin for lower drug prices with manufacturers )
Where is the competition of the "market economy"??
Old people like me are expensive to insure for medical problems, children are the cheapest. In between ages vary of course. In all, I think Medicare for all ( or even make it voluntary --after a few years, very few would buy purely "private health insurance")
Medicare is too good, portable all over the country, no panel of doctors, no specific Hospitals for the Ambulance to know about, etc.
Fewer middlemen in the form of Insurance Companies. ( Why are there all those huge City Buildings with Insurance Companies" names on them? They are using our/your premiums while they contest coverage with their bureaucratic paperwork ways.
And about supply of doctors-- that is dropping even now.
Increase the pay, cut down on the paperwork, etc.
Good Luck Congress.
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@kw12 With the Canadian single-payer system, there are no co-pays, nor are there out of network chareges. And you'll never see a $35 Q-Tip.