Republicans have been cost-shifting at the expense of the bottom four fifths of households since Reagan's tax cuts. Medicare has been in their sights since the law was passed in the Johnson Administration. Now they'll take it away and replace it with a subsidy that benefits only upper income households. This is dead wrong. Shame on us if we let Ryan-McConnell-Trump get away with this.
1
Frakt and Carroll understate the differences between the Medicare premium-support, Part D, and ACA and the problems with the two that currently exist.
All market-based solutions for healthcare strive through an complex web of incentives to coerce businesses to do unnatural things. Many commenters have touched on this truth: no corporation will do anything that doesn't benefit its shareholders.
The free market is a wonderful tool for organically capturing human initiative to create social goods, but it is a wild animal that resists domestication. The smaller the cage you put it in, the more devious its schemes to escape. At a certain point, it is more cost-effective for the enterprise to invest in gaming the system than to play along with the Byzantine rules we policy wonks have created for it.
There are well-researched reasons why healthcare is not a normal market. Inelasticity of demand, Roehmer's law, assymetry of information and bargaining power, and risk avoidance are all unavoidable pitfalls of any market-based solution. Any attempt to close these loopholes will lead to a cat-and-mouse game between industry and regulators, and industry will always win.
Single-payer is the only solution. While we all fear a repressive central government bureaucracy, that beast is much more easily tamed than a whole pack of wild corporations. And the proof is Original Medicare, a program loved by both providers and patients.
Medicare for all!
All market-based solutions for healthcare strive through an complex web of incentives to coerce businesses to do unnatural things. Many commenters have touched on this truth: no corporation will do anything that doesn't benefit its shareholders.
The free market is a wonderful tool for organically capturing human initiative to create social goods, but it is a wild animal that resists domestication. The smaller the cage you put it in, the more devious its schemes to escape. At a certain point, it is more cost-effective for the enterprise to invest in gaming the system than to play along with the Byzantine rules we policy wonks have created for it.
There are well-researched reasons why healthcare is not a normal market. Inelasticity of demand, Roehmer's law, assymetry of information and bargaining power, and risk avoidance are all unavoidable pitfalls of any market-based solution. Any attempt to close these loopholes will lead to a cat-and-mouse game between industry and regulators, and industry will always win.
Single-payer is the only solution. While we all fear a repressive central government bureaucracy, that beast is much more easily tamed than a whole pack of wild corporations. And the proof is Original Medicare, a program loved by both providers and patients.
Medicare for all!
13
Powerfully explained. You should run for office.
2
You are correct. It has been shown many times that the aggregate supply curve for health care is inverse. Health care is unlike commodities such as corn, wheat, soybeans, etc. The greater the supply of health care providers and hospitals, the higher the costs. The greater the competition, the higher the costs. Republican initiatives to increase competition are mumbo jumbo and doomed to failure.
2
Medicare needs to remain the same. Republican politicians like all politicians have wonderful healthcare coverage. They have no idea what we who depend upon Medicare have covered and not covered. The so-called "free market" is corporate, bottom line run. There is no way "competition" will decrease the cost of healthcare. The only solution to this argument is single payer. This question has been answered by all other nations.
6
Voodoo economics brought to you by your (corporate) friendly republicans.
When a Republican says "we are here to fix xyz" it's time to get scared, very scared.
When a Republican says "we are here to fix xyz" it's time to get scared, very scared.
10
So long as costs remain non-transparent and racketeering is enabled through preferred buyer groups, there is no chance for free-market mechanisms to influence or contain health care costs.
5
Well, we've really let things on health care get so out of control in this country that there's a pretty good problem, with no easy solution.
I like the way Bill Gates put it the other day on Charlie Rose: we're among the worst in the developed world in terms of health care access, and the total cost is are also really bad compared to all other countries.
Bill pointed out, in the UK, there are some waiting lists, but access is universal, life expectancy is similar, and the total cost is about half: about 9% of GDP vs our 18%. That means 1 in 11 people here is going to work every day supplying the EXCESS resources needed here vs the UK.
I like Mr. Gates' 1 in 11, but myself I also like to look at it that since the GDP per capita is $56K, than means $5,000 a year per person, $12,500 a year per avg. household of 2.5, is going as EXCESS expense over the UK.
I also like to point that our non-universal-access, pre-ObamaCare and to a lesser extent now, means people going broke and terrified of going broke, and also having to second guess whether they should go to the emergency room when they detect signs of a stroke or heart attack.
Anyway, thanks to Mr. Gates for the helpful analogies. (I now to fully him you for those 50 or so "blue screens of death" that I suffered back in the 90s.)
I like the way Bill Gates put it the other day on Charlie Rose: we're among the worst in the developed world in terms of health care access, and the total cost is are also really bad compared to all other countries.
Bill pointed out, in the UK, there are some waiting lists, but access is universal, life expectancy is similar, and the total cost is about half: about 9% of GDP vs our 18%. That means 1 in 11 people here is going to work every day supplying the EXCESS resources needed here vs the UK.
I like Mr. Gates' 1 in 11, but myself I also like to look at it that since the GDP per capita is $56K, than means $5,000 a year per person, $12,500 a year per avg. household of 2.5, is going as EXCESS expense over the UK.
I also like to point that our non-universal-access, pre-ObamaCare and to a lesser extent now, means people going broke and terrified of going broke, and also having to second guess whether they should go to the emergency room when they detect signs of a stroke or heart attack.
Anyway, thanks to Mr. Gates for the helpful analogies. (I now to fully him you for those 50 or so "blue screens of death" that I suffered back in the 90s.)
4
Well, we've really let things on health care get so out of control in this country that there's a pretty good problem. Indeed, it's sensible for everyone to worry that, unable or unwilling to control costs, we're gonna put the over-65 Medicare people into a position where they have to pay an unmanageable proportion of their medical costs.
I like the way Bill Gates put it the other day on Charlie Rose: we're among the worst in the developed world in terms of health care access, and the total cost is are also really bad compared to all other countries.
Bill pointed out, in the UK, there are some waiting lists, but access is universal, life expectancy is similar, and the total cost is about half: about 9% of GDP vs our 18%. That means 1 in 11 people here is going to work every day supplying the EXCESS resources needed here vs the UK.
I like Mr. Gates' 1 in 11, but myself I also like to look at it that since the GDP per capita is $56K, than means $5,000 a year per person, $12,500 a year per avg. household of 2.5, is going as EXCESS expense over the UK.
I also like to point that our non-universal-access, pre-ObamaCare and to a lesser extent now, means people going broke and terrified of going broke, and also having to second guess whether they should go to the ER when they detect signs of a stroke or heart attack.
Anyway, thanks Mr. Gates for the helpful analogies. (I now to fully forgive you for those 50 or so "blue screens of death" that I suffered back in the 90s.)
I like the way Bill Gates put it the other day on Charlie Rose: we're among the worst in the developed world in terms of health care access, and the total cost is are also really bad compared to all other countries.
Bill pointed out, in the UK, there are some waiting lists, but access is universal, life expectancy is similar, and the total cost is about half: about 9% of GDP vs our 18%. That means 1 in 11 people here is going to work every day supplying the EXCESS resources needed here vs the UK.
I like Mr. Gates' 1 in 11, but myself I also like to look at it that since the GDP per capita is $56K, than means $5,000 a year per person, $12,500 a year per avg. household of 2.5, is going as EXCESS expense over the UK.
I also like to point that our non-universal-access, pre-ObamaCare and to a lesser extent now, means people going broke and terrified of going broke, and also having to second guess whether they should go to the ER when they detect signs of a stroke or heart attack.
Anyway, thanks Mr. Gates for the helpful analogies. (I now to fully forgive you for those 50 or so "blue screens of death" that I suffered back in the 90s.)
1
I suppose when market innovation is mentioned in the sub title what is meant is free market innovation. far from being risky, free market innovation is an impossibility because there are no free markets for health care in the US. health care in the US is the most government controlled and regulated market of any. there are government sanctioned monopolies in the provision of health care and the provision of practitioners. the drug companies enjoy government sanctioned monopolies on the provision of drugs and medical devices. insurance companies enjoy government sanction protections on the provision if insurance. All these monopolies and protections plus the very low almost non existent elasticity of demand, result in a nearly perfect engine for inflation of health care costs. I am not necessarily arguing for the right to practice medicine without a license, but I am arguing for the recognition that in this highly regulated monopolistic market any plans for controlling costs through free marked solutions are doomed to failure with out first getting rid of the monopoly protections and reducing the regulations.
2
The night of the election this was bound to happen, the shift to viewing the elderly like othe groups as expendable. When more and more costs are put on the shoulders of fixed income elderly and disabled, the reaction will be not to seek care when needed. republicans claim they are against euthanasia, except when they can do it quietly under the table. The poor suckers who thought Trump would protect Medicare are in for a rude shock.
8
Here's an idea - Cut the damn defense spending and provide health care for Americans.
15
Looking forward to alternative options in health care for our elderly.
As someone with a mother who has trouble getting out of the house to go see a physician, I'd love a system with more flexibility instead of our rigid claims system that makes doctor visits more like the DMV than you'd expect with modern technology.
I also wonder where all the geriatricians went (as the baby boomers retirement loomed)...until I found out its the only specialty where physicians lose money when they add a specialization (thanks to medicare reimbursement and the its inability to understand the time it takes to actually get to know the complicated histories and medicines of our seniors...we'd rather save money on the primary care visit and spend it on the complications that take the patients to the hospital)
We need some new ideas. I don't know if the ones coming will be good or bad. But the ability to inject some new ones will bring air all on its own.
As someone with a mother who has trouble getting out of the house to go see a physician, I'd love a system with more flexibility instead of our rigid claims system that makes doctor visits more like the DMV than you'd expect with modern technology.
I also wonder where all the geriatricians went (as the baby boomers retirement loomed)...until I found out its the only specialty where physicians lose money when they add a specialization (thanks to medicare reimbursement and the its inability to understand the time it takes to actually get to know the complicated histories and medicines of our seniors...we'd rather save money on the primary care visit and spend it on the complications that take the patients to the hospital)
We need some new ideas. I don't know if the ones coming will be good or bad. But the ability to inject some new ones will bring air all on its own.
5
Sounds like you're saying a rational of where and how to make the most $ may not be the best driver of our health care system.
I'm 72. I'm "lucky" that I have 100% VA Disability for my time in Vietnam and have free medical care. But, I've been around the block with health insurance/costs for many years with my own business as well as having Doctors as clients.
There is NO WAY to control Health costs/Insurance in America. Unlike say Europe, where I go frequently, as well as having done business, no one is as fixated as Americans with going to the Doctor, Prescription drugs as we Americans. Seems to be in out DNA.
There is NO WAY to control Health costs/Insurance in America. Unlike say Europe, where I go frequently, as well as having done business, no one is as fixated as Americans with going to the Doctor, Prescription drugs as we Americans. Seems to be in out DNA.
2
Read the Japanese are very into new treatments and technology with their health care. Doesn't cost as much and they live longer. Why?
It is market magic. We have no idea most of the time how much medical care we are going to need in one year. We're not allowed to switch plans if we discover that the plan we're on or forced into doesn't cover a specialist we need to see or a medication that we have to take. We're told to appeal and we know how that turns out: we're denied because the insurance companies care more about their bottom line than our health. This is more of the same. In addition, it's forcing people to choose the premiums they can afford rather than the care they need. If this country is serious about reforming our current wealth care system into a real health CARE system our politicians would address the gaping holes in our coverage and the way the coverage is set up. Having insurance does not equal access to the health care we need when we need it. All it means is that we can afford the premium.
9
Yes, this is just more "magic market" snake oil being peddled by Paul Ryan and his wealthy cronnies, who resent having any of their tax dollars paying for health care for those less fortunate. It's just a smoke screen for a cost shift, plain and simple, for those that can least afford it.
The real elephant in the room that no one really addresses is why, in the United States, medical costs keep going up double and triple the general rate of inflation, which has been running at less than 2 % for years. This does not even take into account big Pharma gouging people, by raising the costs of Epipens and other drugs where they have cornered the market, by thousands of percent. They are even price gouging on generics that cost two cents a pill to produce. What does Congress do? Nothing, because big Pharma and the AMA are huge lobbies, and contribute millions in campaign funds of these so called, representatives.
It all comes down to profit margins and greed. If medical care is to be a basic human right, we need to take the profit gouging out of it, plain and simple. The insurance companies and big Pharma have the American people over a barrel. Thru lobbying and buying your Congressman, they have essentially made negotiating for volume drug discounts for Medicare illegal. Canadians and Europeans can't believe that Amercans pay 200% or more for the exact same prescription medicines they use, made by the same company. Outrageous. Representative govt is gone.
The real elephant in the room that no one really addresses is why, in the United States, medical costs keep going up double and triple the general rate of inflation, which has been running at less than 2 % for years. This does not even take into account big Pharma gouging people, by raising the costs of Epipens and other drugs where they have cornered the market, by thousands of percent. They are even price gouging on generics that cost two cents a pill to produce. What does Congress do? Nothing, because big Pharma and the AMA are huge lobbies, and contribute millions in campaign funds of these so called, representatives.
It all comes down to profit margins and greed. If medical care is to be a basic human right, we need to take the profit gouging out of it, plain and simple. The insurance companies and big Pharma have the American people over a barrel. Thru lobbying and buying your Congressman, they have essentially made negotiating for volume drug discounts for Medicare illegal. Canadians and Europeans can't believe that Amercans pay 200% or more for the exact same prescription medicines they use, made by the same company. Outrageous. Representative govt is gone.
10
Your mention of the role of insurance companies in all of this has prompted me to wax nostalgic and post to a link showing old "Harrry and Louise" ads from 1993.
https://www.youtube.com/watch?v=Dt31nhleeCg
Recall, if you are old enough, these ads were run, and were successful, at stopping the Bll Clinton universal health plan of 1993. (Hillary in charge.) They worked by manipulating people not well-versed in how insurance pools and the like work.
Note the second ad takes aim at "community rating", which is, in ObamaCare, the component of the law that says no denying coverage or charging more for people with pre-existing conditions.
If you are old enough, I hope you enjoy the stroll down memory lane!
https://www.youtube.com/watch?v=Dt31nhleeCg
Recall, if you are old enough, these ads were run, and were successful, at stopping the Bll Clinton universal health plan of 1993. (Hillary in charge.) They worked by manipulating people not well-versed in how insurance pools and the like work.
Note the second ad takes aim at "community rating", which is, in ObamaCare, the component of the law that says no denying coverage or charging more for people with pre-existing conditions.
If you are old enough, I hope you enjoy the stroll down memory lane!
Look, Republicans especially the billionaires and millionaires in Congress and the Trump Administration will not be satisfied until the elderly, actually 90% of all Americans, are begging in the streets and dying in the gutters. Read the last sentence in Carroll's and Frakt's essay: "...we will need to acknowledge that one of the easiest ways to cut premiums is to shift more health care costs to older Americans..."
The real Republican health care plan is Pray You DON'T GET SICK.
The real Republican health care plan is Pray You DON'T GET SICK.
9
A market in health care? Sure. A friend wrote Sen. Tom Cotton about this and got a letter that along with some platitudes said we could not afford Medicare because of our huge national debt. I'm sorry I do not have the letter so I cannot give the exact quote, but I think I have the sense of it right. It is ironic to hear a Republican saying anything about the national debt since they own it. They took it from under $1 trillion pre-Reagan to $19 trillion today with tax cuts for rich people and a couple of unnecessary wars. Republicans have achieved the goals they set in the Reagan years: run the national debt up to the point that we have to cut social programs and entitlements. There is a simple alternative: increase taxes on the top one percent--and please not by raising the top marginal rate--so we can pay the government's legitimate obligations. I paid SS taxes from the time I was 16 and Medicare taxes from the time it was started until a couple of years ago when I retired. I am entitled--I don't how entitlement got to be a bad word--to receive the benefits I paid for over the years and will go after any politician who tries to cheat me. I suspect I am in good company as long as the people who have trouble with numbers catch on in time.
13
Me too. I paid into Social Security since I was 16 as well. I calculated that between me an my employers I have given the federal government nearly 1/4 of a million dollars. I also retired a few years ago and it will be years before I reach that amount. Again, as I said above, it's the millionaires and billionaires who want to see the elderly begging in the streets and dying in the gutters. Then will the Koch Brothers be satisfied? Remember Soylent Green?
6
Yes, I remember "Soylent Green" and a couple of other episodes on t.v. series where people were sent off to die because they were considered useless. It's nice to know that we live in a country that pretends all life is important but prefers only to support embryos and fetuses. Actual life isn't worth caring about unless the being is rich.
4
Well, yes, and if you cannot pay the bills, are sick without an expensive insurance plan, did work that didn't earn you a pension, never mind being actually 'rich', life is a misery and not worth living.
When are Republicans finally going to understand that there is no "market" for healthcare? Let's bump these over-privileged senators and congressman off their Rolls-Royce healthcare plans and make them subject to the whims of industrial healthcare and big pharma. They wouldn't like it much, I am sure. Oh, wait. They are all millionaires, aren't they?
17
First off: I think it is hypocritical for Reps to replace Medicare with an ACA-like plan.
Second: I am a senior citizen on SS (fixed income) and I cannot afford today's premium much more a plan whose price would go up like ACA did. A lot of senior citizens would be homeless if we have to pay more.
Second: I am a senior citizen on SS (fixed income) and I cannot afford today's premium much more a plan whose price would go up like ACA did. A lot of senior citizens would be homeless if we have to pay more.
14
Medicare premium support should be based on the income of each Medicare beneficiary. Those of us with higher incomes should receive lower or no premium support. Those with lower incomes should receive higher or total premium support. It would also make sense to apply the same approach to Medicaid and to whatever plan replaces Obamacare.
5
What do you consider a higher income?
This is already part of the ACA. If you've noticed, assuming you're upper middle class and on Medicare, is that the proportion for Medicare coming out of your Social Security doubled, which I deem fair. I pay about $14 per month for Part D although I get it from my former employer through a pharmacy plan, and the Part B portion was about doubled. This helps pay for those who cannot afford it. It's called the American way, rather than the "let them just die" plan that a Republican in Congress said a few years ago. So, as they eliminate the ACA, it will also eliminate funding for Medicare. Hey, it's a twofer for Republicans.
1
We all paid into Medicare and therefore it is an entitlement to the payers. Premium support based on income makes it into just a welfare program. If I happened to be careful and prepared for my old age by saving and investing I shouldnt be punished for it by having to pay a higher premium.
Repubs. would do away with Medicare and Social Security entirely if they could get away with it. Their only policy interests are to protect the assets of the wealthy. They don't give a hoot about anything else, not health care, the environment, employment or any policy that does not serve the rich. This article is "smoke and mirrors." Important for the Dems. and their coxtituents to not believe them and oppose them at ever turn.
16
So glad you know what Republicans "would do" I'm a Republican on MCR and SS after years of working as a registered nurse. Not all are rich and not all are crooked.
Amy, Mike wasn't talking about you specifically, just the people you continue to vote for - for reasons that elude the rest of us.
12
Medicare and Social Security are underfunded. If nothing is done, benefits are going to be cut. The longer it takes to fix it, the harder it is going to be.
Let us not forget that Medicare and Social Security taxes are taken out of each and every paycheck to be returned to us in the form of medical insurance and monthly payments in our old age. If they want to call it an "entitlement" I'm ok with that because I am entitled to get this money back. Admittedly it may not be a lot but over the 40+ years a person works, plus carried interest and capital gains it would have gone a long way if the fund had not been looted by the Government.
14
Not everyone gets their Federal Insurance Contribution Act and Employment Retirement Security Act contributions back because of death before age 65 or emigration. In this sense, they are insurance premiums based on actuarial calculations.
2
Correct. Since I began working at age 14 and retired a few years ago, me and my employers have paid nearly 1/4 of a million dollars into the insurance fund. It seems not only immoral, but illegal to take my money away from me since it will take a decade or more to use that up.
Hopefully, the spineless Democrats in Congress will at least mention that when the Republicans initiate their "Pray you don't get sick" health care plan.
Hopefully, the spineless Democrats in Congress will at least mention that when the Republicans initiate their "Pray you don't get sick" health care plan.
2
Good point. Remember some years back when some inCongress talked about putting the money in the Social Security fund in a "lock box?" Sad joke.
Basic moral sense has been lost. On what planet is it right to profit from the sick and dying? We regulate utilities, why not healthcare providers? It's obvious their practices are rife with efforts to exploit market inefficiencies. Why else would they give fake prices "discounted" to half? Why else would pharma evergreen allergy drugs? I could bo on.
Until people can look at it from a perspective of morality, or basic fairness, we'll be stuck in the dystopisn hell that is the healthcare-insurance billing system.
Until people can look at it from a perspective of morality, or basic fairness, we'll be stuck in the dystopisn hell that is the healthcare-insurance billing system.
15
Capitalism cares about profits, not people. Medicine is ostensibly about caring for people first and secondly making a profit. Capitalism fuels the investment and innovation that makes medicine more effective, I.e. expensive, or more efficient, I.e. cheaper. It is the high cost of basic care and prevention that seems to be the problem, quite apart from the expensive burdens of administrative, insurance, and infrastructure costs. The Republican plan of "premium support" will only work if the inexorable increases in basic medical care could be capped or limited in some way. Medical cost inflation will inevitably outstrip "premium support" allowances, leaving aging Americans headed for the poor house or without adequate health care. Somebody is going to have to get less going forward. Who will it be?
4
It is the 40% of Medicare spent on end-of-life care that is the problem, not basic and preventative care.
We need a rational system to protect someone in their last six months of life them from complex, painful, and expensive care
We need a rational system to protect someone in their last six months of life them from complex, painful, and expensive care
9
You forget administrative costs which in aping the remuneration of the captain's of industry and the wall street golden boys have "exploded" from the 70's on. Executive pay was placed on the star system of pro sports. Except that while a basketball players salary is based on the public's evaluation of his hers performance. CEO's salaries go up even when the company loses money.
3
Obama and the Democrats hoisted us all by their own petard when they agreed to saddle us with Heritage Foundation-hatched Romneycare instead of a functional system like those that have proven themselves viable throughout the industrialized world for the better part of fifty years. Will they now collude with the Republicans to ruin Medicare too?
8
Wasn't it the Republicans that 86ed the public option when the ACA was being created? Or was that the secondary cause, with the primary cause being the lobbying of the insurance industry?
Since no Republican voted for ObamaCare, it's hard to understand why you are attributing its many bad attributes to Republicans.
In order to institute single payer, you have to do away with tax free employer provided health insurance. That would be the logical the logical place to get the money to pay for single payer. Everyone would get Medicare, with its 20% co-pays, and the employer would pay a 20% payroll tax instead of paying for health insurance. Is that what you had in mind for the public option?
Or did you think that putting all of the sick individual market people into a government option was going to make their medical costs decline?
In order to institute single payer, you have to do away with tax free employer provided health insurance. That would be the logical the logical place to get the money to pay for single payer. Everyone would get Medicare, with its 20% co-pays, and the employer would pay a 20% payroll tax instead of paying for health insurance. Is that what you had in mind for the public option?
Or did you think that putting all of the sick individual market people into a government option was going to make their medical costs decline?
ebmem says, "Since no Republican voted for ObamaCare, it's hard to understand why you are attributing its many bad attributes to Republicans."
Actually, it is easy. The ACA was based on Romneycare from Massachusetts, which was, in turn, based on the plan cooked up by the Heritage Foundation, which is a conservative foundation. Now you might want to know why the basis for the ACA was a Republican plan based on the plan cooked up by a conservative think tank. The point was to get at least SOME Republicans on board.
Actually, it is easy. The ACA was based on Romneycare from Massachusetts, which was, in turn, based on the plan cooked up by the Heritage Foundation, which is a conservative foundation. Now you might want to know why the basis for the ACA was a Republican plan based on the plan cooked up by a conservative think tank. The point was to get at least SOME Republicans on board.
2
Every member of Congress, and their families, should be deprived of health care until they create a single payor universal health insurance system for all. No checkups, no medical care or prescription drugs. (If they have a life-threatening emergency they can go to the ER like everyone else who can't afford health insurance.)
I bet they'd come up with a solution PDQ.
I bet they'd come up with a solution PDQ.
21
We are the ONLY advanced country without universal health insurance. Every country with universal coverage has some sort of government run or managed system. They have better health outcomes for significantly less cost.
We should study how other countries achieve such good results and use this knowledge to devise a plan that works for us.
The benefits would be enormous. A healthier population. No more worries about losing health insurance or getting care. Companies would be relieved of the burden of providing health insurance.
Refugees and immigrants from third world countries come to America for a better life. Not so much citizens of advanced countries who can't believe how awful our health care system is.
It just seems like common sense.
We should study how other countries achieve such good results and use this knowledge to devise a plan that works for us.
The benefits would be enormous. A healthier population. No more worries about losing health insurance or getting care. Companies would be relieved of the burden of providing health insurance.
Refugees and immigrants from third world countries come to America for a better life. Not so much citizens of advanced countries who can't believe how awful our health care system is.
It just seems like common sense.
20
When the donor class is involved, the ability to look at evidence-based outcomes isn't even discussed. The basic GOP ideology is "I've got mine, the hell with the rest of you". It's difficult to discuss rational alternatives when the basic belief systems aren't compatible.
There is no free-market in medicine.
Insurance companies are in business to make money. They want your premium and don't want to pay for your care. They should not be involved in health care.
Shifting the cost of the care to the patient will only result in delay of care and worse outcomes. We saw it in uninsured patients before the ACA, we saw it in the states before Medicaid expansion, and we saw it in the days before the passage of Medicare.
We see it now in underinsured patients and in Medicare patients who cannot afford copays or who cannot afford their medications. These patients put off physician visits and do not take their medications as directed. The price of glucometer strips has prevented patients from following blood glucose properly.
Single payor is the only way to go. Will we go there? No. Because our political system is too firmly enmeshed in the corporate payroll.
Dollars before people.
Insurance companies are in business to make money. They want your premium and don't want to pay for your care. They should not be involved in health care.
Shifting the cost of the care to the patient will only result in delay of care and worse outcomes. We saw it in uninsured patients before the ACA, we saw it in the states before Medicaid expansion, and we saw it in the days before the passage of Medicare.
We see it now in underinsured patients and in Medicare patients who cannot afford copays or who cannot afford their medications. These patients put off physician visits and do not take their medications as directed. The price of glucometer strips has prevented patients from following blood glucose properly.
Single payor is the only way to go. Will we go there? No. Because our political system is too firmly enmeshed in the corporate payroll.
Dollars before people.
21
Amazing PBS doc airing now, 'Seven Songs for a Long Life,' about a hospice in Scotland.
People in some cases still getting treatment, all getting excellent pain control, and living longer, happier and productive lives. Not out of it. Some return home, for long periods (years).
Care is free via NHS (National Health Service) and some private fundraising.
I remain amazed we can't even do that much -- hospice -- better here. It would seem a collective, corporate will to NOT make it so, to make everything from brith to death as difficult, paper-ridden and expensive as possible.
People in some cases still getting treatment, all getting excellent pain control, and living longer, happier and productive lives. Not out of it. Some return home, for long periods (years).
Care is free via NHS (National Health Service) and some private fundraising.
I remain amazed we can't even do that much -- hospice -- better here. It would seem a collective, corporate will to NOT make it so, to make everything from brith to death as difficult, paper-ridden and expensive as possible.
14
A voucher plan by any other name is still a voucher plan. The only "support" is for the insurers or nursing homes (big businesses) that will use the amount as a BASE and then add lots more.
So they get government money and the person with the "premium support" ends up impoverished when they have to pay out of pocket to get the care they need. And when there's no more pocket? Welcome to elder bankruptcy with more elder poor and homeless.
Whether it's for schools or health care, vouchers by any other name are only good for private corporations who want to get government funds. Not for people who want and need a good education or good healthcare.
So they get government money and the person with the "premium support" ends up impoverished when they have to pay out of pocket to get the care they need. And when there's no more pocket? Welcome to elder bankruptcy with more elder poor and homeless.
Whether it's for schools or health care, vouchers by any other name are only good for private corporations who want to get government funds. Not for people who want and need a good education or good healthcare.
8
This is imply bring on the death panels. Painful ones
1
We need to take the profit motive out of healthcare. The billions of dollars siphoned off to pay insurance company execs alone would lo reduce healthcare costs. Instead, Republicans will do all they can to shift the costs away from high earners, reduce benefits and increase the costs to senior citizens. There will be a healthcare crisis of unimaginable proportions as baby boomers caught in the economic downturns of the last 17 years are forced to increasingly depend on social security for their primary retirement income. The chained CPI won't help as healthcare costs rise, throwing more and more seniors into financial crisis. Republican plans will only exacerbate their problems.
7
Look it's easy to see how to cut health care costs, In fact we have about 30 different ways to do so, all of which have been proved to work.
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Some data:
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
All of these other countries (with the possible exception of Germany) tried a system based on market innovation. None of them could get it to work. As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Some data:
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
All of these other countries (with the possible exception of Germany) tried a system based on market innovation. None of them could get it to work. As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
19
The only realistic alternative is for the Democratic Party to begin now -- today -- advocating for a single payer health care plan based upon the expansion of Medicare to cover ALL citizens. Every other "fix" or premium cap or what have you just delays the inevitable conclusion: nothing America has tried to get a handle on costs while still improving health outcomes works. We are paying more and more for stagnant or eroding outcomes; our health care leadership in the world is largely confined to high end surgery, fantastic new drugs with outrageous price tags, and a vastly outmoded fee-for-service ecosystem instead of team-managed, outcome based medical practice.
The Republican Party will NEVER support single payer. So if Americans want change that actually helps them, the other part is the only other alternative; that is, if the Dems have the courage to take this on as an overriding national issue.
The Republican Party will NEVER support single payer. So if Americans want change that actually helps them, the other part is the only other alternative; that is, if the Dems have the courage to take this on as an overriding national issue.
7
Ah, the wonders of the market! Glorious that it is. Sure, this is the way it works for phone service, internet access, cable, right? And they all have the same problem is suggestion does: monopoly or near monopoly control by a handful of service providers. So, basically, this would be a gift to giant corporations, like Blue Cross or Kaiser who can do whatever they wish. They get the benefit and the so-called "beneficiaries" get the shaft.
Clever, fellows. Very clever. I bet the old folks will never figure it out. So, Congressional Dems, going to roll over, play dead, and wag your tail again?
Universal health care for all. Let the corporations go begging for federal subsidies for a change. Get them off corporate welfare to free up funds for the citizens of this country who currently get the pleasure of paying for everything - especially galling when giant profitable corporations pay zero taxes (Trump, Inc anyone?) and collect subsidies from the government.
Clever, fellows. Very clever. I bet the old folks will never figure it out. So, Congressional Dems, going to roll over, play dead, and wag your tail again?
Universal health care for all. Let the corporations go begging for federal subsidies for a change. Get them off corporate welfare to free up funds for the citizens of this country who currently get the pleasure of paying for everything - especially galling when giant profitable corporations pay zero taxes (Trump, Inc anyone?) and collect subsidies from the government.
8
The democrats and the republicans need to work together on veto-proof healthcare legislation that benefits everyone. Enough with the interminable back-biting and finger pointing. Disgust at the workings of DC is what led to Trump so it is your fault Ms. Pelosi, Mr Schumer, Mr McConnel & Mr Ryan! Grow up and play nice in the swamp box. While you're at it, have a look at the Australian Medicare plan: everyone gets basic healthcare and if you want better, it is entirely out of the person's pocket.
2
Nice attempt to escape responsibility. It was Americans who elected those politicians and who wanted what they were offering. Personally, I voted for the ones who were trying to do the right thing only to face obdurate obstructionism from the other side. Same goes for all those who voted for the lying con man Donald Trump either because they liked his xenophobic, racist, and sexist ideas; were so gullible that they believed all his lies; or were rich and greedy enough to know that he and the Republicans in Congress would cut their taxes. No, it wasn't the fault of everyone in Washington.
8
". . . we will need to acknowledge that one of the easiest ways to cut premiums is to shift more health care costs to older Americans". This is a dangerous and absurd conclusion. Shifting costs to older Americans is NOT a solution to costs. It only means that rich people will afford health care and poor people will not and many will die. Is that the world the authors believe we should aspire to create?
5
Believe that was said sarcastically.
2
It's what the authors think could happen, thus an argument against premium support.
1
In 2015, big Pharma alone, spent over $300 million in lobbying Washington to essentially maintain the "status quo" and that is the ONLY reason why this discussion has been going for over 60 years, a discussion that has long been resolved by all the other countries in the Western Industrialized world. If the GOP were so adamant about maintaining the so-called "free market" and that was the best way to go(which it is not), then why does the healthcare industry have to continue to spend hundreds of millions of dollars every year lobbying Washington? The answer is obvious.
The politicians don't want to "bite the hand that feeds them".
The politicians don't want to "bite the hand that feeds them".
12
I wonder how the other industrialized countries avoided healthcare control by big pharma ?
Yep, everything except the obvious. Want to make health care cost less? Eliminate the need for profits, dividends, and highly paid top executives. Eliminate the multiplicity of plans, so that providers don't have to pay an army of administrative staff just to file claims and figure out how to code for maximum reimbursement. Put treatment choice back in the hands of doctors, not insurance functionaries whose purpose is to deny care. As long as we insist on keeping corporations in the mix, the need to make a profit will drain funds that could have been used to provide actual care, and the complexity of the various options will require endless administrative waste. Single payer now.
23
Exactly. Until we get the profit motive out of the US health care system, we will never obtain the goal which should be quality care for everyone.
11
Can't see how this will end well.
The GOP only likes subsidies when money goes to their corporate donors.
Insurers don't want to enroll more people, only healthy people.
Market magic will mean fewer healthy people will sign up for insurance.
Fewer healthy and unhealthy people with no insurance will drive up costs.
Subsidies will be needed (unless you're making six figures).
Other countries have figured out universal coverage.
The GOP Congress is living in an alternative reality.
The GOP only likes subsidies when money goes to their corporate donors.
Insurers don't want to enroll more people, only healthy people.
Market magic will mean fewer healthy people will sign up for insurance.
Fewer healthy and unhealthy people with no insurance will drive up costs.
Subsidies will be needed (unless you're making six figures).
Other countries have figured out universal coverage.
The GOP Congress is living in an alternative reality.
16
Thanks for the clarifications. They are needed thanks to the continuous fog generated by R politicians and not answered by anyone on the D side.
3
Drive by any hospital in America or any urgent care that pops up overnight all over the place and what do you see? CONSTRUCTION - multi million dollar construction going on - where's that money coming from? The patients who pay the bills, whether it's insurance and copays or direct pay. Ask a doctor what a procedure costs, then ask another one and you get two answers. When is the medical system going to become more efficient all by itself? Doctors getting paid exorbitant amounts of money, hospitals obviously not poor, health care companies buying up doctor's practices - there IS lots of money in the healthcare system. Instead of squeezing it out of patients, get more efficient. Standardize the paperwork so every doctor, hospital, MRI center all use the same forms. We do it with license plate holes in your care - they're all the same and we do it with computer keyboards and NO government agency told them to standardize.
9
Free market, profit based solution to health care is and has been a financial and human disaster. Where has this ever worked in the health care world?
Economic ignorance is a national disgrace. Health care has an inelastic demand curve (you will pay anything to get well). Therefore, we spend twice as much on health care and get worse outcomes that the other industrialized countries.
Why don't we just accept universal health care and take the best ideas form the other successful programs around the world. Don' t try to say that those programs are bad when there is not one country that would trade their health care system for ours.
ACA was to be a step towards universal health care not a blueprint to go backwards.
Economic ignorance is a national disgrace. Health care has an inelastic demand curve (you will pay anything to get well). Therefore, we spend twice as much on health care and get worse outcomes that the other industrialized countries.
Why don't we just accept universal health care and take the best ideas form the other successful programs around the world. Don' t try to say that those programs are bad when there is not one country that would trade their health care system for ours.
ACA was to be a step towards universal health care not a blueprint to go backwards.
21
"Why don't we just accept universal health care and take the best ideas form the other successful programs around the world."....Because the Republican mantra is that the Federal Government is necessarily bad and every effort should be made to make it as small as possible - even when making it smaller is obviously more expensive and not in the publics best interest.
6
Shifting more healthcare costs to a vulnerable group without their ability to obtain employment, too old to be employable, then you might as well dig their graves. These people have worked all their lives so the Republican Party's answer is to kill them off early so that longevity is kept only for those who can afford it. This is another way to increase the pot of gold, tax them while they are employed, reduce benefits while on Medicare and let go of the poor who cannot pay. One problem, there are two middle classes, one who lives pay check to pay check and another with investment accounts for their children's future. Both will be tested but one would disappear. The Republican Party did not read their history books, when the masses are poor governments fall.
18
Single payer stops all this nonsense in one fell swoop. Change to Medicare for all and the entire cost of healthcare for the country drops by a third.
It covers everyone and quality is inevitably higher. Getting the profit motive out of healthcare is actually what causes innovation.
It covers everyone and quality is inevitably higher. Getting the profit motive out of healthcare is actually what causes innovation.
29
Let the market control costs? I guess that's why within minutes the price of gas raises immediately at all stations. It used to be that competition would allow a lower price to more that make up for the lower unit profit to be compensated for volume growth. I guess the invisible hand of competition doesn't work that way any longer. If you can find a hospital with lower costs that is 2,000 miles away with lower health care premiums why not buy insurance there? You'll be saving on your cost... oh yeah, you will also have to travel there for care.
10
At the end of the day the GOP cares only about cutting the taxes of their rich constituents. The employee share of the Medicare tax is 1.45% of gross salary with no cap, plus another.09% on incomes over 200K to pay for the ACA.
14
Call "premium support" by its proper name--vouchers--just another way to make patients pay more and to make doctors and hospitals get paid less. The Republicans can't get away with destroying Medicare yet so they instead want to chip away at it until it's on life support. And then pull the plug.
13
"one of the easiest ways to cut premiums is to shift more health care costs to older Americans." That sounds like a plan Republicans can support!
16
Well. That was certainly a naive article. Doctors don't know anything about insurance. I have been a senior broker for more than a decade and one thing I can tell you is the Medicare Part D plan is a disaster. The market has been horrible at controlling costs and generic drugs can be classified into tier three categories, forcing seniors to spend thousands on drugs that only benefit big pharma. Medicare is solvent, works and should not be tampered with.The Republicans don't care about our healthcare, they care about the trillion dollars in the Medicare Hospital fund they can convince us to give them so they can spend it on anything but our healthcare.
23
This business of changing Medicare and of providing "access" to healthcare to all Americans is such a smokescreen. Will the electorate be able to clearly see through the fog and resist these changes? That is the question.
One reader last week made the point that he has "access" to buying a Rolls Royce, but he can't afford it. That had such resonance. Our Founding Fathers were banking that our democracy would work only if the electorate was both informed and involved. Now is the time for us to step up to the plate.
One reader last week made the point that he has "access" to buying a Rolls Royce, but he can't afford it. That had such resonance. Our Founding Fathers were banking that our democracy would work only if the electorate was both informed and involved. Now is the time for us to step up to the plate.
11
Healthcare and health insurance do not follow simple market principles because of the unequal knowledge between buyer and seller.
Most studies show that cost-sharing does not dramatically reduce healthcare costs. Instead, it leads to folks postponing or doing without care.
Here's the important question:
Is healthcare a right of all citizens or a privilege to those who can afford it?
Most studies show that cost-sharing does not dramatically reduce healthcare costs. Instead, it leads to folks postponing or doing without care.
Here's the important question:
Is healthcare a right of all citizens or a privilege to those who can afford it?
14
When I read your comment about people postponing or doing without care I remembered that right-wing economists tell us that retired people do not need more in Social Security because as you age you spend less. Darn right, because you have less to spend. There is a direct correlation there, folks. When we are dead, we spend nothing at all.
4
My husband and I are covered by Medicare, but we also have supplemental insurance. It has been increasing in cost to the point where we are looking at options. What we want to avoid is a medical incident that would devastate our savings and devour our pensions as we struggle to repay medical bills.
We've already had a couple of life-threatening medical problems, blocked carotid artery and prostate cancer, that were pretty scary. We did have out-of-pocket expenses from treatment, but they were manageable. Most important to us, our children did not have to chip in save our lives.
This is not just about shifting costs to older Americans. It's fraught with dangers for everyone who is close an older American. I get that taxpayers no longer want to help anyone out, but, unlike ACA, this will have impact on a majority of Americans.
We've already had a couple of life-threatening medical problems, blocked carotid artery and prostate cancer, that were pretty scary. We did have out-of-pocket expenses from treatment, but they were manageable. Most important to us, our children did not have to chip in save our lives.
This is not just about shifting costs to older Americans. It's fraught with dangers for everyone who is close an older American. I get that taxpayers no longer want to help anyone out, but, unlike ACA, this will have impact on a majority of Americans.
14
The Affordable Care Act does have an impact on a majority of Americans. All employer plans are affected which is half the county. Remember children can stay on their parents plan until age 26 and no one can be denied coverage because of preexisting conditions. Those are just 2 rules among many others. This is a little discussed aspect of the ACA.
4
But not everyone can get Medigap policies. While the companies are not allowed to consider pre-existing conditions when you first apply for Medicare, they can and do later. The ACA does not cover this.
3
One way to increase competition is to allow Medicare to pay for care outside of the US where services are much cheaper. Now people often go to foreign countries, for elective surgery since it is much cheaper, especially if they have to pay out of pocket.
Even drugs can be obtained less expensively from Canada, since drug companies are not allowed to gouge consumers.
Open competition to the world, it may work.
Even drugs can be obtained less expensively from Canada, since drug companies are not allowed to gouge consumers.
Open competition to the world, it may work.
9
Sanders introduced a bill to allow for lower drug costs by lifting the prohibition on importing drugs from Canada. Twelve Republicans supported it and it might have passed but thirteen Democrats opposed it. Guess who funds their campaigns?
Health care reform and campaign financing are linked.
Health care reform and campaign financing are linked.
2
Many seniors have trouble making it to a neighboring town or going to a large hospital in the nearest big city, so I doubt that traveling to foreign countries will be of much benefit to them.
1
This article states that private plan are likely to bid lower rates to the government than traditional Medicare and so would erode the traditional plan. As far as I know, traditional Medicare already has lower reimbursement rates than any other health insurance company. So how exactly are competing plans going to enroll doctors when those doctors are reimbursed less than traditional Medicare pays? Insurance companies are out for their own bottom lines, not their enrollee's well-beings, it doesn't wash...lower bids = less care.
14
Interested - No, the Medicare Advantage plans have lower rates than traditional Medicare. That is why their networks are so small.
I had 6 local physicians all of which took Medicare. I switched to Medicare Advantage and discovered that NONE of them would take it. I switched back the next year.
I had 6 local physicians all of which took Medicare. I switched to Medicare Advantage and discovered that NONE of them would take it. I switched back the next year.
4
The GOP would like government involvement in healthcare to go away. They know that they have to do that gradually when it comes to Medicare (though their rank & file seem to have no problem with many citizens having no access or even ripping healthcare from poor kids). So, they support shifting the burden to older adults, then we'll have vouchers. Over time those vouchers will pay for less and less so more and more seniors will have no access. The Congress is not worried, they will always be able to pay for what they need.
16
Not only that, but as one ages it gets harder and harder to deal with complexity. I take care of the affairs of a couple of aging seniors and can see how much more difficult it gets for them to understand things that they never had any difficulty with before, to make choices, etc. That's why so many scams are directly targeted at the elderly, from the fake "grandchild calls" to appeals for money to support misleading claims and promises for all sorts of things from religion to social security.
3
Thanks for a very clear explanation of Republican goals.
4
When Medicare was enacted a majority of the health care insurance companies were not for profit. Most were Blue Cross and Blue Shield companies. Today, the health insurance landscape is completely changed. Most BCBS plans are now for profit. Republican tinkering with Medicare simply to drive down costs because their the old Republican guard (many of their voters no longer believe in conservative philosophy) does not believe in government spending, a consequence of Republican elected thugs spending too much time chowing down at the campaign financing trough, and the U.S. Chamber of Commerce, desire to seek profits for their constituents at any price, is very bad idea. The one program that has worked in this for profit American form of capitalism has been Medicare. Republicans thugs will prevaricate anything to keep their campaign financing piggery.
16
Why not be clear about what Republican health care policy is really about? It all follows from three principles:
1) Lowest possible taxes for the wealthy (always, lower taxes so the wealthy can be wealthier).
2) Highest possible profits for drug companies, private hospital companies, device manufacturers and others who bribe the GOP with campaign contributions and lucrative jobs after they leave Congress.
3) Maximum extraction of money from elderly people in their final years, particularly in their final illness -- so as to support goals #1 and #2.
Republican health care means patients who have any money to their name are treated like ATM machines to be looted. Those who have no money will receive as little care as possible, and die as early as possible, because they are of no financial benefit to the GOP and its allies.
The quality of care for elderly people -- indeed, whether elderly people receive medical care at all -- is at the very bottom of the GOP's list of objectives.
1) Lowest possible taxes for the wealthy (always, lower taxes so the wealthy can be wealthier).
2) Highest possible profits for drug companies, private hospital companies, device manufacturers and others who bribe the GOP with campaign contributions and lucrative jobs after they leave Congress.
3) Maximum extraction of money from elderly people in their final years, particularly in their final illness -- so as to support goals #1 and #2.
Republican health care means patients who have any money to their name are treated like ATM machines to be looted. Those who have no money will receive as little care as possible, and die as early as possible, because they are of no financial benefit to the GOP and its allies.
The quality of care for elderly people -- indeed, whether elderly people receive medical care at all -- is at the very bottom of the GOP's list of objectives.
38
The Republican plan would shift more of the cost to the wealthy retired, which is what the Democrats find offensive.
Nothing has done more for the drug companies that ObamaCare and the FDA. the FDA slow walks generic approvals: That's how Manchin's daughter, a donor to the Clinton Foundation, managed to increase the cost of EpiPens from $100 to $600. Then we have a big show trial in Congress and they make one available for $400.
You criticize private hospital systems, but the "charity" hospital chains (gee, like the one that hired Michelle Obama for a part time job at $350,000 per year) have raised their prices for private insurer plans, but oops, they are out of network for O'Care plans.
There is no hospital chain more profitable than the Kaiser system--that would be the charity system--so they are compelled to pay their executive high salaries in order to remain non-profit.
Your objection to the potential profiteering under the Republican plan has happened to a huge extent under O'Care and to a much greater extent under the Medicare Advantage and Part D plans. Republican plans are designed to minimize price growth by limiting the ability of cronies to game the system to benefit themselves. Democrats invite their donors to write the regulations.
When Medicare part D was instituted in 2006. We did not see an explosion of generic drug prices until 2015, after the crony friendly ObamaCare was established.
Nothing has done more for the drug companies that ObamaCare and the FDA. the FDA slow walks generic approvals: That's how Manchin's daughter, a donor to the Clinton Foundation, managed to increase the cost of EpiPens from $100 to $600. Then we have a big show trial in Congress and they make one available for $400.
You criticize private hospital systems, but the "charity" hospital chains (gee, like the one that hired Michelle Obama for a part time job at $350,000 per year) have raised their prices for private insurer plans, but oops, they are out of network for O'Care plans.
There is no hospital chain more profitable than the Kaiser system--that would be the charity system--so they are compelled to pay their executive high salaries in order to remain non-profit.
Your objection to the potential profiteering under the Republican plan has happened to a huge extent under O'Care and to a much greater extent under the Medicare Advantage and Part D plans. Republican plans are designed to minimize price growth by limiting the ability of cronies to game the system to benefit themselves. Democrats invite their donors to write the regulations.
When Medicare part D was instituted in 2006. We did not see an explosion of generic drug prices until 2015, after the crony friendly ObamaCare was established.
Whether it is the "wealthy" retired who will face higher costs is a matter of perspective. I suppose that in Memphis, anyone with more than $100,000 in savings is wealthy, but middle-class people in more prosperous parts of the country are more likely to have enough savings to afford a decent retirement. The Republican plan would put middle-class people's retirements at stake. The people who will be immune to this threat are the truly wealthy—those for whom medical costs of $100,000 or more per year would be insignificant, because their net worth in the hundreds of millions or billions. These are the people who truly stand to gain from the Republican plan, because their income-tax savings alone could exceed $1 million per year.
5
Well Ebnem, you're right that Obamacare didn't address the underlying problem - that virtually everyone in the health care system is shaking down patients for as much money as they can extract. But the reason it didn't address cost control is that the Republican Party and conservative Democrats wouldn't allow it and still don't allow it.
I think Obama and the Democrats should at least be given credit for trying to provide medical care to ordinary people. Ironically, the price they -- and we -- pay for this act of kindness is probably a permanent GOP majority in this country and a big step toward Fascism.
We will now almost undoubtedly return to a system that provides extremely overpriced coverage for about half of the American population -- and the other half will be left to bankruptcy, suffering and death. Naturally, the GOP will blame Obama for this -- they always do.
I think Obama and the Democrats should at least be given credit for trying to provide medical care to ordinary people. Ironically, the price they -- and we -- pay for this act of kindness is probably a permanent GOP majority in this country and a big step toward Fascism.
We will now almost undoubtedly return to a system that provides extremely overpriced coverage for about half of the American population -- and the other half will be left to bankruptcy, suffering and death. Naturally, the GOP will blame Obama for this -- they always do.
8
In the same way the that the free market has encouraged businesses to create subpar products to guarantee repeat customers, there is no incentive for the medical complex to provide cost-effective, efficient care - outside of a moral imperative, of course, something that more and more Americans petition the government to enforce on their fellow citizens, but not on the institutions at their disposal. In a country so politically polarized, with a growing divide between the religious and the secular, I often find myself wondering what is our responsibility to ourselves, and each other?
9
We have not been anywhere near a free market in health care for decades.
We keep dancing around the elephant. Start here : "Nobel Prize winner Angus Deaton stated clearly what is wrong. The American health care system “seems optimally designed for rent seeking and very poorly designed to improve people’s health.” And nothing is going to get better until we tackle that problem head on."
http://www.nakedcapitalism.com/2017/01/debate-health-care-yet-omits-elep...
http://www.nakedcapitalism.com/2017/01/debate-health-care-yet-omits-elep...
22
When most older people have very little chance to replace savings, any increase is harmful. Single payer is a way but seems impossible for republicans to accept. Maybe they should deal with a little pain instead of retired people. If you screw up Medicare, you better keep your heads down.
13
One mistake made by all Republican plans is assuming competition is about insurance vendors. It's not. It's about access to medical care. Insurance companies have precisely zero medical expertise--but they are great at beating down the prices doctors charge, denying patient medical treatments (with absolutely know interest in knowing why this procedure is appropriate for this patient). Insurance companies compete by offering a more attractive front door to their plan, then making a profit by denying requested care.
The problem with medical care costs in this country is that there is no effective way to control prices. As we have seen with Epi-Pens and overdose life saving injections, the market for medical devices, drugs, and services is not competitive--and is driven by local monopolies and totally asymmetric information (you can't even price shop for medical services, nor can you easily determine which is best for you.
Effective cost control with vast savings is possible--the rest of the first world gets the same or better health outcomes at about 1/2 the cost. Everything the Republicans offer is about denying medical services, making people pay with their lives rather than controlling costs.
The problem with medical care costs in this country is that there is no effective way to control prices. As we have seen with Epi-Pens and overdose life saving injections, the market for medical devices, drugs, and services is not competitive--and is driven by local monopolies and totally asymmetric information (you can't even price shop for medical services, nor can you easily determine which is best for you.
Effective cost control with vast savings is possible--the rest of the first world gets the same or better health outcomes at about 1/2 the cost. Everything the Republicans offer is about denying medical services, making people pay with their lives rather than controlling costs.
24
Every problem has a solution that is simple, straightforward and likely, wrong.
Here's mine: Index all Medicare premiums to the recipients ability to pay, based on their previous year tax returns.
(Devil in details!)
Here's mine: Index all Medicare premiums to the recipients ability to pay, based on their previous year tax returns.
(Devil in details!)
1
So someone who pays no federal taxes, given the calculations on the 1040 and other forms, would not pay much because he or she could not afford to do so? Hmmm....think Donald Trump, sir!
1
Since Trump has paid no income tax, he'd receive yuge subsidies, eh?
3
Medicare already does this. There are several levels of premiums, each depending on the enrollee's previous tax return.
Medicare's primary challenge is that it is trapped inside the American healthcare system, a system that will never be effectively "market driven". The necessary ingredients for market driven health care system will not magically appear regardless of what supply side acolytes suppose.
The for-profit insurance industry isn't the biggest villain in this sorry situation, although we did much better under the pre-1995 not-for-profit system. The biggest contributors to excessive health care costs in the U.S. are the drugs companies, not-for-profit hospitals, durable medical equipment makers and byzantine calculations of hospital charges. I suggest to readers the work already done to uncover these outrageous, non-market-driven excesses by Steven Brill in his book, "America's Bitter Pill". Have your Tums handy.
Medicare's primary challenge is that it is trapped inside the American healthcare system, a system that will never be effectively "market driven". The necessary ingredients for market driven health care system will not magically appear regardless of what supply side acolytes suppose.
The for-profit insurance industry isn't the biggest villain in this sorry situation, although we did much better under the pre-1995 not-for-profit system. The biggest contributors to excessive health care costs in the U.S. are the drugs companies, not-for-profit hospitals, durable medical equipment makers and byzantine calculations of hospital charges. I suggest to readers the work already done to uncover these outrageous, non-market-driven excesses by Steven Brill in his book, "America's Bitter Pill". Have your Tums handy.
4
Single payer health care is the only sane health care plan for our country. It would make my job as a physician better (less red tape with insurance companies) and get back to what really matters: bedside care and making sure patients are well taken care of.
For patients, it would be a boon -- no longer would they worry about medical bankruptcy or the idea of being sick as a huge financial burden. Isn't being sick a burden enough that people shouldn't have to worry about also going broke from outrageous medical bills?
The only reason why it isn't a reality right now: health insurance and pharmaceutical lobbyists and campaign contributions to legislatures.
For patients, it would be a boon -- no longer would they worry about medical bankruptcy or the idea of being sick as a huge financial burden. Isn't being sick a burden enough that people shouldn't have to worry about also going broke from outrageous medical bills?
The only reason why it isn't a reality right now: health insurance and pharmaceutical lobbyists and campaign contributions to legislatures.
124
Yes. And we need to be pointing the finger at them. Those companies, the insurance companies anyway, need to see the handwriting on the wall. They are impediments. They are obsolete. They are hurting people.
9
I'd like to recommend this a hundred times.
2
One aspect of the inability yo control Medicare costs I'd the double-dipping by veterans aged 65 and older into VA health care and Medicare. I worked for the VA and had patients who had duplicate doctors in the VA and privately courtesy of Medicare - 2 primary care providers, 2 catdiologists, 2 endocrinolgists, 2 urologists, 2 gastroenterologists, etc. While service in the military is to be honored an appreciated, it isn't license to raid the US Treasury! Vets should be limited to EITHER VA care or Medicare, but not both - choose. Significant savings to be achieved with this restriction.
22
You go ask people to risk their lives for (1) a war based on lies for the profit of Halliburton and Cheney's stockholdings in it and (2) a new Administration whose standard of ethics makes child rape look wholesome...and then you limit their healthcare choices?
My husband has a form of ALS, and his doctor at Columbia also works at the Bronx VA, and he told him that the VA has an excellent program for his ailment. My husband is a Vietnam-era veteran of the Medical Corps.
I don't know why any rational person would serve in the Armed Forces under these circumstances. "Loyalty," like taxes, seem to be for "little people" in the USA.
My husband has a form of ALS, and his doctor at Columbia also works at the Bronx VA, and he told him that the VA has an excellent program for his ailment. My husband is a Vietnam-era veteran of the Medical Corps.
I don't know why any rational person would serve in the Armed Forces under these circumstances. "Loyalty," like taxes, seem to be for "little people" in the USA.
4
I'm not actually sure what the problem is here. How many of these doctors would be treating someone at a given moment in time? Second opinion, yes, quite probably--and properly, but duplicate treatment? I guess a few hypochondriacs might bounce between doctors seeking care from two different docs for the same problem (will they take two different meds? have two different surgeries? at the same time?) but I doubt there are "significant savings to be found. And besides, if someone qualifies for both, then they qualify for both.
1
How many millions of veterans are doing that? And could there be a reason like the inefficiency of the VA? Besides which, your solution doesn't solve the problems millions more face which is access to medical care when they need it, not when they can afford it.
Another broken promise. First pensions now Medicare.
19
Let's hope that doesn't prove true. The pushback against repeal of the ACA is only starting. On Medicare it would be worse.
6
The alternatives are pretty clear. The Democrats want to convert Obamacare to Medicare, while the Republicans want it the other way around.
10
I have yet to see any proof, either from here or abroad, that market pricing of health care can even remotely compete with price regulation, as far as bringing prices in line with actual costs. The effect of this proposal, if it junks the Medicare price control backstop, would be to expand the bottom lines of the health care industry.
31
See, the market works! (To make the insurance industry richer.)
5
Politicians (whether Republicans, Democrats, or Independent) who play with Medicare/Social Security are playing with fire, pure and simple. At some point, people will rise up and say "enough."
Btw, why are Americans so currently gung-ho about "outside" causes, but fail to protest for and protect our United States citizens who are vulnerable--the poor, elderly, disabled. What did those people do to rate second class? If anything, they belong at the top and those "other" causes need to take a backseat, at least for now..
Btw, why are Americans so currently gung-ho about "outside" causes, but fail to protest for and protect our United States citizens who are vulnerable--the poor, elderly, disabled. What did those people do to rate second class? If anything, they belong at the top and those "other" causes need to take a backseat, at least for now..
15
This country is rich enough to take care of its poor, elderly, and disabled as well as those "other" causes. That it is not is a myth put out by the Republicans on behalf of their richest supporters. A lot of the country's wealth is in the hands of less than .1% of the population so it isn't available for all the needs of the rest of us. And because--thanks primarily to Reagan--we decreased the progressvity of our income tax system, very high earners contribute far less to our Treasury than they should, again hurting all the rest of us.
3
Norton, they made the bad choice to be born poor.
All these solutions are tweaks on an insoluble problem. The sensible cure is to have a single-payer, government-run health system, like every other civilized country, including Great Britain. That would cut out the cost of medical insurance and reduce administrative costs. Free-market enthusiasts will counter by saying that this would reduce the rate of medical and drug innovation.
To what end? To keep people with infirm minds and bodies alive till 115?
To what end? To keep people with infirm minds and bodies alive till 115?
45
With the plan they're pushing, we won't be living until 115. I'm 60 myself, and while my health is good, I assume I won't make it past 75 - I'm low-income and won't be able to afford the extra health care costs.
4
Diogenes - not sure i agree. I think we need a government financed health care system that assures everyone access to reasonable health care. Set reasonable regulations and let it work. that is what most modern countries ( and some not so modern) do and they have better outcomes than we do.
1
Take a hike! We know what we pay now. It's taken from our Social Security directly, about $110 per month. Then we already buy supplemental or secondary if we want on our own. Ours is $200 per person, per month. In addition, part D an in addition to the $110. And the $200. We're retired! We paid our working dues. We paid into this Medicare system for years and counted on it.
You're telling me Medicare will pay 75% - of what?
I called Paul Ryan's office and asked for specifics. No call back.
Republicans are willing to jack around us seniors. Well, guess what. They mess with us. We mess with them and send them right smack home - without jobs. They're not representing us. No how, no way.
You're telling me Medicare will pay 75% - of what?
I called Paul Ryan's office and asked for specifics. No call back.
Republicans are willing to jack around us seniors. Well, guess what. They mess with us. We mess with them and send them right smack home - without jobs. They're not representing us. No how, no way.
131
Republicans are willing to jack around anyone if their wealthy sponsors request it.
52
You may want to look into a Medicare Advantage policy. After the $110 from my SS, I pay $32/mo. NO deductible; co-pay of $15 for primary, $50 for specialist (in network, which includes many docs), no referral required. I pay nothing for my 3 regular old-lady drugs (for blood pressure, thyroid and heart) which are mailed to me. This is Humana, in Maine. I don't mean for this to be an advertisement for this company, but I've been happy with it. Again, you may want to look around.
3
Medicare Advantage programs are intended to undermine traditional Medicare. The premiums seem low, when you sign up. But the insurers can change the benefits, and then the plan may not look so attractive. I advise everyone do some research on this issue before they give up traditional Medicare, which I have been extremely happy with.
3
Risk? HE stated, today, that he is going to do a " big number" on
regulations. And that big number, is number two.
regulations. And that big number, is number two.
17
You can bet that it's going to cost more for older Americans. That's what Republicans do. Medicare is a good plan and beloved by recipients. They are going to get a lot of backlash on this.
19
So many of "them" voted for Trump--now see what they get!
6
"As we consider any premium support approach, we will need to acknowledge that one of the easiest ways to cut premiums is to shift more health care costs to older Americans."
Wrong. What we need to acknowledge is the easiest and moist ethical way to make health insurance affordable is for every...every American adult to be paying into our health care system. No illusions that when you are young, you can get by without paying in.
Wrong. What we need to acknowledge is the easiest and moist ethical way to make health insurance affordable is for every...every American adult to be paying into our health care system. No illusions that when you are young, you can get by without paying in.
33
Who cares anymore? King Putin wants us in the toilet so in we shall go.
12
If they harm Medicare it will be their final mark as a party in this system of government. They have done nothing to the American people (99%) that hasn't caused harm and suffering. They have become sociopaths; everyone of them monsters at the gate.
40
Go with single payer and get rid of the insurance middlemen and then save a lot -- simple.
65
"Americans ALWAYS do the right thing....after they exhaust every other option!"
-Winston Churchill-
-Winston Churchill-
17
If many had to defray the cost from their Social Security benefit, then there would be a demand to increase that. It just goes around and around. Such is Washington, indeed.
4
One must look to the goals of reform, which is where this analysis fails. The Democrats goals were to increase coverage and to gain conservative support, where the Republican goal is to reduce spending. Therefore the slippery slope argument of Democrats is more appropriate and any efficiency theory is just that; a theory.
6
The best way to keep Medicare fiscally sound is to continue the ACA. First, Medicare is not going bankrupt. It is fully funded, depending on the article I read, to somewhere between 2029 and 2040. Second, full funding for Medicare has been extended by approximately ten years by the ACA. Look at the Medicare.gov web site for the reasons for this, which include better health systems, more support for preventive primary care programs, the gradual elimination of the "donut hole" for drug costs, and better oversight to avoid fraud. There is no reason to "privatize" Medicare or to shift any more costs to seniors. Any arguments to the contrary are simply more Republican lies.
38
Regular check-ups and lifelong medical care as needed should do much to reduce overall costs per patient over time. Without affordable care the last thing people spend money on is health care that can be put off indefinitely until it becomes a crisis. Ignoring symptoms leads to very costly care down the road. Improving the health of all Americans should be an end in itself.
8
Any market driven solution proposed by conservatives always has the goal of enriching corporations at the expense of the average person. Medicare for all,would have a 5% overhead as opposed to insurance companies 10-18%. That works.
35
"A society is judged by how it treats its most vulnerable". The Republicans have already shown how they intend to treat our country's most vulnerable. Slash safety nets for the poor (children included), the Middle Class, and the elderly. The Republicans always find money to wage war, but disdain helping the most vulnerable citizens of this country. "...one of the easiest ways to cut premiums is to shift more health care costs to older Americans". I am 71 years old, retired, and on a fixed budget. My husband has been diagnosed with the beginnings of dementia, and I have a 90 years old mother with health issues and I am her health-care proxy, so I have to be with her for any medical procedure. How do I go out and get a job to support higher premiums? I would be more than willing to do so.
Why is no one acting to make our drug prices more in line with the rest of the world? Why are health care costs spiraling out of control with no brakes? How is Canada managing its health care system? Could we not learn from them and other countries where citizens have government sponsored health care. Do what Ross Perot suggested all those years ago. Look at health care plans others have enacted, and try them on a small scale first, fix the problems, and then implement a national health care plan. Single-payer across the board for young and old alike would work. Vouchers won't. The larger the pool of all who are insured, spreads risks and reduces cost. That is how insurance works.
Why is no one acting to make our drug prices more in line with the rest of the world? Why are health care costs spiraling out of control with no brakes? How is Canada managing its health care system? Could we not learn from them and other countries where citizens have government sponsored health care. Do what Ross Perot suggested all those years ago. Look at health care plans others have enacted, and try them on a small scale first, fix the problems, and then implement a national health care plan. Single-payer across the board for young and old alike would work. Vouchers won't. The larger the pool of all who are insured, spreads risks and reduces cost. That is how insurance works.
77
Read "The Lie Factory" at The New Yorker (http://www.newyorker.com/magazine/2012/09/24/the-lie-factory) for some insight into how Americans were turned against the idea of universal, single payer health insurance back in the 1940s. (Note that the part about health insurance shows up some way into the article, not at the beginning.) Unfortunately, the same kind of lies spouting from the likes of Fox and right-wing talk radio keep too many people convinced that we cannot afford universal health care (right, one of the richest countries in the world) or that we have the best health care in the world and everyone envies us and universal health care would mean that we would suffer like the Canadians or that universal health care would mean that "those lazy people who just want entitlements" would benefit at their expense.
1
Many seniors wouldn't be able to afford insurance at all under a premium support scheme. Consider someone living on less than $1000 a month. Where would they get the money to buy insurance on the open market? If Medicare supported their new free market insurance, it would become unaffordable too. Then, the GOP leaders could tell them to go to the ER with the rest of the uninsured created by repeal of the ACA. They want old people to die sooner, obviously.
18
It is called Trumpcare-get sick, die quick.
18
Exactly. I'm going to take my Social Security benefit next year when I turn 62 next year. I can't afford to wait any longer - I make a poverty-level income and my savings will run out if I don't. My benefit will be less than $900/month. While my health is good, I had hoped to get Medicare. With this "free market" plan, I won't get health insurance. Not when it's a choice between HI and eating. Eating wins every time.
1
@PoorButFree - You can take Social Security at 62 but you can't get Medicare until 65 even if you want to. Also, you can defer Social Security past the "full benefit" age for your age group, but if you have employer-supplied health insurance, your company will make Medicare your primary insurer when you turn 65, with their insurance plan secondary.
1
Its all smoke and mirrors talk. Complication piled on complication. How about a single payer system that almost all others have? The Big costs are provider servuces and drugs. These are not affected by any of the 'private" ideas. Deductables and incomplete plans also are a big loss. One plan, covers all, no deductables, reevaluation of costs based on facts . Raising the payroll taxes and certain other taxes on non payroll incomes a small amout would cover the plan. yes increased taxes of maybe $4000 per family saves $6,000 in health care costs.
10
Nobody, including media talks about the reasons behind such high cost of healthcare:
1). Why in the world do we Americans pay $347 for a pill that costs $3 in other developed economies.
2). Why we do not produce enough doctors so as to bring the cost of services down. Its a basic principle of Economics that when demand is more than the supply, prices rise.
3). World over the Governments negotiate with the Drug companies by virtue of being the biggest consumer of medicines. Here, Medicare is prohibited by law to negotiate the prices of the drugs.
Its very easy to not to care for the weak and elderly, but is it moral to do so? I feel the members of the Congress should also have Medicare and not have special Cadillac medical plans they now have, for them to realize the value of Medicare and Medicaid.
1). Why in the world do we Americans pay $347 for a pill that costs $3 in other developed economies.
2). Why we do not produce enough doctors so as to bring the cost of services down. Its a basic principle of Economics that when demand is more than the supply, prices rise.
3). World over the Governments negotiate with the Drug companies by virtue of being the biggest consumer of medicines. Here, Medicare is prohibited by law to negotiate the prices of the drugs.
Its very easy to not to care for the weak and elderly, but is it moral to do so? I feel the members of the Congress should also have Medicare and not have special Cadillac medical plans they now have, for them to realize the value of Medicare and Medicaid.
105
Anyone who has struggled to find a doctor who will accept Medicare patients (few PCPs in my relatively wealthy area in suburban Maryland) or who pays attention to the measily sum paid doctors for treating Medicare patients would not agree with your second point. The reason we do not produce enough doctors is that they must take on enormous debt to complete years of training for which they receive miserly remuneration, except for a few high-paid specialties. Medical school and internship/residency programs should be better subsidized by the government and companies making exhorbitant profits in the healthcare industry. I am not a doctor, nor is anyone in my family, but if we want good doctors, we need to pay them fairly for their services and their training and let them talk to us for more than five minutes.
I love and agree with your last paragraph regarding enrolling members of Congress in Medicare. They should not receive better benefits for life than the rest of us. I lost my employee healthcare when I retired - and was surprised to find how much easier and more efficient Medicare was to live with.
I love and agree with your last paragraph regarding enrolling members of Congress in Medicare. They should not receive better benefits for life than the rest of us. I lost my employee healthcare when I retired - and was surprised to find how much easier and more efficient Medicare was to live with.
33
I totally agree.
1
Quality coverage is a perk of being powerful, and lousy (or no) coverage is the devil to catch the hindmost. It supports the status quo, increasing the ability of leaders to control their flock.
5
Whether it is through premiums, co pays or deductibles, Americans pay far too much for health care no matter what happens the patient always gets stuck with the increases. The private sector has not come up with a way to do this and they refuse to have a single risk pool for the whole country to even out premiums. I like medicare. I do not like the IRAA surcharges we should get rid of them.
10
"As we consider any premium support approach, we will need to acknowledge that one of the easiest ways to cut premiums is to shift more health care costs to older Americans." Where are seniors supposed to get the money to pay more when costs "shift?" My Social Security cost of living increase was $5 last year. My pension (that I have only because I left a Fortune 100 company 25 years ago to start a second career) was converted into an annuity administered by Fidelity. The amount of the payment was calculated in 1992, when I left the company and will never increase. I have been getting close to zero interest on my savings for almost ten years. The 2008 recession and age discrimination in employment have adversely affected me and legions of others. The cost of everything keeps going up, including for-profit healthcare. And we have a President now who thinks it's smart not to pay taxes.
89
Yes, my cost of living increase was $6 and the increase in my cost of Medicare Part B was the same. You can really go out on the town with increases like that!
2
I have spent most of my working life in the health insurance industry. I've seen all sorts of new programs come around that will help curtail runaway costs and none, let me repeat none have managed to do this.
HMO, PPO, HSA, and ACO have all begun with a happy face and within two to three years crash and burn like programs it was meant to replace. Although many people like to point to the insurance industry as the culprit there is plenty of blame to go around. The pharmaceutical industry currently being the biggest culprit.
As much as people want the market place to solve the problem, health insurance doesn't respond to basic fundamental economics. The law of large numbers doesn't apply as much as the law of healthy numbers.
The Euro model as used in France, Germany and other nations is the way to go. Everyone is in everyone who works pays insurance companies compete on service and networks. Prices are determined by bid process that all carriers and providers participate in.
HMO, PPO, HSA, and ACO have all begun with a happy face and within two to three years crash and burn like programs it was meant to replace. Although many people like to point to the insurance industry as the culprit there is plenty of blame to go around. The pharmaceutical industry currently being the biggest culprit.
As much as people want the market place to solve the problem, health insurance doesn't respond to basic fundamental economics. The law of large numbers doesn't apply as much as the law of healthy numbers.
The Euro model as used in France, Germany and other nations is the way to go. Everyone is in everyone who works pays insurance companies compete on service and networks. Prices are determined by bid process that all carriers and providers participate in.
131
Bravo. The Republican premise that the market place actually exists and competition exists is a lie. That is why premium support will fail miserably if enacted.
8
When you ask the question "why don't we have universal coverage" there is something else to consider. I would like to present two "facts", and for the sake of my argument, let's pretend that they are true.
Fact 1: American corporations don't like to pay for things if they can get someone else to pay for it instead.
Fact 2: American corporations are really good at getting the government to do what they want.
If these two things are true, they present a puzzle: why aren't American corporations lobbying tooth and nail for universal coverage, and why haven't they succeeded?
I can only presume that they don't want universal coverage, but this leads to another puzzle: why not? What do they gain for all that money that they spend on health insurance for their employees?
I can only speculate that they are willing to spend that money to gain control over their employees. It gives them a sword of Damocles to hang over the employees' heads, and makes the employees less likely to quit, demand raises, or do other things that might cost them and their families their health insurance.
Fact 1: American corporations don't like to pay for things if they can get someone else to pay for it instead.
Fact 2: American corporations are really good at getting the government to do what they want.
If these two things are true, they present a puzzle: why aren't American corporations lobbying tooth and nail for universal coverage, and why haven't they succeeded?
I can only presume that they don't want universal coverage, but this leads to another puzzle: why not? What do they gain for all that money that they spend on health insurance for their employees?
I can only speculate that they are willing to spend that money to gain control over their employees. It gives them a sword of Damocles to hang over the employees' heads, and makes the employees less likely to quit, demand raises, or do other things that might cost them and their families their health insurance.
58
I have been wondering about this myself, for quite some time. One would think that businesses would rejoice in taking the burden of healthcare off of their shoulders and assigning that function to our government.
That would really cut down on overhead expenses and make US businesses more competitive with other countries. In effect, it would be like the US government subsidizing US businesses. It would lower the overall costs of goods and services making us more competitive in a global market.
That would really cut down on overhead expenses and make US businesses more competitive with other countries. In effect, it would be like the US government subsidizing US businesses. It would lower the overall costs of goods and services making us more competitive in a global market.
10
In fact, why should employers be responsible for employee's health care? It may have worked when people died earlier, but can be a burden to small, medium and even large companies. Single payer! Since a large portion of our premiums pays for all the skyscrapers full of people who work for the insurance companies. As often as not, their job is to find ways not to pay medical bills of their customers. I do not want these people to be out of a job, but we will need more people to provide health care and to perform associated jobs.
12
I have been bringing this up in discussions for years. It makes no sense to me that corporations are paying huge amounts to provide healthcare, but make no attempt to do anything about it. It would only take a few large corporations lobbying together to have a lot of clout. I have come to the same conclusion as Michael Collins, they use healthcare as leverage to keep employees from seeking employment elsewhere.
6
"Because insurance companies want to attract more enrollees, they are motivated to drive their bids downward, driving subsidies downward as well and saving taxpayers money."
Let's be clear: insurance companies want to attract healthier enrollees (if we're talking Medicare Advantage plans) and people without chronic conditions. In return, they offer a more limited network of physicians but cheaper out-of-pocket expenses—except for those who have chronic conditions, where they recoup their costs with punitive drug formularies that charge much higher prices for drugs in higher "tiers."
Insurance companies mostly want to make a profit. There's something obscene about profiting on people's maladies, especially when they reach old age.
Let's be clear: insurance companies want to attract healthier enrollees (if we're talking Medicare Advantage plans) and people without chronic conditions. In return, they offer a more limited network of physicians but cheaper out-of-pocket expenses—except for those who have chronic conditions, where they recoup their costs with punitive drug formularies that charge much higher prices for drugs in higher "tiers."
Insurance companies mostly want to make a profit. There's something obscene about profiting on people's maladies, especially when they reach old age.
65
As any number of sources will show, up to more than half of Americans have zero retirement savings. Of those who do, many baby boomers are still recovering from the 2008 crash. To talk of eroding the safety nets of medicare and social security is setting up a wasteland. My Mom's medicare works beautifully; it should be a no brainer to expand it to single payer and let those who want to buy gap policies to expand benefits. But with the insurance lobby and the 1% wanting all the pie, the future looks grim.
79
Republicans hate the ACA so much that they want to turn Medicare into it. Premium supports = subsidies. Let's hope that seniors are wiser to these tricks than was the general population during the election (read Wisconsin, Michigan, Pennsylvania).
16
"Seniors" are just as wise as Fox Alternatenews allows them to be. Which is, not so much . . .
4
If the goal is to reduce and control the costs, isn't single payer the most efficient approach? Isn't it well documented that Medicare costs less than private insurance - with far lower administrative costs - with comparable results for patients? Why make the national healthcare debate more complicated than that? One of the reasons some people supported Trump I think is that he presents solutions to problems in a simple direct way - albeit solutions often detached from reality in his case - but there is an appeal in this approach to people frustrated with a system that too often is bogged down in minutiae focused on groups lobbying to protect their profit, tax breaks or narrow political interests.
29
Sorry, Roger, but Medicare is not single payer (is nothing like HR 676 for example).
Also it is well documented that the overhead for Medicare is about twice that of commercial (not private) insurance. The people that make the claim that Medicare has low overhead fail to count the costs of Medicare absorbed elsewhere in government (SS and IRS for example), the profits built into the contracts insurance companies receive to run Original 1965 Medicare, the huge difference in net improper payments between Original 1965 Medicare and commercial insurance (11% for Original 1965 Medicare vs 2% for Part D of Medicare, for example) and the estimated fraud and abuse in Original 1965 Medicare (estimated to be as high as 25% by former acting Medicare Director Berwick although he might have included the net improper payments in his estimate)
But I agree with your comment with the rest of your comment starting with "Why make..." It's just that we have to start with facts and words we all agree on. A voucher is a coupon; it does not mean the same thing as premium support. Fixed means fixed; if a number is adjusted for sex, age, geography, health and income, it is not fixed. If a proposal claims to be single payer, there must be just one payer
Also it is well documented that the overhead for Medicare is about twice that of commercial (not private) insurance. The people that make the claim that Medicare has low overhead fail to count the costs of Medicare absorbed elsewhere in government (SS and IRS for example), the profits built into the contracts insurance companies receive to run Original 1965 Medicare, the huge difference in net improper payments between Original 1965 Medicare and commercial insurance (11% for Original 1965 Medicare vs 2% for Part D of Medicare, for example) and the estimated fraud and abuse in Original 1965 Medicare (estimated to be as high as 25% by former acting Medicare Director Berwick although he might have included the net improper payments in his estimate)
But I agree with your comment with the rest of your comment starting with "Why make..." It's just that we have to start with facts and words we all agree on. A voucher is a coupon; it does not mean the same thing as premium support. Fixed means fixed; if a number is adjusted for sex, age, geography, health and income, it is not fixed. If a proposal claims to be single payer, there must be just one payer
2
Never heard Trump say anything simple and clear about insurance. Simple? That's a given.
1
Dennis, I dispute your "facts." Like you, I am not offering a citation, but government does some things better- defense and health care are two of them.
4
Market forces will reduce expenditures on health care.
Market forces will DECREASE the level of care.
When necessary screening tests are not covered or copays are increased people will often not undergo these tests.
A cancerous lump, diabetes, high blood pressure /cholesterol will not be discovered in time.
People will die unnecessarily.
But that is acceptable to conservatives because all conservatives care about is reducing expenditures.
For an explicit example of conservative thinking see
https://www.washingtonpost.com/opinions/end-obamacare-and-people-could-d...
Market forces will DECREASE the level of care.
When necessary screening tests are not covered or copays are increased people will often not undergo these tests.
A cancerous lump, diabetes, high blood pressure /cholesterol will not be discovered in time.
People will die unnecessarily.
But that is acceptable to conservatives because all conservatives care about is reducing expenditures.
For an explicit example of conservative thinking see
https://www.washingtonpost.com/opinions/end-obamacare-and-people-could-d...
8
Interesting to think that the country that set the whole medical modernization in motion will soon (if not already) be the only one who can't afford any of the innovations for its average citizens. Harvard and its ilk might as well be in a separate country.
3
Reince Priebus said that he would support provider price listings so health consumers could compare. Eliminate discounts that jack up prices for the uninsured. Consumers should pay what they can afford based on both income and family wealth. Either the government or private health insurance will have to pay the rest.
3
Over the long run subsidies will pay a smaller percentage of the Medicare plan and force more and more into advantage plans that cost the government more and have smaller networks
We should consider raising the cap in social security, taxing all income as ordinary income and negotiating drug prices before we change anything
My husband and I paid more than. $6000 in Medicare taxes last year and neither of us are on Medicare. Salaried workers carry the load while investors skip out.
We should consider raising the cap in social security, taxing all income as ordinary income and negotiating drug prices before we change anything
My husband and I paid more than. $6000 in Medicare taxes last year and neither of us are on Medicare. Salaried workers carry the load while investors skip out.
14
Everybody pays into Medicare throughout their working life.
Including everyone who now has Medicare coverage.
Otherwise, Medicare premiums would be a lot higher than they are. That's how the system was set up, just like you pay Social Security throughout your working life.
Including everyone who now has Medicare coverage.
Otherwise, Medicare premiums would be a lot higher than they are. That's how the system was set up, just like you pay Social Security throughout your working life.
4
Everybody pays on wage income, up to a certain cutoff point (I think the cutoff is around $110,000 a year), further wages after that are not subject to Medicare/Social Security taxes. Dividend, capital gains, interest, etc. income is not subject to the tax. I agree with Randolph Mom, remove the cap on taxable wages and tax all income equally. Of course the investment banks and investors would have a fit, but the way it is now, the working stiffs pay in and the rentier class does not.
2
There is a salary cap on social security taxes; there isn't one on the Medicare tax--all earned income is subject to the tax, and, in fact, incomes over certain limits (depending on filing status) are subject to an additional .9% tax. So, of course, you can see why the wealthy want to reduce Medicare spending. It should also be noted that investment income is not subject to either social security or Medicare taxes.
1
These authors consistently and incorrectly portray the Medicare market as binary as in the statements in this article about "eroding traditional Medicare." Medicare beneficiaries do not choose "traditional Medicare." Eliminating those dual eligible for both Medicare and Medicaid, most (but not a majority of) Medicare beneficiaries get a private retirement policy as an employment perk; the perk mostly piggybacks on Original Medicare Parts A and B. They are choosing to accept the retirement perk, not choosing "traditional Medicare." The second largest cohort chooses the current Medicare premium support choice. Premium support is described in this article as if it were a new idea; it has been around formally for 20 years. For a variety of reasons, the rest of the beneficiaries (about 20% of all) cannot choose the first or second most popular approaches and therefore are on "traditional Medicare," which is public/private combo usually involving three or four insurance companies and yet still lacking complete protection. That is not a choice
I read this and haven't the foggiest idea of what you're going on about. In some of your statements you're flat out wrong; in others you are making questionable assertions; and in yet others--well, I have no idea what you're saying.
There's no mystery about how to "fix" healthcare; the problem is the powerful interest groups profiting from the current system who fight tooth and nail to prevent any change.
26
Look at the "ends", not the "means". The real goal of Republican leaders like Paul Ryan and Tom Price is to reduce entitlement programs in order to reduce taxes on the wealthy and shrink government. Proposing a plan to reduce Medicare expenses is just one of the means to do that. Ryan and Price don't believe that premium subsidies, supports or caps will be good for Medicare - will "save" Medicare as they claim. They don't give a fig about that.
The authors are falling into the trap of taking that as their objective and then debating the pros and cons of their "means". But an erroneous implicit assumption in the authors argument points out the folly of taking them seriously.
The authors state that the premium subsidies of Part D and of the Affordable Care Act are no different than the premium subsidies Republicans are proposing for Medicare. They claim partisanship is the reason Democrats support the ACA but not premium subsidies for Medicare. No!
Part D, the ACA and Medicare Advantage Plans require insurers to cover specific benefits. Republicans have not said their "market based" approach would continue to guarantee the same coverage to retirees. In fact, they have said they will promote "Choice" - the offering of plans with much less coverage. If they do this to Medicare, market competition will drive coverage levels down because the healthier elders will switch to cheap plans which will put the premiums of plans for the sick in an upward spiral.
The authors are falling into the trap of taking that as their objective and then debating the pros and cons of their "means". But an erroneous implicit assumption in the authors argument points out the folly of taking them seriously.
The authors state that the premium subsidies of Part D and of the Affordable Care Act are no different than the premium subsidies Republicans are proposing for Medicare. They claim partisanship is the reason Democrats support the ACA but not premium subsidies for Medicare. No!
Part D, the ACA and Medicare Advantage Plans require insurers to cover specific benefits. Republicans have not said their "market based" approach would continue to guarantee the same coverage to retirees. In fact, they have said they will promote "Choice" - the offering of plans with much less coverage. If they do this to Medicare, market competition will drive coverage levels down because the healthier elders will switch to cheap plans which will put the premiums of plans for the sick in an upward spiral.
24
What always amazes me is that we fail to look to other countries and their healthcare plans. We spend twice plus more then most countries who offer a Medicare for all with much better outcomes then we have. We hear scare stories about how Canadians die waiting for healthcare and it is true in a certain way, they die waiting for elective procedures like hips and knees which are managed (rationed) by the Provinces.
We ought to have Medicare for all with a basic benefit package and allow a private system to operate along side the public system. That way rich people could have their hip operations right away.
If we did that we could eliminate Medicaid, the Public Health System, most of the VA and significantly reduce worker's comp costs and other liability policies which not only provide income but medical also.
But I forgot to add that what we have that other countries do not is a lot more private health insurance companies who only add to our costs.
We ought to have Medicare for all with a basic benefit package and allow a private system to operate along side the public system. That way rich people could have their hip operations right away.
If we did that we could eliminate Medicaid, the Public Health System, most of the VA and significantly reduce worker's comp costs and other liability policies which not only provide income but medical also.
But I forgot to add that what we have that other countries do not is a lot more private health insurance companies who only add to our costs.
98
The Republican plan is relatively simple: Push the cost of health care on older Americans so we can give the really wealthy a big tax cut. Just like the frog in the pan with cold water who dies as it heats up the older American will be drained of his or her savings as premiums rise and the subsidy shrinks through inflation and cuts in it's amount. And, as the older folks lose insurance, they'll become sicker and die earlier.
Oh, did I mention the crap plans that Republicans will allow? You know, a bottle of aspirin and two boxes of band aids? Who's creating death panels?
Oh, did I mention the crap plans that Republicans will allow? You know, a bottle of aspirin and two boxes of band aids? Who's creating death panels?
54
Bottom line here....history has shown that less or unregulated plans like the Republicans want turn into de facto criminal health plans like we have today ie..be rich, don't get sick and/or don't have a bad life event.
Medicare if fine. It is just being ripped off by everybody.
1-Our criminal health care system that overuses procedures, tests etc.
2-Hypos that rip it off with unlimited visits, tests etc.
3-Outright thieves who rip off the system.
Crack down on these guys and you will save trillions over time...
Medicare if fine. It is just being ripped off by everybody.
1-Our criminal health care system that overuses procedures, tests etc.
2-Hypos that rip it off with unlimited visits, tests etc.
3-Outright thieves who rip off the system.
Crack down on these guys and you will save trillions over time...
7
Part D insurers are already playing shell games with formularies, drug tiering, and outright fibs about how they are covering meds that Medicare beneficiaries base their plan choices on. It will get worse - much worse- with voucherizing the financing.
10
Instead of building a 50 billion dollar "Wall," maybe we should use that money to help our citizens with their health care?
146
Project future US economy, the difference between Republican and Democrat governing. Hence Medicare.
PoliticsThatWork.com Change in Unemployment Rate by Party of President- Since 1945
Each party has held the presidency for the same number of years since 1945. During those years, the unemployment rate has risen 11.8% under Republican presidents and has fallen 7.2% under Democratic presidents. Unemployment has fallen during the overwhelming majority of Democratic years since 1949. Unemployment rose steadily under Republicans up until 1982, then fell during the remaining Reagan years, and then rose again under both Bush Presidents.
PoliticsThatWork.com Dow Jones Performance by the Party of the President
During the most recent 15 years during which Republicans have held the presidency, the value of the Dow has increased by 42%. During the Democratic presidencies, it has increased by 609%- 14.5 times faster. The average growth in the value of the Dow under Democrats during this period has been 14.75% and under Republicans it has been 5.11%.
PoliticsThatWork.com Change in Disposable Income Since 1930 by the Party of the President
In the 44 years that we have had Democratic presidents since 1930, the real per-capita disposable income has increased 271%. During the 40 years during which we have had Republican presidents, it has increased 44%. On average, it has increased 3.1% (after adjusting for inflation) under Democratic presidents and 1% under Republican presidents.
PoliticsThatWork.com Change in Unemployment Rate by Party of President- Since 1945
Each party has held the presidency for the same number of years since 1945. During those years, the unemployment rate has risen 11.8% under Republican presidents and has fallen 7.2% under Democratic presidents. Unemployment has fallen during the overwhelming majority of Democratic years since 1949. Unemployment rose steadily under Republicans up until 1982, then fell during the remaining Reagan years, and then rose again under both Bush Presidents.
PoliticsThatWork.com Dow Jones Performance by the Party of the President
During the most recent 15 years during which Republicans have held the presidency, the value of the Dow has increased by 42%. During the Democratic presidencies, it has increased by 609%- 14.5 times faster. The average growth in the value of the Dow under Democrats during this period has been 14.75% and under Republicans it has been 5.11%.
PoliticsThatWork.com Change in Disposable Income Since 1930 by the Party of the President
In the 44 years that we have had Democratic presidents since 1930, the real per-capita disposable income has increased 271%. During the 40 years during which we have had Republican presidents, it has increased 44%. On average, it has increased 3.1% (after adjusting for inflation) under Democratic presidents and 1% under Republican presidents.
19
You miss the point when you expect the market to innovate and be efficient and still be even minimally responsive to human needs. The market, unlike the government, is in business for one reason -- to make as much money for companies and investors as possible, and it will innovate and be efficient as much as possible in terms of the bottom line, no matter the cost, both financial and otherwise, to the people who actually need to use the plans.
12
Every argument I read on this issue focuses solely on outflows, and the outflows are tied to emotional argument about reigning in rising costs, disregarding the dynamic that increased health care leads to increased employment because this is one service that cannot be automated.
Perhaps it is time to look at the funding mechanism. Right now it is a payroll tax, and only a payroll tax. In the current economic and political atmosphere, that is not going to be raised, but the investors who own your local MDs and hospitals are under no constraint to cap their profits, and they won't. Consequently, mental midgets such as Paul Ryan seek to shift the cost burden to the general population, following the time honored tradition of the investor class to privatize profits and socialize losses.
Look to Colorado, where a consumer tax on the voluntary purchase of recreation cannabis is building schools, paving roads, installing street lights, pouring sidewalks - all of this without imposing a general tax on the overall population. Legal cannabis has the additional benefit of reducing the cost of criminal administration, from the street to the prison; and the tertiary effect of depriving criminals of a revenue source because, honestly, the nixon/reagan war on drugs, youth, and people of color has been and will remain a dismal. expensive failure. Marijuana has become ubiquitous in this and many other societies. Demand pushes supply.
Just as it does in healthcare.
Perhaps it is time to look at the funding mechanism. Right now it is a payroll tax, and only a payroll tax. In the current economic and political atmosphere, that is not going to be raised, but the investors who own your local MDs and hospitals are under no constraint to cap their profits, and they won't. Consequently, mental midgets such as Paul Ryan seek to shift the cost burden to the general population, following the time honored tradition of the investor class to privatize profits and socialize losses.
Look to Colorado, where a consumer tax on the voluntary purchase of recreation cannabis is building schools, paving roads, installing street lights, pouring sidewalks - all of this without imposing a general tax on the overall population. Legal cannabis has the additional benefit of reducing the cost of criminal administration, from the street to the prison; and the tertiary effect of depriving criminals of a revenue source because, honestly, the nixon/reagan war on drugs, youth, and people of color has been and will remain a dismal. expensive failure. Marijuana has become ubiquitous in this and many other societies. Demand pushes supply.
Just as it does in healthcare.
8
Start with the human beings, and work your way back to the best way to provide for them. Don't start with the money and try to see how many Americans you can cram into an algorithm.
Here's the hard, simple truth of the matter: If Congress (and the government) was better at doing their jobs governing the healthcare system, they'd already be saving taxpayers billions of dollars annually. Rather than policing and price controlling the system overall, they spend countless hours debating which gnat's butt deserves more suntan lotion. They constantly bury themselves in a never-ending often series of contradictory arguments, rather than busying themselves by fixing what is right in front of them.
If Congress passed legislation to control price gouging by pharmaceutical manufacturers and their distributors, for example, drugs and devices would cost substantially less for patients. If the government truly attempted to police Medicare and Medicaid abuses by insurers, healthcare providers and patients, the programs would cost billions less annually to execute. There are countless ways we can save money in our system if we cared to actually think about solutions rather than faceless, ivory tower macroeconomics.
We don't need "market magic." We need to put the spread sheets away and use a heaping dose of common sense.
Here's the hard, simple truth of the matter: If Congress (and the government) was better at doing their jobs governing the healthcare system, they'd already be saving taxpayers billions of dollars annually. Rather than policing and price controlling the system overall, they spend countless hours debating which gnat's butt deserves more suntan lotion. They constantly bury themselves in a never-ending often series of contradictory arguments, rather than busying themselves by fixing what is right in front of them.
If Congress passed legislation to control price gouging by pharmaceutical manufacturers and their distributors, for example, drugs and devices would cost substantially less for patients. If the government truly attempted to police Medicare and Medicaid abuses by insurers, healthcare providers and patients, the programs would cost billions less annually to execute. There are countless ways we can save money in our system if we cared to actually think about solutions rather than faceless, ivory tower macroeconomics.
We don't need "market magic." We need to put the spread sheets away and use a heaping dose of common sense.
45
"Market magic" is crap--it's just a scam to justify a skim at all levels by private businesses.
5
Congress has been captured by corporations. We no longer have a functioning democracy. They allow us to vote to continue the illusion of having a voice. We do not. This has been demonstrated by research and reported on in this very "paper".
If you vote Republican - or even for blue dog Democrats - expect this to continue. One day soon, the people are going to reach the breaking point. I think we can hear the groaning of the firewalls now. It is not going to be a pretty picture. Think Arab Spring on steroids.
If you vote Republican - or even for blue dog Democrats - expect this to continue. One day soon, the people are going to reach the breaking point. I think we can hear the groaning of the firewalls now. It is not going to be a pretty picture. Think Arab Spring on steroids.
3
The republicans are so focused on getting rid of entitlements that they are missing a key point. Voucher plans, etc are going to mean rising healthcare costs for elders on fixed budgets. The result is going to be a generation of bankrupt seniors that can't afford medical care until they exhaust all of their accumulated savings. Then they will be eligible for Medicaid and we will have a massive base of financially ruined seniors.
73
The CBO (of the Democratic majority) begs to differ with you. See the September 2013 CBO analysis of how a variety of generic premium support plans might work. No one has proposed a voucher since Dick Gephardt in 1981 but I understand that is a typical Democratic Party dog whistle.
Sorry, Dennis Byron, Paul "Lyin" Ryan has had his arrow on Medicare (and SS) for years. He's finally got his chance.
I am neither Democrat nor Republican (or even "Independent"). I vote for the candidate whom I feel would best represent me. So far, none of these current turkeys fit that bill.
I am neither Democrat nor Republican (or even "Independent"). I vote for the candidate whom I feel would best represent me. So far, none of these current turkeys fit that bill.
I hate to break it to you, friend. The GOP and their masters could not care less.
3
Equating premium support for ACA plans with premium support for Medicare may be intellectually rational but it's not politically rational. Premium support for Medicare has political support because seniors are both sicker (due to old age) and can't work (again, due to old age). Premium support for ACA plans does not have political support because the insureds aren't seniors. Sure, I understand that if insurers must cover pre-existing conditions, the young and the healthy must be required to purchase insurance or only the nearly old and sick will, and that not every young and healthy person can afford insurance. But while Americans are willing to subsidize insurance for seniors (Medicare) many do not wish to subsidize premiums for those who are not seniors. Carroll and Frakt, by equating premium support for seniors and non-seniors, create the impression among seniors that Medicare is no different from ACA, an impression that causes them to fear loss of political support for Medicare.
3
Some people work after age 64.
1
Yes, Sbarris, a few lucky (imo) people can and do work after 64. However, most either cannot, due to poor health, or lack of job diversity (i.e., no one will hire older workers in a million years). So what does that have to do with the majority that are stuck paying high costs for health care- despite working to retirement/contributing to Medicare/Social Security for all of their working lives. How is that fair to them?
4