The public option failed for only one reason: Joe Leiberman, from Insurance-Rich Connecticut. It was an essential part of Obamacare, and the fact that it is missing is the main reason Obamacare has most of its problems.
1
It all matters with what assumption we begin:
1) Pre-Obamacare health insurance was fine and just needed a few tweaks
2) Obamacare is fine and just needs a few tweaks
3) Our health-care system is failing apart and needs serious planning to replace it before people get hurt.
1- Is mistaken. Many were uninsured, and prices were rising too fast.
2- Can possibly work -- but needs a lot of tweaks (reduced cost of medical care and more people covered). The problem with reform of any kind is that it is hard to get the privileged to voluntarily give up some of their advantages, and it is hard to motivate people for gradual changes.
3- Has a chance, but requires serious work and a carefully planned roll-out and transition. It will require this planning work to go on through several administrations, through major political shifts. Meanwhile #2 will have to do for the next 5-10 years, so keep tweaking it.
1
A government run health insurance program that everyone must contribute to through payroll taxes solves many of these problems. The government uses its clout to negotiate prices for doctors, hospitals, tests, drugs, devices - every part of the health care system. Everyone gets good coverage. Costs are contained. Everyone wins.
3
Why do we have employers in the health care business? Don`t think for a minute that because someone is working for an employer that offers health care means that the employee is covered, because too often the employee cannot afford to pay their share of the required cost. No one ever mentions that fact when figuring statistics. There are many people that have no health coverage because, for many different reasons found themselves to be unemployed in their fifties or sixties, and considered no longer employable. They must wait for several years to be eligible for medicare.
It is time the United States has a "single payer plan." Everyone should have medical care regardless of age, status, or money. It is just as important as the fire and police protection that we pay from our taxes. We need Medicare for all.
It is time the United States has a "single payer plan." Everyone should have medical care regardless of age, status, or money. It is just as important as the fire and police protection that we pay from our taxes. We need Medicare for all.
7
In World War II the govt had wage and price controls, so employers could not attract workers by offering higher wages. So they began offering "benefits", like health insurance, to compete for workers. From that start, it got entrenched and then through the workings of "the market economy", insurance companies grew and more businesses bought into the idea, and finally the now-familiar pattern of costs going up so people needed insurance to protect from big bills, and premiums going up to match, and the spiral leading to people not able to afford either care or insurance, and the mess that ACA was supposed to solve, or at least make progress toward solving. But by then the power of insurance and drug companies, and the vast intricate web of it all, made a sensible and workable solution for the people just about impossible.
So now we have many more people "insured" but the market forces are still at work, and I expect the mess to get worse until finally the pain of the people is enough to drive some kind of push to have universal coverage through, yes, the government. Nothing else will work, it's just a matter of time before the pain gets there. I have just gotten into Medicare, so I feel like I have been rescued. All the insurance plans I ever had were incredibly complex, almost opaque. And I was always on the phone to straighten something out. Govenrment run health care is working fine for me.
So now we have many more people "insured" but the market forces are still at work, and I expect the mess to get worse until finally the pain of the people is enough to drive some kind of push to have universal coverage through, yes, the government. Nothing else will work, it's just a matter of time before the pain gets there. I have just gotten into Medicare, so I feel like I have been rescued. All the insurance plans I ever had were incredibly complex, almost opaque. And I was always on the phone to straighten something out. Govenrment run health care is working fine for me.
2
I'm sorry, but it is hard for anyone outside the united States to comprehend why there is any reason a nations populace could be against universal health care. Put yourselves ahead of the private insurers.
5
Why do we allow insurance companies to manage our health care? It is crazzzzy.
4
Haven't either of you traveled abroad or considered what the OECD countries have done to provide better health care at one half or one third (Japan) the cost?
4
A fraction of the costs of our unnecessary wars (some wars are necessary) and Pentagon overruns/wasteful spending (the Pentagon has been unable to produce its congressionally-mandated budget audits in the last 10 to 20 years) would go a long way to funding a truly competitive health care system (including education, research, labor, and infrastructure).
As Eisenhower warned - beware the military/industrial complex.
Today one needs to add - beware the health/pharma complex.
Its time to reset out priorities and tackle these issues head-on.
As Eisenhower warned - beware the military/industrial complex.
Today one needs to add - beware the health/pharma complex.
Its time to reset out priorities and tackle these issues head-on.
7
I am American but shut out of the US system when I was diagnosed with a rare genetic disease while in college in Canada. It is not life threatening but it has meant hospitalization, sometimes fir weeks and home care. have spent more then 20 years involved wuth health policy in Canada and wat hoping I would also be able to return to the US where all of my family lives. 3 things to think about. 1st it was built incrementally. 2 it attracted manufacturing including the car companies and 3 it contributed to social cohesion because everyone benefitted. There was alt of opposition at times and it has had to change as new issues arose but ending it is political suicide. It also let me work without having to worry about going broke and the only people who decide whether I need a specialist or hospitalization is my dr. Perfect no but nothing is.
I am so happy that at 70 years old, I have never in my life have had to use private health insurance. Spending 30 years in the U.S. military, I've found slngle-payer Tricare works efficiently and quickly, actually better than Medicare which I use when I'm not near my military base. The VA is not the example to cite when discussing single payer. The real examples are Medicare and Tricare. I also am influenced by my use of single payer systems overseas while stationed in countries that have it. It works well. If we really wanted to get rid of private insurers, we'd simply phase in the population in 5 year groups every year. In 10 years, the entire country would be covered. And I strongly suspect Medicare wouldn't cost $600 a month like some private, for-profit systems.
8
We used to have a version of this, called Blue Cross/Blue Shield. Introducing non-competitive "competition" is what has made things worse over time.
1
Before 1999 in NY, Empire Blue Cross/Blue Shield used to be not-for-profit. Allowing it to become a for-profit publicly traded company was a serious error. Health insurance and health care companies should NEVER be for profit. Who benefits? Corporations should never have been made legal "persons" either, but that was an even older mistake. This way, profits will always take precedence over service and keeping it affordable.
We have an example of a Federal single payer public option: the Veterans Administration. Obama promised to fix that, too.
3
There are many things Obama wanted to fix and would have done so had the Republican Congress allowed it, but they did not want him to look good, as they stated "he should be a one term president." It is amazing that President Obama accomplished as much as he did in spite of the Republicans.
3
Any health 'option' including the current Medicare needs to look carefully at coverage for Rx. Take for example biologics used routinely now and with good effect for autoimmune illnesses. $$ coverage for these medications is low to non-existent by Medicare or supplemental plans (funny how Enbrel is given away by the manufacturer, but not if you become Medicare covered). That's a difference from private to 'public' coverage of many thousands per year in out of pocket costs. (not to mention it comes a a surprise to new Medicare enrollees)
2
Why is it that the French, Germans, Canadians, and the rest of the industrialized world can pay for health care and we can't? Two reasons: ours is more expensive, and we have too many people.
Maybe they should let the Canadians run the public option. If you wanted Canadian-style health care, they could price it and sell it to you at the same price that the Canadian government pays to insure its citizens. The French or Germans could run it too, but Canada is geographically and culturally closer. And if industry is really more efficient than government, industry could compete with the Canadian-style system, offering better coverage at a better price. Ya think, eh?
Then there's population. America has roughly 3x the population of any other industrialized nation. It's a bigger, more complicated problem. Still, I think the Canadians could manage it.
Maybe they should let the Canadians run the public option. If you wanted Canadian-style health care, they could price it and sell it to you at the same price that the Canadian government pays to insure its citizens. The French or Germans could run it too, but Canada is geographically and culturally closer. And if industry is really more efficient than government, industry could compete with the Canadian-style system, offering better coverage at a better price. Ya think, eh?
Then there's population. America has roughly 3x the population of any other industrialized nation. It's a bigger, more complicated problem. Still, I think the Canadians could manage it.
2
Michael,
Population has little to do with being able to have a single payer system. It's just, bigger. More money, more doctors. Bigger doesn't mean unmanageable. The population argument sounds like an argument that really isn't.
Then ask yourself, why is the same care and the same medication so high in cost in the US. Because it is (generally speaking) an unregulated market. For profit corporations price their drugs as they wish and the insurance companies have to adjust their coverage, or drop it, for the market place.
It is cheaper in other countries because of government regulations on costs.
It's a simplistic version of the reality but the reality is, the high costs are directly related to the shareholders profits. Follow the money.
Population has little to do with being able to have a single payer system. It's just, bigger. More money, more doctors. Bigger doesn't mean unmanageable. The population argument sounds like an argument that really isn't.
Then ask yourself, why is the same care and the same medication so high in cost in the US. Because it is (generally speaking) an unregulated market. For profit corporations price their drugs as they wish and the insurance companies have to adjust their coverage, or drop it, for the market place.
It is cheaper in other countries because of government regulations on costs.
It's a simplistic version of the reality but the reality is, the high costs are directly related to the shareholders profits. Follow the money.
8
Medication in the U S is taxed on gross sales by ACA
That tax is added into the price
That price is a factor in why your premiums are so high.
also
Rx in the U S is highly regulated
Ever since the Tylenol scare, the paperwork that follows RX ismore than the Rx costs
That tax is added into the price
That price is a factor in why your premiums are so high.
also
Rx in the U S is highly regulated
Ever since the Tylenol scare, the paperwork that follows RX ismore than the Rx costs
Any further efforts to control payments to private practice doctors, who already limit their medicare "burden" because the payments are below their costs, particularly with the increasing documentation requirements, will drive the last of them out of Federal programs, and into the growing "tier" of medicine, often referred to as "concierge" medicine.
The real solution is so simple--take outpatient care, which is the majority of healthcare, out of high cost expensive marble laden hospitals and hospital systems, and put it back to the low cost setting of doctors' office buildings. And outlaw hospital employment of physicians.
As it is now, doctors are forced by low payments, into hospital employment, where patients and insurance companies pay up to 3X as much for outpatient visits and tests, even if the doctor is the same office that he once owned. This differential payment system is one incentive for hospitals buying practices. The other is the fact that an "owned doctor" is required to make all his referrals to other doctors employed by his boss. This reduces the quality of care because it takes away the ethical responsibility of the doctor to do what is best for his/her patient and choose from the whole pool of specialists, not just the one at his hospital.
It is still illegal for a hospital to even buy dinner for an independent doctor, lest it appears they are soliciting his referrals, yet it is legal for that hospital to simply buy the doctor him/herself.
The real solution is so simple--take outpatient care, which is the majority of healthcare, out of high cost expensive marble laden hospitals and hospital systems, and put it back to the low cost setting of doctors' office buildings. And outlaw hospital employment of physicians.
As it is now, doctors are forced by low payments, into hospital employment, where patients and insurance companies pay up to 3X as much for outpatient visits and tests, even if the doctor is the same office that he once owned. This differential payment system is one incentive for hospitals buying practices. The other is the fact that an "owned doctor" is required to make all his referrals to other doctors employed by his boss. This reduces the quality of care because it takes away the ethical responsibility of the doctor to do what is best for his/her patient and choose from the whole pool of specialists, not just the one at his hospital.
It is still illegal for a hospital to even buy dinner for an independent doctor, lest it appears they are soliciting his referrals, yet it is legal for that hospital to simply buy the doctor him/herself.
3
As a small business owner, providing health insurance is the bane of my existence. I agree with your suggestions and I want to add one thought. It seems that all proposals look to extract savings from the care providers - Dr's and Hospitals.
My thought is that by eliminating the middle man - publicly traded insurance companies, Dr's could cut out the massive back office operations they necessarily maintain in order to code claims and run collections. In addition, the insurance companies themselves represent billions of dollars in costs and infrastructure and are managed for quarterly returns to shareholders which means they need to reduce expenditures to Dr's and Hospitals for services and are incentivized to deny claims. All of this money could and should be redistributed to our care providers. Even medicare would be able to pay providers more if they had young, healthy people paying into the system.
I would happily give every one of my employees a raise equal to the exorbitant amount I pay for their insurance - up to $11,000 for a family - in order for them to be able to buy into the Medicare and supplement market.
Lastly, this could all be paid for with a consumption tax that would capture a percentage of the billions in off-the-books earnings in this country.
My thought is that by eliminating the middle man - publicly traded insurance companies, Dr's could cut out the massive back office operations they necessarily maintain in order to code claims and run collections. In addition, the insurance companies themselves represent billions of dollars in costs and infrastructure and are managed for quarterly returns to shareholders which means they need to reduce expenditures to Dr's and Hospitals for services and are incentivized to deny claims. All of this money could and should be redistributed to our care providers. Even medicare would be able to pay providers more if they had young, healthy people paying into the system.
I would happily give every one of my employees a raise equal to the exorbitant amount I pay for their insurance - up to $11,000 for a family - in order for them to be able to buy into the Medicare and supplement market.
Lastly, this could all be paid for with a consumption tax that would capture a percentage of the billions in off-the-books earnings in this country.
11
When ACA was passed, it created a pass on health care becomming a monopoly as Accountable Care Organizations.
All those private practices were gobbled up to form clinics, which can bill the same process at a higher clinical rate.
All those private practices were gobbled up to form clinics, which can bill the same process at a higher clinical rate.
There is absolutely no reason for an employer to be be in the health insurance business anymore than car and homeowners insurance. Take insurance companies out of the equation completely and have a single payer plan.
the world is full of fools.
all of ylu have been fooled into thinking medical is so expesnive that without insurance you would die.
ladies and gwntlemen. your insurance companies 10-20% of the amount on a bill.
real cash price
regualr chekup real price $50
childbirth $1500
broken limb $300
heart attack $4000
cat scan $300
ask yourself...... why is a typical family of 4 dolling out $20000 a year for medical coverage with deducts and copays of 10000 per year when you will probably never incur more than $200000 in real medical cost in your life.
outside of some odd persciptions most people would pay about as much for healthcare as they do to keep a car running.
the greatest cost most people incur is for long term nursing care. which is limited by almost all policies including medicare
all of ylu have been fooled into thinking medical is so expesnive that without insurance you would die.
ladies and gwntlemen. your insurance companies 10-20% of the amount on a bill.
real cash price
regualr chekup real price $50
childbirth $1500
broken limb $300
heart attack $4000
cat scan $300
ask yourself...... why is a typical family of 4 dolling out $20000 a year for medical coverage with deducts and copays of 10000 per year when you will probably never incur more than $200000 in real medical cost in your life.
outside of some odd persciptions most people would pay about as much for healthcare as they do to keep a car running.
the greatest cost most people incur is for long term nursing care. which is limited by almost all policies including medicare
2
There should be universal catastrophic coverage.
5
Medicare for all with the government setting prices is a tenable option. Insurance products like Medicare Supplements could fill gaps in coverage. It's not ideal because it still creates a tiered system where those with more money have better options but it gets at cost problems which is the root of the problem today. And legislators in states like CA better consider it because the current marketplace is hanging on by a thread. In a year, there will be significant exits by carriers. I don't think the Medicare Advantage model is a good one. As you'll see in the next couple of weeks, those plans pull out of markets regularly when the financial picture becomes unviable, leaving seniors in a lurch. And, the so called national competition Trump proposes would only lead to more of the same. Inexperienced national carriers come in and see the market opportunity but fail because they lack knowledge on the population. What seemed like an opportunity at the outset proves too costly to be viable as too few medical systems lead to poor contract negotiations. We have a year to get it right or it's going to start hobbling badly.
Americans are already angry over "access" issues. They've been given mandated benefits but too many either cannot afford to access them or are too severely restricted by limited physician and hospital networks to get the care they had been receiving or believe they need.
If they're already angered by these limitations, why would anyone believe they will find a single payer system, which will necessarily bring its own cost-management restrictions, any more acceptable? Does anyone believe these Americans will be happy with 6-month waits for basic services?
There's no simple one-program solution. Democrats should stop pretending there is. They have demonstrated they know little when it comes to planning and implementing health insurance plans. They'll sell the benefits without a lick of understanding of what they're really doing. We've seen that already.
It's time for solutions that work for ALL income levels. Obamacare dealt with a solution for subsidized insureds. It overlooked middle and upper income insureds, who have been hit the hardest by it.
We need solutions that provide options for people who cannot afford health insurance but also for people who can and do not want their health care choices curtailed.
If they're already angered by these limitations, why would anyone believe they will find a single payer system, which will necessarily bring its own cost-management restrictions, any more acceptable? Does anyone believe these Americans will be happy with 6-month waits for basic services?
There's no simple one-program solution. Democrats should stop pretending there is. They have demonstrated they know little when it comes to planning and implementing health insurance plans. They'll sell the benefits without a lick of understanding of what they're really doing. We've seen that already.
It's time for solutions that work for ALL income levels. Obamacare dealt with a solution for subsidized insureds. It overlooked middle and upper income insureds, who have been hit the hardest by it.
We need solutions that provide options for people who cannot afford health insurance but also for people who can and do not want their health care choices curtailed.
1
1) Like any other industry, we need to be able to import doctors from other qualified countries. A software engineer who programs a 777 control system can be hired anonymously on the fly, but someone who looks at a wart needs to be board certified? If it is some objective knowledge based licensing body that would be fine. But it exists just to keep the supply scarce so that salaries can be kept high.
2) We don't need insurance companies working across state lines. Let doctors work across state lines, and prescribe medicine by video & Tele consultation. The prices would drop tomorrow. I would happily swap a doctor who keeps me waiting in a 4x4 cell for 45 minutes before seeing me for 3 minutes with someone who can give me the time of the day but lives 200 miles away, where the real estate is cheaper.
3) Ban all direct to consumer advertising of prescription medicines.
4) Link pharma patents to vaccine development, R&D spending, executive salary, and US taxes paid. Patent protection is a government (public) benefit given to the company with the expectation of some public good. Not for leaches.
5) Lastly, the health insurance companies don't serve any useful purpose other than being in the middle to siphon health care dollars and collude with the pharma and hospital industry. They should be snuffed out.
2) We don't need insurance companies working across state lines. Let doctors work across state lines, and prescribe medicine by video & Tele consultation. The prices would drop tomorrow. I would happily swap a doctor who keeps me waiting in a 4x4 cell for 45 minutes before seeing me for 3 minutes with someone who can give me the time of the day but lives 200 miles away, where the real estate is cheaper.
3) Ban all direct to consumer advertising of prescription medicines.
4) Link pharma patents to vaccine development, R&D spending, executive salary, and US taxes paid. Patent protection is a government (public) benefit given to the company with the expectation of some public good. Not for leaches.
5) Lastly, the health insurance companies don't serve any useful purpose other than being in the middle to siphon health care dollars and collude with the pharma and hospital industry. They should be snuffed out.
8
If the US is in a such a position that we have to important doctors trained in third world countries, we are in big trouble.
Reed Abelson has it right: whether the bill is paid by a government-run public option plan or a private insurance company, if the bill is the same, the only saving will be the differential in the profit margin of private insurance. To bend back the increasing cost of health care, the the other side of the equation needs to be addressed: strict schedules on what we as a society are willing to pay for the services of doctors, hospitals, pharmaceuticals, medical devices. Health care is a right of all people, and those who work in that sector must realize that they do so as a service to society, not themselves. The rest of the industrialized world has already taken this step, so if those who have become accustomed to enriching themselves at the expense of the rest of America don't like it, where else will they go? Frankly, I would much rather be treated by a doctor who sees me as a patient than one who simply sees me as a payday.
7
The rest of the industrialized world pays for nearly all of a doctor's education. In our country, doctors frequently graduate with a quarter of a million dollars in debt while making $150-$200k if they are in primary care. How would you like to spend 10 years training only to be paid so little you can barely service you debt while working 60-80 hours per week...and be told that's required because you are there to serve society not yourself?
As a patient, how would you like to spend no more than 5 minutes with a doctor? Remember, overheard costs are fixed, so reducing pay means doctors have to squeeze more visits into an hour. That's how the 15 minute office visit became standard: medicare decided to set their prices such that doctors had to see 4 patients an hour to cover their expenses and a middle-class salary. Insurance companies followed suit and and medicaid paid even less. There isn't time or incentive to practice real medicine, so PCPs order shotgun tests and punt to specialists, which ends up costing more money than the system saved. And yet people can't figure out why doctors are burning out and costs keep rising.
Worse, it doesn't address the fact the vast majority of increaded medical costs come from expensive treatments and hospitalizations in the last two years of life.
As a patient, how would you like to spend no more than 5 minutes with a doctor? Remember, overheard costs are fixed, so reducing pay means doctors have to squeeze more visits into an hour. That's how the 15 minute office visit became standard: medicare decided to set their prices such that doctors had to see 4 patients an hour to cover their expenses and a middle-class salary. Insurance companies followed suit and and medicaid paid even less. There isn't time or incentive to practice real medicine, so PCPs order shotgun tests and punt to specialists, which ends up costing more money than the system saved. And yet people can't figure out why doctors are burning out and costs keep rising.
Worse, it doesn't address the fact the vast majority of increaded medical costs come from expensive treatments and hospitalizations in the last two years of life.
2
ockham, you write "I would much rather be treated by a doctor who sees me as a patient than one who simply sees me as a payday."
Why are the two mutually exclusive? Shouldn't someone who supplies a needed service be paid a good wage?
Why can't a doctor be talented and devoted to his patients AND want to earn a good wage, especially when his overhead can be hundreds of thousands of dollars a year? Who will pay his malpractice insurance premium which can be $200,000 a year? Who will pay for his medical school education?
Why should society determine how much to pay doctors, hospitals, etc.? What happened to free market economics? Should society also determine how much to pay everyone else: bus drivers, lawyers, bankers, teachers, artists, janitors, etc.? Where does it end? Why attack only doctors?
Why are the two mutually exclusive? Shouldn't someone who supplies a needed service be paid a good wage?
Why can't a doctor be talented and devoted to his patients AND want to earn a good wage, especially when his overhead can be hundreds of thousands of dollars a year? Who will pay his malpractice insurance premium which can be $200,000 a year? Who will pay for his medical school education?
Why should society determine how much to pay doctors, hospitals, etc.? What happened to free market economics? Should society also determine how much to pay everyone else: bus drivers, lawyers, bankers, teachers, artists, janitors, etc.? Where does it end? Why attack only doctors?
1
The real way to reduce healthcare costs is to outlaw the direct employment of doctors by hospitals. A good start would "site neutral payments" as recommended by MedPAC for Medicare (insurance companies would follow suit). Ie Medicare should pay the same amount for all services wherever they are provided.
Then hospitals would no longer be paid 3X what an an independent physician is paid for an identical service provided in a doctors outpatient office. Now, outpatient visits to employed doctors are paid up to three times what private docs are paid, even if the hospital owned clinic is in a regular office building. Because it is classed as "hospital outpatient Department" it can and does charge hospital fees including facility fees. And if an enterprising self pay or high deductible patient tries to find out the cost of a visit to its owned doctor, they will have a very hard time finding out. And when they do, it may not include the facility fee charge that will be tacked on.
On the other hand, the offices of independent physicians will usually quickly provide an estimate of the cost of a first visit, based on the reason for the appointment, even checking the patients' insurance for them. Of course, the patient with a high deductible may be asked to have a credit card on file.
Private doctors can not afford to provide free care for non-paying patients. Sad to have to turn away ACA patients who did not understand their deductibles until they really need care...
Then hospitals would no longer be paid 3X what an an independent physician is paid for an identical service provided in a doctors outpatient office. Now, outpatient visits to employed doctors are paid up to three times what private docs are paid, even if the hospital owned clinic is in a regular office building. Because it is classed as "hospital outpatient Department" it can and does charge hospital fees including facility fees. And if an enterprising self pay or high deductible patient tries to find out the cost of a visit to its owned doctor, they will have a very hard time finding out. And when they do, it may not include the facility fee charge that will be tacked on.
On the other hand, the offices of independent physicians will usually quickly provide an estimate of the cost of a first visit, based on the reason for the appointment, even checking the patients' insurance for them. Of course, the patient with a high deductible may be asked to have a credit card on file.
Private doctors can not afford to provide free care for non-paying patients. Sad to have to turn away ACA patients who did not understand their deductibles until they really need care...
1
I don't know why some American people don't think we deserve universal health care like Canadians, Europeans, or Japanese. The US spends the most per capita in the world and still leaves 29 millions uninsured and more underinsured.
http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/...
Research shows that Canada and Scotland's universal health care enjoys the lowest administrative costs in healthcare with its one network and one insurer. On the other hand, our highly fragmented healthcare systems are making us all pay the highest administrative costs (25 cents per dollar of our premium) in the world and it also proves true that a market-oriented healthcare system does not work efficiently. A free market needs price transparency, which we don't have in healthcare. Without price transparency and other market information, patients cannot make sound decisions on where and which doctor to see or surgical procedure to sign on.
http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/...
Research shows that Canada and Scotland's universal health care enjoys the lowest administrative costs in healthcare with its one network and one insurer. On the other hand, our highly fragmented healthcare systems are making us all pay the highest administrative costs (25 cents per dollar of our premium) in the world and it also proves true that a market-oriented healthcare system does not work efficiently. A free market needs price transparency, which we don't have in healthcare. Without price transparency and other market information, patients cannot make sound decisions on where and which doctor to see or surgical procedure to sign on.
12
We have the largest federal bureaucracy. Few in those countries would ever turn their health care over to a government the size of ours and that functions as it does. Think Brexit.
1
That's why places like Canada leave it up provinces to provide healthcare based on regional factors, supplemented by federal money. A large federal buteacracy is not required.
1
There are so many things wrong with the health care system in our country that it is hard to know where to start to reform the system. Mr. Obama's plan which did improve some aspects of the system on the whole is very disappointing. The high cost of care (17+ percent of GDP) is the problem. Any reform is doomed if that number remains unchanged. In the current system the changes which need to be made are impossible. The problem can only get worse.
1
I am still practicing after 30 years and still waiting for single payer universal coverage.
When I saw the headline, I was optimistic.
However, if you read between the lines, HRC's article and the discussion following are very depressing because there seems to be more hidden preservation of the status quo than it appears.
Giving private insurance and drug companies a larger share of the healthiest patients, while using more tax subsidies to help with their premiums, is just feeding the beast, not starving it.
I get paid well enough by Medicare and I am well cared for as a patient myself on Medicare.
I say lower the Medicare age to zero and then create a PRIVATE option for anyone who wants it.
When I saw the headline, I was optimistic.
However, if you read between the lines, HRC's article and the discussion following are very depressing because there seems to be more hidden preservation of the status quo than it appears.
Giving private insurance and drug companies a larger share of the healthiest patients, while using more tax subsidies to help with their premiums, is just feeding the beast, not starving it.
I get paid well enough by Medicare and I am well cared for as a patient myself on Medicare.
I say lower the Medicare age to zero and then create a PRIVATE option for anyone who wants it.
34
@Husky, since you have been practicing 30 years, I trust you do not have any college or medical school loans to pay off. Would you feel the same way if you were just starting in your career.
Plus, if we have universal Medicare, as you suggest, what would you do when the government decides to reimburse you $10 for seeing a patient? Do you really trust the government when it has such power to set compensation? I don't. You are giving the govt. a virtual monopoly over your pay.
Plus, if we have universal Medicare, as you suggest, what would you do when the government decides to reimburse you $10 for seeing a patient? Do you really trust the government when it has such power to set compensation? I don't. You are giving the govt. a virtual monopoly over your pay.
If you accept the proposition that private health insurance with its high prices and limited networks is a current ongoing disaster, as I do, we must come to the conclusion that the public option should be the ONLY option, the sooner the better
24
will not cut the cost, as the federal system for the 80% Medicare covers costs 1,000 per person per month.
The cost is in the federal, state and local governance, and the taxes imposed by each.
Maryland adds a 15% tax on medical services
The U S taxes drugs, and taxes drug makers on gross sales.
The U S also taxes insurance policies
Why would a government profit off of sickness?
The cost is in the federal, state and local governance, and the taxes imposed by each.
Maryland adds a 15% tax on medical services
The U S taxes drugs, and taxes drug makers on gross sales.
The U S also taxes insurance policies
Why would a government profit off of sickness?
The most billed office code in America (billed tens of thousands of times every day) is a 99213. It's essentially a 15 minute visit for an established patient. If you really stay focused, you can see 4 patients like this, per hour. If you are a physician in a private practice, you get $70 from Medicare for that visit. If you work for a hospital system though (even far away from an actual hospital) Medicare will pay you $120. That's $280/hr private. $480/hr hospital employed. Considering typical office overhead is ~$250/hr, you can have $30/hr left over for profit in a private practice, or $230/hr profit as a hospital employee doctor.
Pay doctors Medicare rates, and the private practice of medicine in America is gone. Then they don't work for you, the patient, any longer. They work for some hospital suit.
It is the cost of expensive drugs and technology that is driving inflation in healthcare. In 1980 healthcare spending was 9% of GDP. Physicians were in small group and solo practices and it was 90% fee for service and private. How doctors work and get paid has little to do with cost inflation. I don't know a single doctor whose wages went up 1000% in the last few years for doing the same exact thing, but dozens of "generic" drugs have......
Pay doctors Medicare rates, and the private practice of medicine in America is gone. Then they don't work for you, the patient, any longer. They work for some hospital suit.
It is the cost of expensive drugs and technology that is driving inflation in healthcare. In 1980 healthcare spending was 9% of GDP. Physicians were in small group and solo practices and it was 90% fee for service and private. How doctors work and get paid has little to do with cost inflation. I don't know a single doctor whose wages went up 1000% in the last few years for doing the same exact thing, but dozens of "generic" drugs have......
16
The cost of drugs (retail plus hospital) per year is about $400B, while physician salaries are around $250B-300B. All health care labor costs total to a little north of $1T, possibly $1.5T. Drugs are definitely expensive, but the high cost of labor needs to be addressed as well.
3
Nicky,
Medicare also pays for a significant portion of the drugs and expensive technologies used today, not to mention medical procedures. Do they have a problem with "Medicare rates"? Is the problem that of a single payer, or of successful lobbying by different healthcare groups for more money? While I absolutely respect the role PCPs can play in controlling medical spending and monitoring patient care, keep in mind that we hardly need doctors if all they are good for is telling patients what they should eat and avoid reminding them to exercise and not smoke. Why shouldn't most of our spending be on medicines and technological advances.
Here's something I don't understand. If drugs and technology are inflating the cost of medicine, but at the same time administrative costs - consistently remain at 20% spending, doesn't that make them inflationary as well? If they weren't a contributor to rising costs in medicine, wouldn't the percentage of spending on them be shrinking relative to the other spending? The fact is, we spend an unconscionable amount of money on administrative costs in this country, because of the ridiculous complexity of our healthcare system.
Medicare also pays for a significant portion of the drugs and expensive technologies used today, not to mention medical procedures. Do they have a problem with "Medicare rates"? Is the problem that of a single payer, or of successful lobbying by different healthcare groups for more money? While I absolutely respect the role PCPs can play in controlling medical spending and monitoring patient care, keep in mind that we hardly need doctors if all they are good for is telling patients what they should eat and avoid reminding them to exercise and not smoke. Why shouldn't most of our spending be on medicines and technological advances.
Here's something I don't understand. If drugs and technology are inflating the cost of medicine, but at the same time administrative costs - consistently remain at 20% spending, doesn't that make them inflationary as well? If they weren't a contributor to rising costs in medicine, wouldn't the percentage of spending on them be shrinking relative to the other spending? The fact is, we spend an unconscionable amount of money on administrative costs in this country, because of the ridiculous complexity of our healthcare system.
4
Medicare claims to have administrative costs of 2-3%, but 35% of its payments are for either unnecessary or duplicated services or for services billed but not rendered.
Administrative costs are nowhere near 20% of spending for large group plans.
Administrative costs are nowhere near 20% of spending for large group plans.
1
there are pros and cons to every option. and there are a couple of ways to really cut costs. one is certainly via single payer. another is to change healthcare, mandating that smokers quit smoking and those with chronic ills, e.g. diabetes, hypertension, heart disease, cancer, obesity, go vegan, or nearly so. American healthcare is mostly irrational, hence ineffective at treating chronic diseases.
1
America doesn't deal with chronic diseases because of insurance churn. To really see someone with a chronic disease stabilize or improve often takes an intensive initial program. For an overweight, diabetic 20 year old improving diet and getting blood sugar controlled can have huge lifetime payoffs. But the short term intensive inputs probably won't pay off for the insurer. In fact, if any ACA insurer had a program for better managing diabetes, they'd probably attract patients with diabetes -- in short not-so-healthy people. So, instead, they offer discounts on fitness centers to attract the healthy.
1
The media has finally learned that it does not have to treat Trump like an acceptable alternative for President even though he is the Republican nominee; unfortunately, the same cannot be said of Republican proposals for healthcare "reform", which in fact consist mostly of proposals to make the cost of health insurance cheaper for healthy individuals. Even after numerous instances in which various Republicans have made it clear that they don't think it is necessarily the job of healthy people to subsidize the medical costs of sick people, or of people who use more medical resources, this blog still insists on pretending that a proposal to allow insurers to sell insurance across state lines has any purpose other than to allow insurers to avoid the mandates that protect sicker people, and make insurance cheaper for healthy people. Even though it is clear as day to most healthcare economists, that such a proposal would lead to a death spiral as a result of adverse selection, and is therefore the opposite of the goals of healthcare reform, as traditionally understood, reporters continue to pretend that it is a serious proposal, just as it continues to pretend that a large choice of insurers, as opposed to providers has any benefit to consumers other than the ability for healthier wealthier people to opt out of subsidizing sicker poorer people. When will the charade of pretending that current Republican proposals have anything to do with real reform end?
9
In 2008-2010, there were 40 million uninsured. Of them, 10 million were illegal aliens who could get emergency and maternity care paid by Medicaid, and their circumstances haven’t changed. Ten million were eligible for Medicaid. Ten million were young and healthy and could get health insurance for $50/month. The remaining 10 million uninsured were either uninsurable or couldn’t afford health insurance because of their age and health.
There were also 10 million participants in the individual market.
Under O’care the 10 million eligible for Medicaid are forced to enroll under threat of penalties. Medicaid expands to include another 2 million.
The 10 million people who already have insurance in the individual market, 9 million young and healthy (charging them $250-300/month) and the 9 million old and sick go into the exchange pools.
After the exchanges blew up in late 2013, Obama granted an exception and allowed the individual market to continue. Five million stayed with their old insurance and 5 million of the sickest moved into the exchanges. Four million of the sickest uninsured moved into the exchanges along with 2 million of the young and healthy.
We still have 7 million young and healthy uninsured along with 5 million of the old and sick.
The pool now consists of 2 million young and healthy and 9 million of the old and/or sick.
Too bad there were no competent healthcare economists involved in the design and execution of the Democrat dream accomplishment.
There were also 10 million participants in the individual market.
Under O’care the 10 million eligible for Medicaid are forced to enroll under threat of penalties. Medicaid expands to include another 2 million.
The 10 million people who already have insurance in the individual market, 9 million young and healthy (charging them $250-300/month) and the 9 million old and sick go into the exchange pools.
After the exchanges blew up in late 2013, Obama granted an exception and allowed the individual market to continue. Five million stayed with their old insurance and 5 million of the sickest moved into the exchanges. Four million of the sickest uninsured moved into the exchanges along with 2 million of the young and healthy.
We still have 7 million young and healthy uninsured along with 5 million of the old and sick.
The pool now consists of 2 million young and healthy and 9 million of the old and/or sick.
Too bad there were no competent healthcare economists involved in the design and execution of the Democrat dream accomplishment.
2
Health care costs are killing Americans Quit all the hand ringing. Socialize the system and be done with it.
26
About 75% of workers and their families are covered by employer provided health insurance. They are not going to be pleased with trading their superior insurance for Medicaid-for-all.
There is a reason why the Democrats did not elect to go this route in 2010.
There is a reason why the Democrats did not elect to go this route in 2010.
3
Socialized medicine?! OMG. That would be awful.
It is sad that some people have no medical care or poor quality medical care. Socialized medicine would mean almost everyone (except the very very rich who pay cash) would be forced to have crappy medical care.
It is sad that some people have no medical care or poor quality medical care. Socialized medicine would mean almost everyone (except the very very rich who pay cash) would be forced to have crappy medical care.
1
First of all this dialogue should have emphasized there can't be such thing as 'for profit healthcare' for the masses. This is an oximoron of the first degree. With a lot of friction and some mindlessness Sanger-Katz and Abelson come to see that the great expansion of Medicare as a 'single payer' (read people will get taxed) solution will make healthcare affordable for everyone with a huge cost reduction as well, since leverage on treatments and medicines can be put to work. Mind you: This is not a new idea but mentioned numerous times everywhere. And please stop questioning if a government controlled and regulated healthcare plan can like Medicare for all work. Other civilized wealthy countries have shown for decades it does.
29
and who pays for the drugs and the 20% cost that Medicare does not?
Medicare cost per HHS budget is over 1,000 per month - per person. Can you fund that for yourseldf and the family your taxes support?
Medicare cost per HHS budget is over 1,000 per month - per person. Can you fund that for yourseldf and the family your taxes support?
Why not have a public option for those with employer-sponsored health care as well? Their plans are too expensive and increasingly stingy. Why not give them an option?
9
Being able to buy into Medicare At a fair cost would help the health care system in a variety of ways. It would grow the pool of insured in the system giving it huge leverage in buying drugs and testing. It would bring younger paying people into the program diluting the current pool of over 65 participants. Of course the biggest benefit would be the holy grail of the GOP, "competition" to the insurance companies, if the private se3ctor can do it better for less, prove it.
7
Per HHS budget Medicare is over 1,000.00 per month, an it only covers 80% of medical, and no drugs.
Are you ok paying that premium for that coverage?
Are you ok paying that premium for that coverage?
The public option can't fix our health care system. The private for-profit insurance companies are the problem. Their control gives us the most expensive health care system in the world with worse outcomes than the rest of the industrialized world. We can and must move to a national single payer program that can curtail costs while expanding care. Look at HR 676 in Congress--a beautiful bill just awaiting the dynamic movement that will make it possible to pass.
22
Entire "conversation" is from an ultra-privileged point of view. Appears designed to sow doubt and fear, as if Medicare isn't already working and cheaper.
12
Margot:
Remember there are states — Vermont, Colorado, California — where there is an active and somewhat mainstream movement to get to a single-payer health care system. ... Of course, ironically, the most receptive states tend to be the ones with the most stable exchanges.
Not said, but more interesting: These are three very different states in terms of size, demographics, economics, level of urbanization. They have in common a commitment to making the law work. The "irony" Reed and Margot are not confronting is that health care is faring worst in the states that would rather do away with it.
It is difficult to imagine that there are many states that could not learn from these three -- if they wanted to.
Remember there are states — Vermont, Colorado, California — where there is an active and somewhat mainstream movement to get to a single-payer health care system. ... Of course, ironically, the most receptive states tend to be the ones with the most stable exchanges.
Not said, but more interesting: These are three very different states in terms of size, demographics, economics, level of urbanization. They have in common a commitment to making the law work. The "irony" Reed and Margot are not confronting is that health care is faring worst in the states that would rather do away with it.
It is difficult to imagine that there are many states that could not learn from these three -- if they wanted to.
20
Reed
"But it seems to me the real debate is whether the only way to make care affordable is for the government essentially to dictate prices. The hospitals and doctors are none too happy about that prospect."
Exactly. Every developed country in the world that has a functioning health care for all system manages provider prices. There simply is no other way.
An inconvenient truth if ever there was one.
"But it seems to me the real debate is whether the only way to make care affordable is for the government essentially to dictate prices. The hospitals and doctors are none too happy about that prospect."
Exactly. Every developed country in the world that has a functioning health care for all system manages provider prices. There simply is no other way.
An inconvenient truth if ever there was one.
47
Great comment, and a truth that a lot of people keep trying to avoid. It's not about insurer competition. Every other developed nation in the world has either a single payer health care system, or a government managed price fixing board that contains prices in essentially the same way. There is no back door to cutting costs. The government must negotiate the prices either way.
4
Yes, this is an issue that doesn't get discussed often when everyone asks "why can't we have single payer health care like the rest of the world?" Orthopedic surgeons in Germany and Denmark don't earn $400K per year, probably not even $100K. High provider costs is one of largest drivers of health care costs. Naturally.
3
Doctors in Germany, France, Canada, U.K. Etc., make as much per hour as American physicians. They just work a whole lot less. They are immune from lawsuits, and they get extraordinary pension benefits. Their training is free.
I know many physicians from those countries. Some have practiced in the US, then went back. Most would not trade their pay, benefits, work hours and time off for an American doctors paycheck......
I know many physicians from those countries. Some have practiced in the US, then went back. Most would not trade their pay, benefits, work hours and time off for an American doctors paycheck......
22
A public option model could take any number of forms. As long as it remains an "option"---which people are free to choose or not---how could anyone object to it?
The most creative objection to the public option was the one offered by Tea Party Congresswoman Michele Bachmann. She didn't want it one, because then "everyone" would choose it. Hard to argue with logic like that.
The most creative objection to the public option was the one offered by Tea Party Congresswoman Michele Bachmann. She didn't want it one, because then "everyone" would choose it. Hard to argue with logic like that.
13
I favor and think we will get to single-payer health coverage. But that affects all citizens and has implications beyond the ACA exchanges. In 2015, less than 4% (11 of 318 million) of citizens were enrolled in ACA exchanges.
The authors pointed out a number of challenge in designing and offering a public option on ACA exchanges that could work along side insurers' offerings and add beneficial competition.
The ACA law allows insurers to sell Qualified Health Plans either through the exchanges or directly to individuals. Insurers that withdraw from the exchanges continue to sell directly to individuals without the competitive pressure they face on the exchanges - expecting to be able to sell higher priced policies and/or attract more favorable risk.
Relatively simple* changes to the law could make ACA exchanges work better - to avoid adverse selection and to control pricing.
*Simple to conceive, not simple to get passed by a dysfunctional Congress
The least costly would be to only allow individual policies to be sold via the exchanges. The insurance industry will want to sell to the 27 million eligible for the exchanges. Another, more costly but less dictatorial, approach would be to give subsidies to young people, but only when they purchase a plan on an ACA exchange. That would lower the risk profile on the exchanges and increase adverse selection for insurers outside the exchanges. More lives and competition on the exchanges would better hold down prices
The authors pointed out a number of challenge in designing and offering a public option on ACA exchanges that could work along side insurers' offerings and add beneficial competition.
The ACA law allows insurers to sell Qualified Health Plans either through the exchanges or directly to individuals. Insurers that withdraw from the exchanges continue to sell directly to individuals without the competitive pressure they face on the exchanges - expecting to be able to sell higher priced policies and/or attract more favorable risk.
Relatively simple* changes to the law could make ACA exchanges work better - to avoid adverse selection and to control pricing.
*Simple to conceive, not simple to get passed by a dysfunctional Congress
The least costly would be to only allow individual policies to be sold via the exchanges. The insurance industry will want to sell to the 27 million eligible for the exchanges. Another, more costly but less dictatorial, approach would be to give subsidies to young people, but only when they purchase a plan on an ACA exchange. That would lower the risk profile on the exchanges and increase adverse selection for insurers outside the exchanges. More lives and competition on the exchanges would better hold down prices
1
There's much to like in Hillary Clinton's healthcare plans, as described in her recent NEJM article, including efforts to control rising drug costs and combat fraud, but the needed reforms must go beyond just fixing problems with Medicaid, Medicare, and how care is delivered or paid for, including a public insurance option with the ability to buy into Medicare.
By far, the biggest financial, health, and related productivity benefits will come from an increased focus on prevention and wellness. Clinton did mention plans to encourage partnerships between providers and public health organizations, so I hope that means she understands this need and just neglected to emphasize it.
Note that even though NEJM also invited Trump to submit his own health plan, he failed to do so.
By far, the biggest financial, health, and related productivity benefits will come from an increased focus on prevention and wellness. Clinton did mention plans to encourage partnerships between providers and public health organizations, so I hope that means she understands this need and just neglected to emphasize it.
Note that even though NEJM also invited Trump to submit his own health plan, he failed to do so.
8
Politically possible or not, it is time for the public option. Next step-- Medicare for all and leave private insurance companies the remains.
39
Utterly absurd. Bureaucrats, either directly or indirectly, already control USA medicine and have made it a financial mess. Adding an alleged "public option" would only create another layer of wasteful bureaucratic fraud.
As for alleged "single-payer" -- Vermont, home of Socialist Sanders, rejected that theory as immediately financial bankrupting. If it cannot pass in Vermont, to think it would pass in Texas or Indiana, that is to believe in the Tooth Fairy. And this is not a comedy, this is real life.
In Europe, their "single-payer" plans are burdened by labor strikes, poor quality, long waits, and increased demands by "the undocumented. Look it up.
Much of the cost of medical care is self-inflicted. At the local bus stop, one sees grossly over-weight persons smoking and boozing-doping. Whose fault is that? Who should pay for that smoking-doping-boozing binge?
As for alleged "single-payer" -- Vermont, home of Socialist Sanders, rejected that theory as immediately financial bankrupting. If it cannot pass in Vermont, to think it would pass in Texas or Indiana, that is to believe in the Tooth Fairy. And this is not a comedy, this is real life.
In Europe, their "single-payer" plans are burdened by labor strikes, poor quality, long waits, and increased demands by "the undocumented. Look it up.
Much of the cost of medical care is self-inflicted. At the local bus stop, one sees grossly over-weight persons smoking and boozing-doping. Whose fault is that? Who should pay for that smoking-doping-boozing binge?
3
Blame the victim politicking is always the easiest solution and a great rationale for attempting nothing. An a-priori anti-government attitude predictably produces the argument that nothing should disturb the market-driven status quo, which condemns many if not most Americans to medical care of lesser quality than might otherwise be the case. If you believe moralistically that people who appear less advantaged than you are -- those "at the local bus stop," for example -- deserve to become ill and ultimately, die, you are part of the problem. I've lived overseas for many years. Never did I encounter problems with socialized medical care as profound as those that afflict the availability and provision of medical care in the USA, at least for the vast majority of Americans. In fact, the doctors and nurses and technicians and social workers, even the administrators, all seemed pleased with their stations in life and their gift, the chance to do well by doing good. Nor did the patients complain and moan as they do here. You're binging away on denial, Urko. Who should pay for that?
3
Although the design of the public option could vary from a private-style model with high deductibles and narrow networks to a public-style model similar to Medicare with expanded benefits, it will remain a small player in our fragmented, dysfunctional system of financing health care.
We will not get a grasp on costs, quality, equity and universality until we enact a single public financing program for health care that is designed to achieve these goals. It really is as simple as that.
We will not get a grasp on costs, quality, equity and universality until we enact a single public financing program for health care that is designed to achieve these goals. It really is as simple as that.
10
And that program simply must manage provider prices, across the entire system. Get ready for a fight between the health care industry and the rest of us that will make Trump vs. Clinton seem like a friendly game of checkers.
6
"Medicare with expanded benefits
In what known universe? The benefits are quite narrow and - if you really need care - very expensive and the out-of-pockets without limit
No dental
Vision only treatment if things like cataracts or similar conditions
Medicare deductibles for hospitalization (Part A) , non-hospitalized care (labs, office visits, outpatient etc) Part B and prescriptions (Part D) are a respectively $1288, $166 and $360 for a TOTAL of $1814 PER person .
Medicare copays are
* Part A = $0-644 PER DAY
* Part B = 20% (Percent) of the bill
* Part D = varying amounts from $10 to 20% or more of the drug cost
There are NO LIMITS on the total of out-of-pocket costs.
All the whining about the ACA where for an individual there could be $6,850 in out-of-pockets ---- Medicare has NO LIMITS
And Medicare out-of-pockets do not change no matter what the income. Only way to have lower deductibles and copays is to be so poor (under 135% Federal Poverty Level household) that Medicaid pays them
Advantage plans are terrible! They end up costing an enrollee MORE in their deductibles + set copays for non-hospitalization care than just paying the Medicare B 20% would.
I did the math based upon my actual medical bills (paid by Medicare and a Medigap) for several years - including every 3 month out-patient specialty care that will go on until I die. An Advantage plan costs me 27.85% MORE a year than the Medicare 20% copays would
In what known universe? The benefits are quite narrow and - if you really need care - very expensive and the out-of-pockets without limit
No dental
Vision only treatment if things like cataracts or similar conditions
Medicare deductibles for hospitalization (Part A) , non-hospitalized care (labs, office visits, outpatient etc) Part B and prescriptions (Part D) are a respectively $1288, $166 and $360 for a TOTAL of $1814 PER person .
Medicare copays are
* Part A = $0-644 PER DAY
* Part B = 20% (Percent) of the bill
* Part D = varying amounts from $10 to 20% or more of the drug cost
There are NO LIMITS on the total of out-of-pocket costs.
All the whining about the ACA where for an individual there could be $6,850 in out-of-pockets ---- Medicare has NO LIMITS
And Medicare out-of-pockets do not change no matter what the income. Only way to have lower deductibles and copays is to be so poor (under 135% Federal Poverty Level household) that Medicaid pays them
Advantage plans are terrible! They end up costing an enrollee MORE in their deductibles + set copays for non-hospitalization care than just paying the Medicare B 20% would.
I did the math based upon my actual medical bills (paid by Medicare and a Medigap) for several years - including every 3 month out-patient specialty care that will go on until I die. An Advantage plan costs me 27.85% MORE a year than the Medicare 20% copays would
16
We need access to health care no matter where we are in America, where we live, what our incomes are or aren't, our ages, etc. If we cannot look at what other countries do far better than we do in terms of health care, and learn from them, we are going to see more problems in people's ability to receive the care they need. There is no reason to have narrow networks, to turn down legitimate claims, to balance bill patients, or to turn bills over to collection agencies before the insurance company has paid its share. There is also no reason for the prices Americans are charged for various aspects of medical care.
If we need medical care the last thing we should have to worry about is if the facilities and doctors in our immediate area are in our network. Other countries finance medical care for all through taxes. We could do the same. Instead of wasting our money on paying for premiums, deductibles, co-pays, out of network costs, donut holes, etc., we could be paying into a system that covers all doctors, the entire country, and gives us access to the care we need. Would there be rationing? Yes, but we already have it in the number of people who, insured or not, cannot afford the care they need. Had the healthcare industry behaved better around the ACA we wouldn't be facing this question. Since they didn't and decided instead to continue with a punitive, restrictive model coupled with through the roof cost increases, we need something better.
If we need medical care the last thing we should have to worry about is if the facilities and doctors in our immediate area are in our network. Other countries finance medical care for all through taxes. We could do the same. Instead of wasting our money on paying for premiums, deductibles, co-pays, out of network costs, donut holes, etc., we could be paying into a system that covers all doctors, the entire country, and gives us access to the care we need. Would there be rationing? Yes, but we already have it in the number of people who, insured or not, cannot afford the care they need. Had the healthcare industry behaved better around the ACA we wouldn't be facing this question. Since they didn't and decided instead to continue with a punitive, restrictive model coupled with through the roof cost increases, we need something better.
24
So, take healthcare resources from those who currently get what they pay for and give it to those who pay nothing? That is essentially what rationing is. No, healthcare is a service, not a right, and it does not grow on trees. If you cannot afford it, sorry.
1
QED, Bravo.
While the ACA has improved health care in some important respects it has also illustrated the kinds of severe malfunction that federal management of health care in the U.S. can bring. These include reducing the number of patients providers can see a day by as much as 20%, demoralizing providers and burying them in dysfunctional electronic records, endless redundant regulations and documentation. While the ACA and Medicare do not overlap, the Center for Medicare and Medicaid Services, eager to adopt ACA-like policies has added to the mess. The result for physicians has been a rush from independent practices into hospital or other institutional employment which often actually increases costs(reimbursements to institutions for outpatient care) in many respects as increasing administrative costs of institutional provider structures are added to the high costs of private insurer administration. Further cuts in reimbursement will only exacerbate the problem by further reducing availability of physicians as many are retiring earlier and the quality of training programs is in decline. Supplementing the pool of providers with midlevels(Nurse Practitioners and Physician Assistants) can be a good thing but the end result of current trends will be substitution of midlevels for physicians to an extent that will actually impair patient care and outcomes.
4
Bravo.
If it is important to control expenditures in the disease care sector, it is necessary to have adequate controls on prices and profits.
We are smart enough to implement changes in our own country based on what works well in our own programs and the successful experiences of other nations, which have better outcomes with lower costs. (Both a tv special, "Sick around the World" and a follow up book "The Healing of America" summarized this clearly.)
Except, of course for the efforts of those who put their own profits above the needs of the nation and its citizens.
The barrier to implementing a working system is the political power of these profiteers and the saturation negative advertising they engage in to brainwash folks.
It's a shame that the "Upshot" doesn't focus on how a good system could be implemented and what it could offer - in decreased costs and better outcomes - rather than focusing upon the possible current usages of "public option" by different proponents.
It seems to me that would really be the upshot.
We are smart enough to implement changes in our own country based on what works well in our own programs and the successful experiences of other nations, which have better outcomes with lower costs. (Both a tv special, "Sick around the World" and a follow up book "The Healing of America" summarized this clearly.)
Except, of course for the efforts of those who put their own profits above the needs of the nation and its citizens.
The barrier to implementing a working system is the political power of these profiteers and the saturation negative advertising they engage in to brainwash folks.
It's a shame that the "Upshot" doesn't focus on how a good system could be implemented and what it could offer - in decreased costs and better outcomes - rather than focusing upon the possible current usages of "public option" by different proponents.
It seems to me that would really be the upshot.
10
One of the great ironies of the Reagan legacy is his pivot on Medicare.
The 1960s actor version, Reagan 1.0, who was paid to describe Medicare in apocalyptic terms as a socialist takeover, ended with the following:
"We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free."
The upgraded 1980s President Reagan 3.0, ushered in the greatest system of price controls in US history to save Medicare, setting prices for a new system of DRGs. effectively telling providers how to bill and how much to bill.
This means that today Medicare, Medicare Advantage and Medicaid all pay less than a third of what employer insurance plans pay for the same procedures.
Extending Medicare buy-in to people in their 50s can address the very high ACA premiums for this age group, while leaving younger people in the ACA, a reasonable next step.
Even that will be politically difficult with major pressure from the health care provider lobby on both GOP and Democrat representatives, who they shower with money.
And the "price control" issue needs to remain well hidden to protect the legacy of St Reagan.
The 1960s actor version, Reagan 1.0, who was paid to describe Medicare in apocalyptic terms as a socialist takeover, ended with the following:
"We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free."
The upgraded 1980s President Reagan 3.0, ushered in the greatest system of price controls in US history to save Medicare, setting prices for a new system of DRGs. effectively telling providers how to bill and how much to bill.
This means that today Medicare, Medicare Advantage and Medicaid all pay less than a third of what employer insurance plans pay for the same procedures.
Extending Medicare buy-in to people in their 50s can address the very high ACA premiums for this age group, while leaving younger people in the ACA, a reasonable next step.
Even that will be politically difficult with major pressure from the health care provider lobby on both GOP and Democrat representatives, who they shower with money.
And the "price control" issue needs to remain well hidden to protect the legacy of St Reagan.
25