And when physicians can't keep their doors open because of the low Medicare payments (let alone pay off their training debt), then what do you think will happen? Pretty sure our greatest minds will not voluntarily sign up for a career that mentally and physically bankrupts us with no financial incentive. Quality of care will take a nose dive. Don't believe me? It is already happening to a degree as private health insurance tries to justify mimicking a Medicare pay scale. It is only a matter of time. Politicians don't care about this. They only care whether or not they get elected and will tell you whatever they think you want to hear. SMH....
Those who want Medicare for all are not talking about todays Medicare, where the premiums are deducted from social security checks and supplemental for outpatient visits medication etc are sold by private companies. To bring all of that under one Federal umbrella ignores the fact that politics and politicians will be dictating the parameters of care for all Americans. If you want an abortion gag rule applied to every American patient and doctor, then vote for government insurance. If you want your insurance company to refuse to pay for expensive care unless federally mandated blood tests and diagnosis are followed despite you physician's advice, then vote for Medicare for all. PERSONALLY I FIND IT FRIGHTENING.
It's easy, and appealing to talk about a one size fits all medical solution, but impossible to find. Of the countries that offer a government program, most, like the UK, Germany, the Netherlands, Switzerland, France, etc. offer a private option. People who can afford it want to have a choice as to who is their doctor. Of course, it would be silly to offer an insurance program for cosmetic surgery, unless it was really expensive to begin with, and had very high co-pays.
Why does the fact that the Democrats; particularly Kamala Harris, will say just about anything do you find surprising? Has even one a single substantive idea on economic growth and security? If so, name it.
An entire stage full of blabbermouths advocating freeloaders.
1
Lets call it Medical Care For All and then figure out how to make it happen.
Yet another article in the mainstream press that goes out of its way to frame a medicare for all system in a negative light.
Also: "In some countries, individuals are expected to pay deductibles or co-payments toward their treatment, and private companies offer insurance to fill those financial gaps in coverage. In others, certain benefits are left out, and private companies then offer coverage for, say, prescription drugs."
How about a source? What countries exactly? Or what about the countries where you don't have to pay outlandish prices for prescription drugs, let alone even have to think about "deductibles or co-payments".
People are literally dying in the US because they cannot afford healthcare, and yet the mainstream press here seems more concerned with the "insurance industry", the very system that is basically murdering people.
1
Cosmetic surgery prices are unaffected by insurance and should stay that way.
You cannot get things for free (Nancy Pelosi could attest to that). People do not want medical insurance premiums to interfere with their lifestyles: just ponder the cost of forty years of beer and cigarette consumption.
More sensibly, medical insurance companies should be incorporated nationally (national incorporation was an idea of John Quincy Adams) and federally regulated as such. Policy choices could be tailored to individual needs. A more standardized system could reduce premiums and clarify coverages and benefit the consumer.
One size does not fit all. Therefore, the federal government is better equipped to fund and provide care for the indigent. Anyone who is not indigent should be able to buy into the indigent care system, and pay a premium based on income and resources.
Medicare for all is a first step to herd all but the elite into government clinics. It is a deliberate assault on the middle class.
1
@J.Jones
"One size does not fit all" - but it does, if sufficiently broad. You either need the care or you don't; and covering it may cost more for a private corporation, it makes no sense in a plan designed to supply all needed medical services.
Many Countries like England, France, Canada Germany have health coverage provided by the Govenment, and thay also have Private health Insurance. So those who are for Medicare for all do not need to end Private health insurance.
2
Private health insurance in Canada is very limited.
@Jack P Not really. There are many private nursing homes, and hospice centers in Canada. The list to get into the government ones can extend to over two years, and can still cost thousands of dollars per month. https://www.comfortlife.ca/retirement-communities/long-term-care#6
And what about the 35% of Medicare beneficiaries who choose a private insurer (Medicare Advantage plan) instead of "traditional" Medicare. As long as the government pays an "actuarially equivalent" monthly capitation (equal to traditional Medicare costs) what is the advantage of eliminating beneficiary choice?
Regarding employer based private coverage, it is true that a Medicare option would result in the demise of private insurance because this covered population pays on average 2.4 times what Medicare pays for the same procedures/treatments. The option would provide a slower, consumer led path to Medicare for all.
Absence price controls on providers or trust busting to break up the vertically integrated health system cartels, organized principally to raise prices, there is no other solution to our exorbitant health prices, that are so divergent from the rest of the developed world.
1
Medicare for all does not need to abolish insurance. What we need is a minimum amount of care for everyone (excluding Viagra, including medically necessary cosmetic surgery to maintain the patients health) and the option of buying insurance for additional care. We could even allow private insurance to cover deductibles. Yes, some people will not be able to afford that extra insurance and will be forced to survive on whatever the minimum coverage is. We need this two tier coverage to allow people who already have insurance to apply that insurance to the extended coverage instead of having something they paid for disappear.
1
@William E. Keig Viagra was created for pulmonary hypertension, and some people actually take it for that.
@William E. Keig
There is no medical need for cosmetic surgery. By definition, surgery to improve a normal appearance (facelift, breast augmentation, etc.) is never medically necessary. Surgery to correct deformity after cancer (breast reconstruction, eyelid reconstruction) is medically necessary and is routinely covered by third party insurance, including Medicare for those who have it. The real challenge is in the treatment of complications of cosmetic surgery. This is usually not covered so patients have additional costs to bear and should be aware of this prior to undergoing cosmetic procedures.
I have medicare and a good supplemental. A doctor paralyzed my face (Left side) and when I had surgeries, a brow lift a few face lifts, part of a lip removed all to help mimic symmetry my insurance refused to pay for any of it despite it being reconstructive and not cosmetic.
I currently am looking at having surgery for my facial pain disorder trigeminal neuralgia, a severe debilitating and in many cases, including mine, disabling pain disorder.
The doctor called medicare and my supplemental. They said "oh yes she has 100% coverage". "Then you will cover the surgery and all associated costs? "Oh no we wont know what is covered until we get the bills" Well thats great. Potentially because they refuse to say if it will be covered or not I could be left with thousands in medical bills to pay on my own. As a disabled senior I dont have funds for that and thght that was why I had insurance.
(and strangly if I had a different form of supplemental they said they could tell us what would be covered and what, if any, not.)
1
The four European countries in which I have lived for the last 40+ years all have universal health care, a taxpayer funded single payer system of affording health care to all. My experiences are that they are all adequate to cope with the normal examinations and vaccinations, the simple "first-aid" necessities, and, especially, the emergency care when necessary. They are lacking only when the non-emergency, elective type surgery (cosmetic, for example), and things like eye exams or dental work is desired. In these cases the "wait time" can be several months.
If I want quicker service, I could "go private" either paying myself or through a medical insurance policy (which I have chosen not to have). Knowing the time it takes to do these I simply schedule the exam with months of intervening time.
"Medicare for all" does not mean the abolishment of private medical insurance. It probably means a reduction of the people who are willing to pay to "save time", but voters should not accept the misinformation that insurance companies and their lackies in Congress are spreading.
A "Medicare-for-all" system in the USA would not abolish medical insurance.
6
@James K Griffin
The bill that Senator Sanders is offering does indeed go beyond what other countries in the EU and Medicare currently offer, and does abolish the use of private insurance for any service covered under the new bill. This is specifically stated by Sanders and plainly written in the text of the bill-it is not the talking point of the opposition, but a feature of the bill’s supporters.
3
@Mike Well maybe Sanders is right though... Let them do this and negotiate the rates and then they could always negotiate back in some private option... it is too expensive ... it is too bloated.. it is too corrupt .. if they do not do this it will eat the economy ... Too many innocent people suffer who work. They should force the issue and stand up to the insurance companies and the health insurance companies and the Pharma companies the way they selll in the U.S. - all those who have been really getting paid and not doing the work... If they insure everyone and require it then at least they can begin negotiations.. an they cannot negotiate by hiring the private companies... they will have to have this break... and move from there. Maybe people can go elsewhere and pay cash if they want to go above and beyond... Maybe some Drs can be cash only... are we ok with this. I guess I am ok with some being cash-only.. the problem in the U.S. is that Drs they many of them get lost in it this way and no body respects a dr like that... how can a dr be good if he is only in it for money... where and how does this part of it have to change.. maybe the cost of becoming a dr. the education has to come down...
Why crocodile tears for the end of 'for-profit' health insurance. Those businesses do nothing but stand in the middle and collect cash - take 25-30 pct off the top to feed their shareholders and executives - and muddy the world with their administrative costs including 'denials'. After which, the turn around and milk more from everyone for co-pays, deductibles, and 'limits'.
For-Profit health insurance is bleeding small and mid-size businesses dry. They serve no purpose other than profit. Get rid of them... and good riddance.
8
@John OBrien
Absolutely, bravo! Somebody else gets it. And, in getting rid of them, we get a tiny amount of revenge due to them for killing so many with their "denials".
I agree that elective surgeries and cosmetic procedures (except in exceptions like reconstruction following surgeries or bad burn injuries) would not be covered by Medicare-for-All. I disagree that it would eviscerate insurance companies. Their roles would change and they would become contracted claims operations, a familiar role they essentially play now in the Medicaid space.
It is essential that Dem. politicians educate the general public as to how Medicare works for seniors. Shucks, if the general public understood it, perhaps the Dems could garner more support for it before the GOP-Insurance Alliance completely distorts it. It isn't 'socialism' because healthcare providers never become salaried or owned by the government.
So while nothing resembling a common definition of whatever Democratic candidates choose to call a single payer healthcare system exists, insurance companies are engaged in successfully growing aka increasing Medicare Advantage plans enrollments. Then they will make the argument that they are indispensable.
The insurance companies will not go quietly into the night. They want to retain the bloated status quo with all of its unnecessary and massive infrastructures, multiple profit centers, marketing expenditures, redundant I.T. technologies and information systems, and the C-Suite salaries and perks.
At a minimum Democrats, control the narrative and educate voters. Going from rhetoric to reality is a tough journey. Ask the public for help.
7
I wonder if the politicians confused "plastic surgery" and "cosmetic surgery". Plastic surgery includes putting people back together after injuries or birth defects.
8
Medicare for all that eliminates private insurance is a non starter and any Democrats who promotes will never be elected president of the US. Democrats that talk about cosmetic surgery insurance are justified when there is cosmetic surgery needed due to burns or injuries or surgeries to remove tumors. It is an issue worth debating.
4
@Girish Kotwal What can stop a right idea.. though. .what is right is right.. it is more a question of when it will happen.. not if it will happen.. how long will people accept the status quo of Big Pharma in the U.S. , big insurance, big hospital greed... how long will the people and those who claim to support them or represent them support this... the cost of it which is unjustifiable... the wasted energy and resources and lack of focus on health on making people healthier..
While I prefer Medicare for All, without the current copays and perhaps deductibles, a plan that includes all remaining uninsured and underinsured American residents without doing away with private insurance is probably more likely to be enacted.
Note that I said "residents," because it is cheaper to include everyone than to pay for emergency care because they could not afford to see a doctor.
It looks like we have to do this in increments in order to get people to support it.
5
I don’t see how it is fair to limit coverage to “residents.” What about travelers who are in the US and need care? How can you deny them this fundamental human right of healthcare? Unfair and shameful society!
@Barbara The Dutch, German, and Swiss national health care systems are based on heavly regulated private insurers.
@Fred I hope you're not serious.
Are you unaware of the issues Britains' National Health has with medical tourists? And they don't even grant citizenship to those born in the country by foreigners!
Medical tourism where the costs are not considered is a very heavy burden for the host. Not only is cost a big problem, but it crowds out those who legitimately have a higher interest in the available care.
What about substantial dental insurance?!
6
in my experience counyries outside the U.S. do not offer plastic surgery with basic/public insurance policies except to correct damage due to injury, infection, illness. But I did know someone in Germany many years ago who had supplementary private insurance and they had plastic surgery based on a psychiatrist's diagnosis that they were seriously suicidal and required the surgery. Do not know if that would work within the current German system.
2
What never gets a mention is that Medicare, today, does NOT pay all of the health care costs for anything. Eighty percent is usual...the rest is paid through the annual deductible, and any supplemental insurance you choose to have. What’s wrong with using that model for everyone?
Every retiree I know has a supplemental policy of some kind...I would wager that the only people who don’t, qualify for Medicaid anyway. Can’t we be reasonable? Fix what’s wrong with the ACA for the supplements, and institute Medicare for all as the primary coverage.
Fractious politicians are the problem, as usual. Until you have all the facts there is no way to make good decisions!
10
@Nina. Medicare covers all of part A. Part B covers 80% with a 185 dollar deductible and Park D costs about 500 a year and has deductibles and copays. I just paid a 40 dollar copay for a 150 dollar prescription.
However if you get medicare advantage I think everything is pretty much covered but you lose choices, however this is an oversimplification, there are many different Medicare Advantage plans.
5
@Nina
Some people who qualify for Medicaid as well as Medicare in some states may still buy a supplemental policy, as many doctors don't accept Medicaid. I know of people who have this. Medicaid still helped with prescriptions at that time, paid for Medicare premiums and deductibles, which helped them to afford the supplement policies.
You must only know wealthy retirees. Medigap coverage is brutally expensive.
3
This article is poorly researched. Even in markets with gov't provided healthcare there are often private plans. Some people want to choose a specific hospital that isn't part of the government plan. Others insure for uncovered medical related costs like private rooms. In Hong Kong the government system covers most tertiary care but many still opt for private hospitals. Insurers also sell policies for specific disease areas, like cancer, where the public system might have you wait for care but the insurance lets you accelerate the process.
9
People want free stuff. That's how this works, promise them free healthcare and you get to sell more books (ahem, Bernie, ahem). What they aren't telling you is that Medicare is subsidized by the private insurance market. People on Medicare consume 4 times more than what they paid for. That difference is made up by charging people in the private insurance pool more for the healthcare they consume. They are also not telling you that you need regressive taxation and limited immigration because taxing the rich & corporations is too volatile for such a large program. Let's see how many people like this when they find out that you need a federal VAT tax and high individual taxes that could end up being more than what they are paying in insurance premiums.
5
@boris vian Your subsidizing comment is skewed because Medicare is 65+ and old people consume the vast majority of health care, and most of that within the last 6 months of life. I could say the young and healthy subsidize the old and unhealthy, and it's equally true. You have given no demonstrable causal point.
6
Hospitals and physicians accept Medicare and Medicaid provided they have enough other third party payers in their patient mix to offset the losses. For example I get paid 20 cents by Medicare for every dollar that the average commercial carrier pays. If 20 percent of my practice is Medicare/Medicaid it is doable, if it becomes 100 percent of my practice it is not.
3
@boris vian
If the numbers worked we would have single payer in VT, CA, OR, NY, and MA right now.
1
The United States will never implement a Medicare for All type of insurance, regardless of how comprehensive and cost-efficient the coverage might be. The insurance industry has a stranglehold on politicians, and they would fight tooth and nail against it. After all, their entire existence would be at stake, so why wouldn’t they? If this is ever to become a reality, it will need to be slowly implemented over an entire generation. Otherwise, not only will the insurance companies fight it, but Republicans will trash it like they did ACA. It’ll take decades for the public to digest the benefits, and in the meantime, we will be stuck with a Republican controlled government for far too long.
8
So Bernie Sanders thinks health insurance covers non illness related cosmetic procedures. He's not felt the need for any. Neither should the rest of us. This boob and butt craze squanders resources that are needed elsewhere.
The main point is that private insurance is a for-profit industry that be a drain on our nation's healthcare until it is eliminated. I would give up my insurance plan for Bernie's plan if I had the option. An overwhelming majority would if they sat down and did the math.
2
@Pete
Perhaps you are unaware that some women require cosmetic surgery for breast reduction and others require it for after-mastectomy care.
1
Approximately 160,000,000 people in the US are covered by employer-provided health insurance programs. A single payer, government-provided "Medicare-for-all" type program will cost somewhere between $500 billion to $ 1 trillion per year to fully fund. Currently, the majority of the costs for employer-provided health insurance are paid by employers. If the government provides these benefits, employers will no longer pay the premiums. These employers will obtain a massive income increase by eliminating employee health care insurance expenses.
Will employers will donate those savings to the government?? Will they increase their employees' wages??
The most difficult issues are always financial and no one has proposed any plan that will adequately ensure that these costs are not just redistributed, through increased personal taxes and massive reductions to other entitlement programs and the existing social safety net (thin as it already is). Until someone proposes a coherent plan to protect all the programs Americans need (not just health insurance) by insisting that employers and the affluent fully participate in the funding for these programs (including the unemployment costs associated with the disruption in the insurance markets), it is just another campaign fever dream.
4
@dave
I agree in spirit, but would challenge you on the numbers (though I agree they are thrown around).
In 2017, Medicare spending was 709 billion dollars, providing coverage for 44 million Americans (Data source, CMS).That coverage is not as comprehensive as the proposed Medicare for All bill. I therefore do not see how funding a no copay, full benefits version of Medicare for 330 +million Americans would only cost 500 billion-1 trillion.
Also, only 10% of those on Medicare rely exclusively on Medicare (data source, also CMS) - this, plus the fact that up to 30-40% of Medicare plans are managed by private health plans-is what makes the claim that we can eliminate private health plans spurious. CMS does not have the bandwidth to manage and administer benefits to every American without their help.
In terms of “employer savings on health premiums”- it’s not that clear. Every state proposal for a single payer plan has added on at least an additional 7.5% payroll taxe to the employer, with some pundits opining that the funding gap on the federal plan would be a payroll tax that approximated their current spend on premiums.
I am 100% for universal healthcare, but I instinctively cringe when I hear politicians tout proposals that show that they are either willfully misleading or ignorant. I will never hand over my health (or a fifth of our economy) to a candidate that glosses over these issues as minor details.
6
@dave "Approximately 160,000,000 people in the US are covered by employer-provided health insurance programs. A single payer, government-provided "Medicare-for-all" type program will cost somewhere between $500 billion to $ 1 trillion per year to fully fund."
How much has 17 years in Afghanistan cost taxpayers?
1
No one is talking about the care givers strain that will be produced under a Medicare for all system.
The influx of patients would generate wait times for the simplest of appointments. It would take years - the amount of time to train more doctors - to offset this unless the program is rolled out very gradually.
Canada, a system that is often used as a comparison - uses wait times to encourage patients not to have non-life threatening procedures, according to an AARP article that was overwhelmingly positive towards Canadian healthcare. The author openly admitted those wait times could be fixed, but would cost more.
The British system is overwhelmed, according to a 2018 NYT article that said: .."Cuts to the National Health Service budget in Britain have left hospitals stretched over the winter for years, but this time a flu outbreak, colder weather and high levels of respiratory illnesses have put the N.H.S. under the highest strain in decades."... This would suggests to me that a government run system is fragile indeed and dependent on the political environment.
These downsides don't sound too much different than the current US system. Many procedures are out of financial reach or have long wait times. Why jump to a system that is not that much different? Look at the painful roll out for ACA. It's uneven often erratic coverage did damage to some while helping others.
Frying pan, meet fire....
4
@B Dawson If there is an influx of patients, like you say, that's a strong indication that many people today are going without healthcare, perhaps with serious consequences, and often for financial reasons.
The reason that well-insured Americans don't wait as long as in other countries is because there are other Americans waiting LITERALLY FOREVER because they can't afford it.
6
@B Dawson
Not that much different? Surely you jest ...
In countries like Canada health care is provided on the basis of who needs it. In the US it is provided on the basis of who can afford it.
Simply put, if you don't have the cash in the US you are left to die; in all? other first world (and even some poorer) nations you get the treatment you need no matter the size of your wallet.
You are fine with the US system that just lets people die because they don't have money to afford medical treatment or medicine?
1
@B Dawson
Which is why we need to provide incentives for people to go to medical school.
Hint: Massive student loans and the accompanying debt aren't one of them.
For the Republicans who allegedly want the free market to decide everything (except coal energy I guess), a public option is the way to go. If the private insurers offer a better product and cost, the public option will not thrive. Conversely, if the public option operates with as much efficiency as Medicare currently does, the market will gravitate towards it.
8
The ACA has one particular problem, that for people to 138% of the Federal Poverty, they get Medicaid or ACA expanded Medicaid, and that money is subject to recovery at death by each individual state.
The amount recovered can be for all medical services paid.
That is, ACA expanded Medicaid and Medicaid is not insurance. It's a loan until death. And a loan not for actuarial premiums, but it can be for full medical expenses. Like a million dollars or two. (A second way that it's not insurance.)
I've met with skepticism in the comment at the Times by readers, who said the states can, and they do recover for nursing homes already, but no state would dare do it for medical and expanded Medicaid.
But I've found links that they do in MN: attach liens on houses for expanded Medicaid people.
Even worse, from the current MA paper application, which is combined for expanded Medicaid and subsidized on-exchange plans. (They give you whichever of those their verification of your estimated future MAGI gives you.)
"To the extent permitted by law, MassHealth may place a lien against any real estate owned by eligible persons or in which eligible persons have a legal interest. If MassHealth puts a lien against such property and it is sold, money from the sale of that property may be used to repay MassHealth for medical services provided."
It's worse. It's not a loan until death. It's a loan until you, living, sell your house. Not of premiums. Of full medical expenses!
Yikes!
6
Medical insurance companies contribute nothing to the health care system - they're parasites that exist by collecting as much as they can from policy holders, then paying as little as they can get away with in return. That's how they make a profit, pay for their shiny glass buildings, and give their executives and shareholders as big a return as possible.
I worked as a provider, as a psychotherapist for adolescents in residential care, and when I tracked my hours I found I was literally spending more time each week arguing and wheedling with gatekeepers at insurance companies to cover treatment the kids needed than I was able to spend with the kids. Once I got a lecture telling me we were doing too much therapy and not enough medicating.
Some societal functions should not be privatized: health care, education, law enforcement, corrections, the military, and firefighting. This is an industry that we'd be better off without.
15
@Jim Finley
I can think of one valuable thing they do-administer benefits to about 30% of current Medicare patients. I don’t think those patients would feel better off without it.
Also, administrative burden will not decrease with Medicare for All. Most of my extra time on the EHR is dedicated to obeying maxims in the form of extra clicks, handed down through CMS via HITECH, etc.
4
Let me asset that the President was actually exactly correct in what he intended to say, but he omitted and jumbled a few words.
He meant to say "Who knew any country could succeed in taking so many missteps, over such a long time period, as to make health care so complicated?"
(I'm pretty sure.)
3
Presuming healthcare as a "right", Universal Healthcare or Medicare for All will not, and cannot be a right to the quest for immortality. Healthcare will be a limited right as regards costs. Applied to all, equally, it could be a very good thing.
For anyone with the means to pursue healthcare options beyond Medicare for All it seems likely there will be insurance plans to cater to their wishes. Such policies need not concern the general population as they would, to the average person, look no different than individuals with the financial wherewithal to buy unlimited healthcare out of their pocket change.
5
Everyone hates their private insurance. Insurers whimsically deny coverage, make billing “errors”, & generally interpret their obligations in a way that makes enjoying private insurance an uphill battle even for the luckiest of us. But fear of what comes next is an insufficient reason not to tear down this inefficient anti consumer monster and start something new, more human and universal. Time to try again!
8
@Irma Lighthouse I love my private insurance, so please don't speak for me. I have a high deductible plan that keeps my premiums low and I can put $7500 a year into my HSA. HSA is now my 3 largest investment vehicle, only behind 401K and ROTH.
Keeping as much of my HSA as possible provides an incentive to stay healthy.
The problem with American healthcare isn't the healthcare system, it is the patient population (obese and diabetic). Medicare for All would just further incentivize unhealthy lifestyle choices.
2
@James That is great for you. However research has shown that HDHPs often lead to short-sighted, financially motivated self-rationing in a way that is detrimental over time. Save a few hundred bucks by skipping a physical and pad your tax-advantaged HSA savings this year, have that prostate cancer go unnoticed until next year.
Doesn't have to be this way, and may not be true for you, but that's what population data indicate is happening.
As for a broader comment, it's ridiculous that they can't think of things a concierge/ overlay private insurance would cover. IVF, telemedicine (like Teledoc), access to special urgent care facilities, extra coverage for rehab/ PT post-procedure, home doctor visits, etc. In virtually all publicly funded health markets, there is a thriving private insurance industry that is simply more limited in scope and targeted explicitly at the wealthy and selling convenient access. It would be the same here.
7
@Irma Lighthouse
When I had a Medicare Advantage plan, I needed treatment that precluded driving to receive it. I went around and around with the insurance representative as to whether they would cover it, even though that would be far cheaper than paying for me to stay inpatient. I was in tears at the end and never got an answer. I was lucky that the problem cleared on its own so I didn't have to get the treatment. This is no way to deal with patients' needs.
1
Medical insurance: “It works by pooling together people with different health risks and averaging their costs across the whole population.” When the WHOLE population is paying into and covered by whatever the replacement of the gutted “Obamacare” will be, it WILL work. What insurance companies want, for their own profitability, is to insure only the healthiest and wealthiest (and then deny even those, as much as possible, by digging up “pre existing conditions”, etc.) Then the insurance companies want those with higher risks to be covered by the taxpayers, or just die. There is no “pooling together” when profits are more important than human life. That is why medical insurance has to be a government program that everyone is a part of.
22
There will always be those who want a choice that is not controlled by the system. And this is where the health insurance market will still be needed.
In countries with socialized medicine you could end up waiting for your turn or you could pay "privately" to see a specialist sooner. You could have your GP attend your pregnancy and delivery or pay for an OB/GYN (those being reserved for "high risk" patients otherwise). Your government paid GP may tell you to just wash your face better and refuse to refer you to a dermatologist, or think you should be ok without physical therapy. In socialized medicine the GP is a gatekeeper, your wants may not be considered to be needs as much as being considered wasteful.
With socialized medicine, given an option, I would look for some additional insurance.
9
@Margo
The challenge is whether the proposed government's plan explicitly makes it illegal to offer insurance for the same things the government's plan covers. You just may have to do it out-of-pocket. That isn't really "insurance".
2
@Margo
The health care would not be socialized; only the insurance would be. No more worrying about whether the provider is "in-network". No more wondering whether I'll have to change doctors just because my employer decided to change insurance companies. No more exorbitant ambulance bills because calling 911 is a crapshoot as to the company that responds.
Sign. Me. Up. ASAP.
2
Once insurance is socialized, the present hospital system would collapse under the inevitable bureaucratic bean counting, leaving only a shell.
Senator Sanders's claim that private insurance would be for elective cosmetic surgery was indeed tantamount to saying there would be no private insurance. It is entirely possible that he thought that was obvious to the world at the time he said it, because it should have been.
I did not interpret this statement as trying to soften the blow, unlike Senator's Harris's dancing on the topic. He was likely saying "let them eat cake" to private health insurance. This is part of his appeal that the many candidates who have adopted his policies cannot so easily copy.
5
"Some Democrats Talk About Cosmetic Surgery Insurance."
Wrong. One Democrat, Bernie Sanders, mentioned cosmetic surgery once. In fact, Bernie isn't really a Democrat. He's an independent running in the Democratic primary.
16
Cosmetic surgery is not covered by insurance. Anyone I know who had a facelift, breast augmentation or the like have paid for these procedures themselves. Post cancer treatment and similar situations might be exceptions. Whatever Sanders proposed sounded pretty reasonable. Knowing the mindset of doctors, hospital administrators I can see how difficult it will be to make it work.
3
It’d be nice for the Times to print, regularly, what this shift from private to public would mean for lost jobs and savings gained overall. Administration of health care would still be necessary. Only billing insurance companies and patients would change. Not all insurance industry workers: they would not all be unemployed. How many would find their skills redundant? What would the savings for the US be? What would the shift mean for efficiency, based on the UK and Canada models? What about waiting for procedures? What groups would benefit, as opposed to perceptions about who would benefit? Rationing? How about an overview, please?
14
To actually be affordable, a single payer system will have to limit care, probably very significantly. Thus, there will a big market for private insurance to make up the difference between what well insured people have now and what they will have when covered by a single payer system.
13
@Dave I don't know about Sanders' proposal itself, but Medicare as it exists covers many services, but not all of the cost. It only covers 80% of hospital stays. To cover doctor visits, you must pay premiums to get Part B, which also has deductibles. "Medigap" insurance is private, and covers what Medicare doesn't. I don't see why such policies would not continue.
Want drug coverage? That's Part D, and all such plans are issued by private insurance companies. You can also get a "Medicare Advantage" plan, which replaces Medicare. (Medicare pays the insurance company to provide the same stuff that Medicare does. If they can provide it for less, they make money.) I bet these, too, would continue.
3
@Dave
having worked as an RN in England under a single payer system there is no " limiting care". This is one of the myths spread about single payer systems. Surely we would be seeing caravans of health care refugees coming from Canada if they were " limiting care " up there , this is not the case. Instead Americans are forming caravans to go to Canada to buy Insulin - a lifesaving drug ! Stop listening to the lies being spread by Big Pharma and Big Insurance , they intend to fight to retain their corrupt power over us. Only a tidal wave ( Bernie and Warren Revolution ) can sweep them away , but it is happening and I intend to fight with them for it .
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@L. Finn-Smith
I don't want to put words into your mouth, but what I think you meant to say was you did not see limiting care. Pretty much by it's definition, those who had to wait for care too long never got to see you. They went elsewhere for the care the system asked them to wait for (or denied them access to) or they died.
2
Medicare for All is NOT health "insurance". It is health care. Health care outside it would presumably be fee for service for the few who could afford that.
3
@Michael Munk
Medicare for All is absolutely health insurance. Just as Medicare is insurance today. Healthcare providers will continue to be private businesses.
8
@Michael Munk
Not only is Medicare health insurance, it is very much fee for service.
3
@John Allen But M4A is not, as Medicare is, a program that insures people for premiums, copays and deductibles and is indeed fee for service to providers. M4A in Bernie's version eliminates payments by patients and provides care for all, although I assume it continues some form of the withholding that current Medicare requires.
Why don’t we just admit we no longer need a private insurance market? We can do better so... bye bye. We no longer have many industries that we outgrew as a nation, either due to progress or fashion. It is time to accept the disruption this may cause and move on. We will all benefit from a national health care system.
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@Jean Sims
Private insurance currently administers Medicare benefits to 30% of senior citizens, which means that we currently do very much need it.
2
Are public employee unions, who, at least in New York, have very generous health insurance, going to support an end to their current negotiated plans and go to the government system? I doubt it. Democrats, to keep union support, will not doubt try to carve out an exception to keep union support. Is this fair to everyone else?
10
@John Farrell
The funny thing is that once upon a time even private sector worker have equally as good or better plans. I would guess that many still do if one works for a respectable company, and not a company like Walmart that tells its employees to sign up for Medicaid. Is that fair to the rest of us?
16
@John Farrell
This is an excellent point. All the people who have robust health care coverage now, the insurance industry itself and providers of medical care, drugs and medical supplies that benefit from the status quo together make a very big voting bloc. This implies that a politician would be making an "all-in bet" to abolish private insurance. Even if this is the better way to go more often than not, such bets are rarely politically wise and can be an epic disaster if implemented poorly.
One feature that is nice about an employer-centric system is that many large employers self-insure. This gives them the incentive to not make their employees injured or sick or full of anxiety. Insurance companies act as administrators in these cases but employers assume the risk.
Such a system motivates organizational learning and improvements over time in a way that a purely public system is unlikely to be able to duplicate.
One feature that is not nice is people feeling tied to their employer for the health benefits. Rule changes for Medicaid and COBRA might mitigate much of this problem. There are simply better ways to get much of the benefit than risking more years of Trump on the public's desire to reinvent the health care system.
2
PLEASE take away my private employer-based insurance. I don't want a single penny of my earnings going to insurance execs. I would gladly have that money my employer is paying go towards taxes to fund a public program instead.
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@Claudia Gold - don't worry, money won't go to insurance company execs any more. It will go to a massive bureaucracy that will forever have a life of it's own. Problem is, the bureaucracies have no incentive to be efficient, except in giving lip service to that. You might want to think deeply about what you are asking for, and what in unintended consequences will be. That's what I plan to do before I support anything like this.
2
@RSW Medicare (bureaucracy and all) is way more efficient than insurance by private carriers. This is one area where we have long experience as a nation and know the costs. And it would only get better with simplified rules of single payer. Either we want everyone to have healthcare, or we don't.
5
@RSW Medicare overhead is much less than private insurance overhead, and built into private insurance premiums is a healthy profit so that their executives can earn another few million in bonuses.
5
Instead of this head-fake about "cosmetic surgery," why don't Mss Sanger-Katz and The Upshot begin reporting on what "single-payer" looks like in other countries, and how "Medicare-for-All" has been working in Canada, which originated the term "Medicare" more than half a century ago?
Why not explain to us how much we would save, how much more in terms of medical care we could get for much less money, and how our long-term health would dramatically benefit?
Why not admit the truth: that single-payer works beautifully in every other developed country which has put it in place, and how all of the horror stories about what it would do to America are all falsehoods?
Why not tell us that?
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@Sean
Except isn't state healthcare in Canada limited for such things as mental healthcare, dental care, physiotherapy, coverage for seniors, nursing homes etc? It sounds as though the Sanders bill is much more extensive than any other similar system, maybe unaffordable so..
Certainly all of those things are limited for the UK's national health service: there are a variety of single-payer systems in place around the world, all with their own limitations.
Having noted the limitations, they still certainly provide a degree of security that seems missing in the US, if only because healthcare isn't linked to wealth or employment. Families aren't driven to desperation trying to pay hospital bills when a loved one develops cancer or another life threatening illness.
13
@CSadler Clearly, the limitations are not in Canada or the UK, but in America. Millions of Americans can't afford to purchase insulin. But in Canada, going without insulin because of cost is unheard of.
The "limitations" are overwhelmingly in America, where psychiatric treatment often ends when the private insurance runs out.
Ask yourself why no one in any single-payer country wants to adopt the American system? No one wants our system. People are horrified to hear what Americans go through.
Enough with the falsehoods.
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@CSadler
spot on comment.
Just look at medical bankruptcy rates in US versus other countries.
Under Medicare for All, all the private providers will remain unchanged ie. your Doctor, your Dentist , your Hospital , your Pharmacy will remain YOUR CHOICE to use.
Only the BILLING will be different.
15
Good lord, we just go in circles.
Part of the 2009 American Recovery and Reinvestment Act (ARRA) ($787 billion in total) was spent to create jobs in healthare. Not for nurses or medical researchers, mind you, but jobs for IT specialists and vendors of complex, onerous electronic health records software. Have we considered that medicare for all would result in a loss of jobs far greater than the number we gained under the 2009 American Recovery and Reinvestment Act?
The health insurance industrial complex as it stands currently employs an enormous number of people, whether as employees of insurance companies or as persons who process billing for health care providers. While I don't like this system, the reality is that we would see far more people losing jobs as a result of Bernie's proposal than is readily acknowledged.
6
@Middleman MD
The UK's NHS has always been one of the world's largest employers, along with the Chinese army and the Indian rail service.
Of all of the possible concerns, a loss of jobs shouldn't come anywhere need the top of the list when considering whether or not to move towards a single-payer system.
30
If we switched to the Medicare for all plan many of the same people with this experience could shift into the new entities. Perhaps the Government would take over existing facilities.
4
@Middleman MD
"Not for nurses or medical researchers, mind you, but jobs for IT specialists and vendors of complex, onerous electronic health records software. Have we considered that medicare for all would result in a loss of jobs far greater than the number we gained under the 2009 American Recovery and Reinvestment Act?"
These are precisely the types of jobs that have made American healthcare so bloated and expensive. It wouldn't be a bad thing to see these jobs decrease.
9
This will never happen. Insurance, medical, drug, hospitals, doctors and all their lobbyists will buy off Congress through their PACS and kill it dead.
14
@Keith
this is why it is also time to reform our corrupt lobbying and PACs and repeal Citizens United.
6
@Keith Add in Union workers (who negotiated and received better health care benefits). Most private sector workers (130 million) actually prefer private insurance.
@James
They prefer it until they actually USE it.
Have you ever called your Insurer to resolve an issue or bill? Provider billing also is not transparent and bills are often confusing eg " pay this amount , by this date " ( when the item has not even been submitted to Insurer ! )
I have already reported this issue to CPFB. We need more transparency, we need more clarity. Medicare is super efficient , cost effective and billing statements are easy to read and understand.
2
I wouldn't object to Medicare for all, but I don't understand why having a private option is a problem. Several other countries with excellent universal health insurance do this. Even France, with their "socialized medicine" (which it's not, since most providers are private), allows private insurance companies to offer supplemental policies for people who would like coverage for providers who charge more than the standard rates covered by the free national insurance, or for procedures that aren't covered at all.
All we want is affordable universal health insurance. Whatever gets us that should be fine.
22
@MikeG The key point is that all of the basic healthcare for every person in each country with Medicare-for-All is covered by national health insurance, and everyone is enrolled, while everyone pays into the system that supports it. Where "private for-profit" insurance is available, it is only at the margin. No one has to rely on for-profit insurance for surgery for injuries, for cancer, for chronic medical conditions. Private insurance is marginal.
And that's the key point.
19
@MikeG
That is the logical role for (probably a few, small) private insurers alongside this kind of plan, but I wouldn't be surprised if politicians don't want to say so because people will then start fussing about "two-tiered healthcare." As if we don't already have two-tiered healthcare! The bottom tier is just 'nothing' whereas this would provide a decent minimum, as you seem to recognize. But some political faction always seems to start screaming about it when you talk about a universal coverage system that lets people "buy up" if they can afford it.
6
@MikeG I think the problem with supplementary private insurance is that people expect better, faster service for the money their paying - and why shouldn't they if more is coming out of their pocket? This however means that more wealthy people have access to something that others do not, which is a problematic concept when it comes to healthcare. Furthermore, it propagates the concept that there may be procedures that are necessary, but "unessential", which I think this bill is trying to get rid of.
That said, it's hard to see how the US, or any country, would be able to jump from one extreme to the other. Particularly as it will be a big adjustment for people to feel as though "their" money is going to something they may not agree with - I'm looking at anti-vaxxers and those opposing contraception and abortions.
3
Even Medicare is supplemented with private plans, and not all Democrats support Sander's plan, and Sander's plan is a opening salvo for negotiations, anyway, and Sanders probably meant that cosmetic surgery insurance was something that companies to offer if they wanted to.
We Americans all need to understand the problems with our approach to health care. You can't fix the problems without a clear understanding of what they are.
To start, an outstanding quote from Seeking Alpha:
"In the developed world, market-priced medical care still exists only in the USA.
The USA is the last holdout with market-priced medical care not only because of any inherent conservative or free market ideology. Rather, as the wealthiest nation that ever existed we are the only ones left who can afford it.
The reason that no nation, including the wealthiest, can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic.
Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded.
Basic economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve.
Consequently in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government.
Medical care in the USA being the only exception."
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@The Poet McTeagle
What about gasoline, heating fuel, electric power, food, telephone? Pretty inelastic demand for those too.
@The Poet McTeagle
America may have private insurance (so does that vastly different and better Swiss system) but it is in no way a free market. Any exchange in which a third party- from multiple payers or a single payer- sets the price is not a free market.
The only sectors of healthcare which exist in a free market are direct pay models.
3
Commercial health insurance companies are in the business of collecting premiums and paying nice dividends to their stockholders, not the business of paying claims or taking care of sick and injured people. Commercial health insurance companies should be a much reduced presence in our lives. NOBODY should be able to profit from our misfortune. Period.
27
@ChesBay
to quote an excellent NYT commenter from yesterday,
" Private insurance is a profitable business because it cherry-picks clients at their peak of health."
20
@ChesBay This makes no sense. 1st of all, profits at insurance companies are only about 5%. The secret to saving costs isn't to eliminate insurance profits. You could eliminate 5%, but also eliminate the competitive nature of the landscape and see costs rise much higher.
As far as "NOBODY should be able to profit from our misfortune" does this mean life insurance should also be illegal?
1
In 2005 I had excellent union health insurance and needed reconstruction of two breasts after a double mastectomy. Knowing the drawbacks of implants, I did not want them as part of the reconstruction. I was too thin to have the surgery that takes implant "material" from the belly. For me, the only procedure using fat from my own body involved taking it from the buttocks--an extremely complicated procedure then practiced successfully by only a handful of surgeons in the nation and involving many hours on the operating table. I never saw a bill for the procedure which was successful and for which I remain profoundly grateful. If I'd any coverage other than my union health care, I would have probably been billed *at least* 20 percent of the procedure's costs--many tens of thousands of dollars. I would have faced the choice of implants or depleting my life savings.
6
@trenton By law your procedure is defined as reconstructive surgery, not cosmetic surgery. Different thing altogether.
15
@The Poet McTeagle
Ok.
The law doesn’t define type of surgery. The series of procedures is defined by billing codes, then determined medically necessary or not depending on the circumstances and documentation of such. Whether it is medically necessary is based on a coverage determination document that is written by a non elected committee.
Different thing altogether.
I have been paying into Medicare for decades, since such payroll deductions began in 1986. Now that I am just enrolled, would I get a refund if they pass Medicare For All? Obviously that is a stupid question because the answer is undoubtedly no. But for those who are still working, would they continue to pay even though folks who aren’t working would be equally covered? Since that would certainly create a political backlash, why not just raise the income and other tax rates to cover it and do away with the payroll deduction?
4
@Patrick
You have, of course, been paying into only the hospitalization portion of Medicare (Part A). Part B, which covers doctor bills, and Part D (prescription drugs) are financed by a combination of patient premiums and general tax money.
So, while you raise a legitimate general point about how any new system will be funded, we should all be cognizant of the fact that only hospitalization is covered by workers' payroll deductions during their working years.
6
@Alice Clark
Yes, the Part B $135 Part B monthly deduction from Social Security. I forgot about that. So would workers also then have that amount deducted from their pay checks as well? Or would people on SS continue or not continue to have that deducted? It would truly be a travesty if folks on SS were paying for everyone else besides themselves, wouldn’t it?
2
@Patrick
All the 90 year olds who paid in all their working lives have far exceeded that amount and you are covering them entirely. Will you complain when your mayor wants that coverage to extend to the undocumented? That will be an interesting experiment before the election and before the elderly start showing up at the border.
It would be very good private insurance indeed to cover optional aesthetic surgery.
Medicare still allows & encourages secondary and prescription drug plans. Kinda mandatory to cover the shortfall!
We will still see supplemental insurance plans, cosmetic plans, umbrella plans, foreign plans and concierge doctors. Money will still allow faster and out-of-plan treatment as it does today.
If you must blame Democrats for incomplete future health care, you must really love your plan today...
...and 26 million Americans have no plan at all. That’s an epidemic.
9
The reality is that none of the proposed legislation will ever make it through a congressional committee. Despite claims to the contrary, we don't elect a dictator who writes the laws.
As far as a government run medical insurance plan we have to look no further than those Americans on Medicare today. Almost all of them have supplemental insurance because the federal plan doesn't cover everything or even 100% of all costs. And, what most Americans under 65 don't realize is that you pay for everything except "Part-A" (hospitalization). It is not free.
A "Medicare for All" bill would not end the private sector insurance, it actually might give them a boost in both sales and profits.
5
Thank you. He wasn't the only one who mentioned insurance for cosmetic procedures, but I can't remember who else. How out of touch can they be?
2
It's possible to provide very broad coverage and still have a role for private insurance. I have a Blue Cross card in my purse right now. It covers medication, adult dental and eye care, mobility aids, upgrades (e.g. semi-private to private room), massage, physio and a host of other things that are costly but not generally catastrophic expenses to the uninsured. Take out eye exams and there are still eye glasses to cover. Take out basic dental and there are still upgrades (e.g. amalgam to composite fillings). My insurance doesn't cover non-RX but non-optional OTC like lice treatement or iron pills... but it could. Look at our industry. There's a huge, and profitable, role.
4
If we had Medicare for All covering everything here, an American planning a trip to another country could buy private health insurance to cover the trip.
3
@Eric J We do this. Most Canadians wouldn't dream of leaving the country without travel health insurance.
5
@Eric J
Medicare doesn’t cover foreign travel medical expenses except under very limited circumstances. They (Medicare) recommend that travelers buy travel insurance.
3
Part of me wants Bernie to be the nominee just so that, when he loses in a landslide thanks to his cartoonishly leftwing policies, Democrats can het back to proposing real solutions.
9
This is where that trusty market would come into play. Where there is a want, the market will step in. Providers should be welcome to profit from discretionary health needs. Definitions hopefully to policy professionals rather than politicians.
3
Medicare only pays 80% of covered costs. When originally implemented the remaining 20% was probably not an issue for most patients. Medicare payments, now deemed too low by our insatiably greedy medical/pharmaceutical industry, are subsidized by inflated prices for everyone not yet eligible for Medicare. If we get Medicare for all the medical/pharma industries will make everything so expensive that the premiums we'll have to pay for their supplemental plans to cover the 20% Medicare doesn't will be the same as we are paying for private health insurance now. That's because every dollar we currently pay for health insurance is a corporate CEO's maga-salary/bonus and supports their company stock price. They will defend those dollars to the death. While I support Medicare for All in principle, I don't believe for a minute that the health insurance/pharma industries will ever stop trying to bankrupt every American citizen when we need health care.
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@Steve725
A fair point, but with literally the entire country as their customers, MfA would have god-like bargaining power....unless of course it contained such idiocy as the current rule denying Medicare from negotiating drug prices...
7
@Steve725But MfA in Bernie's version is NOT current Medicare. The 20% , the premiums, the supplemental insurance ,the copays dedeductibles--all will be rightfully dumped in Marx's proverbial "dustbin"
1