Pros: 'Fixing(?)' an existing program instead of creating another bloated bureaucracy like the ACA. Not having to wait until 65 to hopefully recoup some or all of the money confiscated from you during your working life.
Cons: Medicare is still a Ponzi scheme. If Medicare is so good, why do people need, not want supplemental policies? Big government is still very much in charge.
Cons: Medicare is still a Ponzi scheme. If Medicare is so good, why do people need, not want supplemental policies? Big government is still very much in charge.
2
If we have Medicare for all I would not be opposed to calling it TrumpCare. I wonder if he could get a Trademark on that?
8
Single-payer, Medicare-for-all, is inevitable...and a good thing. Since going on Medicare I haven't had to worry about the several medical issues I've had while traveling that would have been a total nightmare if I'd kept with my employer-provided, private health insurance.
26
Citizens of other first-world nations are appalled by the arbitrary, barbarous, uncivilized American medical health care system. The Unites States spends an obscene amount of money on medical and prescriptions costs while achieving far less than other nations do for half the cost. Our Medical/Pharmaceutical/Insurance overlords must be put in their place once and for all. Life and Death are not commodities for competition on the open market, spoils of capitalism to the highest bidders. If excellent health care for all is not an American RIGHT, what else can qualify under our guarantee of Life, Liberty, and the Pursuit of Happiness?
29
We have a universal, publicly funded defense industry.
Why not a universal. publicly funded health-care industry?
Why not a universal. publicly funded health-care industry?
60
the only sane way to go, one that Obama would not even allow to be discussed when he was negotiating the ACA. What a happy surprise Trump would deliver to us if he were to turn to this universal medicare for all system, everybody in nobody out except for the INSURANCE companies who bring nothing to the table but higher costs for administration. Health care should not be an industry but rather a humane way to care for the people of the U.S. After all health care is a human right.
22
What is that noise? Oh, it's the insurance & pharmaceutical companies howling! Medicare for all would work as long as people understand that there are limits to their care. Basic healthcare is a right but limits & personal responsibility are required in order to make it work.
5
Not too long ago HMOs were the devil's spawn. It seems as though now it is the spectre of a universal Medicare type of health care coverage. I read recently where a Dane or perhaps a Canadian stated that yes their taxes were somewhat higher but they had no worries about quality healthcare, and their standard of living would be about equal. Recent polls show they are as a people much happier than Americans (I don't believe the 1% will ever be truly
happy, I call it the Scrooge McDuck syndrome,) I'm from Canada and sometimes consider returning, but I've been here for over 60 years, living in 7 different states and I like it here.
happy, I call it the Scrooge McDuck syndrome,) I'm from Canada and sometimes consider returning, but I've been here for over 60 years, living in 7 different states and I like it here.
3
Something that should be addressed in the "Medicare for All" discussion is the onerous debt that is shouldered by Physicians from their years of Medical School.
10
Bob Frank, through his books and his other writings, seems to be one of the few economists who actually understand how things work. Thank you ... yet again!
9
Good idea!
3
Hey, how about universal access to truly GOOD doctors? Huh?
1
To put it in Mr. Trump's words: "Why not, what do you have to lose?" [on promoting single payer Medicare for all].
6
You've tried all the other brands, now try the 21st century "Medicare for All" offering for a healthier America.
7
Health care should be a RIGHT in America the same as public education, infrastructure and the prison system. However many people believe the Republican lie that almost EVERYTHING including social security and Medicare should be a FOR PROFIT enterprise. I'm sure there will always be a number of people who believe the stupid things they want to believe in and will fight to the death to remain stupid.
8
This is what we need (and I voted for Trump because of the economy and Obamacare) but it will never happen because the insurance companies want to make lots of money, and they control congress and the senate, both parties, you see...it's all about money and the insurance companies are VERY POWERFUL! The idea of medical insurance is wrong, in that it takes lots of people paying a lot into it over a lifetime that will not really use it...just so insurance companies can make lots of money...on the sick...so, are they evil?
6
Fine suggestion, and quite reasonable.
A sane, sober, well though out proposal.
That's precisely why this group in power won't hear it, and will not consider it.
A sane, sober, well though out proposal.
That's precisely why this group in power won't hear it, and will not consider it.
14
A really smart column. Only will Trump knew how to read.
6
The 'one payor solution'.
What took so long to get to this solution that works around the world.
What took so long to get to this solution that works around the world.
6
We the People demand no less than a single payer healthcare plan, that's what we want, they work for us, and they must deliver. Not next year, not tomorrow, right now!
Rise up People, demand what is rightfully yours-you pay for it with tax dollars, so stand up now and demand it!
The cost must be absorbed by reallocation of spending priorities, demand it now!
Healthcare done, simple.
Rise up People, demand what is rightfully yours-you pay for it with tax dollars, so stand up now and demand it!
The cost must be absorbed by reallocation of spending priorities, demand it now!
Healthcare done, simple.
4
I wish Mr. Frank was in charge of Mr. Trump's health care strategy. Medicare for all is the most viable idea. Maybe Ivanka and Jared could whisper in the President's ear that this approach would make President Trump a sure winner
6
Yes! Ryan and Trump can win over the Democrats and become beloved by the nation, if they promote single payer health care. The irony is that the party that so hated Obamacare, can't rid us of it. Why? Because they don't believe that health care is a right. They think each of us is an island, entire of itself, and responsible for our own health and welfare. Oops, the Constitution says something about welfare.... Oops, the Constitution says the primary function of government is not our safety but JUSTICE. Republicans! Come back to the game of governance.
2
Like a lot of other folks, I ache for a solution that promises even a wisp of the common sense of Professor Frank's analysis. What's to lose? Only a lot of vindictive behavior and scuttlebutt that physically hurts people and shortens lives.
4
One man's cost is another man's income. Expect the AMA, drug makers, and insurance companies to find all sorts of reasons why single payer couldn't possibly work in the U.S.
4
As a nurse, I get a kick out of the suggestion of a Medicare for all type insurance plan in America.
Countries that have single payer mandate a much higher level of taxes. Personally, I wouldn't care because it seems like a fair way to assure people get truly affordable healthcare.
But we seem to be oblivious to the fact that many people do not want to pay any taxes, let alone more taxes to allow healthcare for all in this United States. For some reason, when it comes to healthcare, many Americans don't mind if their neighbor drops dead. They more care about making sure that nasty IRS doesn't get their money.
Haven't we just been through these concepts? With Republicans at the helm, isn't it a rather pointless discussion? If this country would have allowed single payer, there is no one other than Barack Obama who would have welcomed it more.
Countries that have single payer mandate a much higher level of taxes. Personally, I wouldn't care because it seems like a fair way to assure people get truly affordable healthcare.
But we seem to be oblivious to the fact that many people do not want to pay any taxes, let alone more taxes to allow healthcare for all in this United States. For some reason, when it comes to healthcare, many Americans don't mind if their neighbor drops dead. They more care about making sure that nasty IRS doesn't get their money.
Haven't we just been through these concepts? With Republicans at the helm, isn't it a rather pointless discussion? If this country would have allowed single payer, there is no one other than Barack Obama who would have welcomed it more.
7
Do as France does. Provide good basic healthcare for all American citizens; single payer.
4
As per a recent NYT article about the paucity or lack thereof of insurance for dental coverage in this country, any consideration for Universal Coverage NEEDS TO include quality dental coverage. Since when did the mouth secede from the rest of us and have separate insurances or discounts to get it covered? If the direction of health coverage seeks to include a universal system as it should in this country don't forget to petition your senators and reps to include dental coverage. In the not too distant past (before HMO's killed the health insurance system) getting oral surgery was covered under our major medical coverage. It never ceases to amaze me how the insurance company's rule the direction and coverage of who gets quality health care. our (wimps) reps in Congress should be forging the path to healthcare for all not the insurance industry! I suppose because of the health benefits they get and the donations (bribes) they get from them, they do not want to rock the boat. What a bunch of phony cowards.
6
Undermining the health, welfare, education and religious freedom of our country is terrorism, plain and simple. We will implode
2
Medicare for all. Eliminate the cap on social security contributions to fund it. Problem solved. You're welcome.
Oh, wait! Do I hear a complaint? Yes I do, from the insurance company CEOs and their Republican legislator minions. Shut up, whiny crybabies.
UnitedHealthcare CEO Stephen Hemsley took home over $66 million in 2014. (Business Week)
Oh, wait! Do I hear a complaint? Yes I do, from the insurance company CEOs and their Republican legislator minions. Shut up, whiny crybabies.
UnitedHealthcare CEO Stephen Hemsley took home over $66 million in 2014. (Business Week)
9
The main reason the rate is lower in other countries is that they do not have so much free care to make up for - they know they get paid for each MRI, each appendectomy vs the amount of bad debt that occurs here. How can hospitals keep the lights on if no one pays?
1
" which is to say, governments — are typically able to negotiate more favorable terms with service providers."
Translation: wage controls.
Translation: wage controls.
2
This very informative Economic View by Robert Frank raises the possibility that President Trump may now reach across the aisle to explore a single-payer Medicare-like system. My question for Mr. Frank: After 65 days in office, how often has the President broadened policy dialogue to include the Democrats?
2
Historically, I have been against single-payer as I think it will relegate everyone, except the very wealthy, to mediocre care. However, with the disaster that the ACA has become, and the Republicans inability to put forward an alternative, I think single-payer is inevitable. If so, we should get behind the idea and make it work to the best extent possible.
7
I am not really sure that Mr. Trump doesn't want a one payer system like the rest of the world has.
5
As a physician I haveeeded. advocate universal haelth care for over 40 years. Dozens of research papers have shown it provides better health at lower cost. I have a patient who died because an HMO would not pay a few dollars for the treatment she needed. Meanwhile the Medicare Disadvantage poviders are doing everything they can to turn Medicare into a bunch of private HMOs.
Speak out, When you see your doctor, tell him/her that you support universal Medicare. Start the conversation.
Speak out, When you see your doctor, tell him/her that you support universal Medicare. Start the conversation.
3
Why is this a surprise? Paul Ryan is an acolyte of Ayn Rand. He and Mitt Romney lost before and now Paul Ryan lost again.So sad that his messenger was Trump.
If you believe Trump will offer anything progressive, that is prima facie evidence that you are high on drugs. Fortunately the ACA will cover your detox program.
2
Nice to see the NYT publishing opinion pieces on medicare for all. However, one cannot but be struck by the late timing of this. During the democratic primaries, this publication treated with utter contempt the one candidate who made medicare for all an essential component of his campaign , first ignoring his campaign, before proceeding to cover it with snarky derision. Apparently, most critics of Sanders thought it was somehow a pie-in-the-sky idea to adopt an approach to health care that even the most conservative parties in Europe and the Canada have viewed as a no-brainer since WWII.
Now that this plan has little chance of success in the next four years, the NYT has finally come around to giving it coverage. Too little and tool late, though entirely unsurprising from the publication that has consistently been on the wrong side of most issues and only changes stances when it's too late to do any good. (Just read Robert Caro on the NYT's glowing coverage of Robert Moses before he succeeded in destroying much of New York or else look the various NYT columnists who beat the Iraq war drums back in '03, including Mr. 'Suck on This' Tom Friedman).
Now that this plan has little chance of success in the next four years, the NYT has finally come around to giving it coverage. Too little and tool late, though entirely unsurprising from the publication that has consistently been on the wrong side of most issues and only changes stances when it's too late to do any good. (Just read Robert Caro on the NYT's glowing coverage of Robert Moses before he succeeded in destroying much of New York or else look the various NYT columnists who beat the Iraq war drums back in '03, including Mr. 'Suck on This' Tom Friedman).
1
Nice to see the NYT publishing opinion pieces on medicare for all. However, one cannot but be struck by the late timing of this. During the democratic primaries, as acknowledged by the Public Editor at one point, this publication treated with contempt the one candidate who made medicare for all an essential component of his campaign , first ignoring his campaign, before proceeding to cover it with snarky derision. Apparently, most critics of Sanders thought it was somehow a pie-in-the-sky idea to adopt an approach to health care that even the most conservative parties in Europe and the Canada have viewed as a no-brainer since WWII.
3
We're lucky if we can keep Medicare for those who now have it. Paul Ryan would abolish Medicare if given half a chance and substitute some half-baked "market" based scheme. Please don't forget he's a Republican and the first principle of being a Republican is that government can do no right.
4
Medicare for All would expand the Nation into one big risk pool, rather than a wish-mash of employer-sponsored plans, private insurance, Medicare, Tri-Care, Medicaid, etc. Also, if we through a good bit of there expense back on Hospitals, especially with ERs, some of them may be closing.
By having one huge plan, the Government would be able to better negotiate fees, both with health care providers, with prescription manufacturers, and health insurers.
Also, Trump would be able to finally DO THE RIGHT THING!
https://thetruthoncommonsense.com
By having one huge plan, the Government would be able to better negotiate fees, both with health care providers, with prescription manufacturers, and health insurers.
Also, Trump would be able to finally DO THE RIGHT THING!
https://thetruthoncommonsense.com
3
The irony is that if Trump get passed a universal healthcare plan like Medicare for All, this would get him the four more years he wants instead of the six more months he is likely to get.
3
President Trump can now, after the GOP 's defeat go it himself with a Medicare for all package. That would fulfil his important promise, even settle his legacy.
It's so common around the world it should be a no-brainer. He will have to find ways to mollify the insurance and pharmaceutical interests. But we already do so in many nations.
It's so common around the world it should be a no-brainer. He will have to find ways to mollify the insurance and pharmaceutical interests. But we already do so in many nations.
2
Trump needs to learn its PORK, and lots of it, that the REPUBs in Congress (and the Senate) want and LOVE....these guys don't give a damn about Heath Insurance. much less reform or improvements - they ALL have their own Cadillac Insurance Policies courtesy of the US Govt and US Taxpayers - I'd love to see the day come when Herr Leader Trump insists EVERYONE live under the same health insurance policy...thats when we'd maybe start to see REAL, HONEST improvements...but, that day Im certain will never come...
note for future negotiations - TRUMP - Bring more CRISCO and PORK to the table...its any easy receive...and a lot less painful on the backside...
note for future negotiations - TRUMP - Bring more CRISCO and PORK to the table...its any easy receive...and a lot less painful on the backside...
For Trump to move towards Medicare for all would require him to: (A) care about the well-being of people other than himself; (B) be willing to actually do some actual work; and (C) have an attention span of more than 90 seconds.
I'd bet my bottom dollar it doesn't happen.
I'd bet my bottom dollar it doesn't happen.
3
Republicans are notorious cheapskates who famously spend money, borrow more and cut taxes for the very wealthy. But the one thing they miss out on is the enormous cost savings of universal health care. If the US spent the equivalent amount of money on each of its citizens for healthcare as the major European countries do, not only would all citizens receive care, but it would cost around $700 billion less each year than we spend to care for a fraction of people under our current system. It would be the biggest tax cut on ordinary citizens the country has seen.
But Republicans are hell bent on dragging our country down so that they can spin their morality stories of pulling themselves up by the bootstrap and liberty and freedom and all the other malarkey they rant about.
But Republicans are hell bent on dragging our country down so that they can spin their morality stories of pulling themselves up by the bootstrap and liberty and freedom and all the other malarkey they rant about.
7
"Loss aversion" is an interesting angle. What we're seeing is the national GOP leadership acting out the equivalent of that guy at some political gathering who, in a now-famous video clip, shouted: "Keep your government hands off my Medicare!" They say they don't like the status quo, but they much prefer it to any alternative.
1
Bipartisanship is gone. Whichever party proposes any idea will be opposed by the other party - no matter how good the idea.
Sure, Trump could cooperate with the Dems to fashion a good healthcare bill and get around the die hard Freedom Caucus, and deny the Dems their main talking point in 2018. But he won't.
We have seen that already when Trump sacrificed every vestige of healthcare in the AHCA to placate the Freedom Caucus anti-government radicals. And Trump's budget, his tax reform, his appointments, his weakening of regulations of all kinds, all these actions, show Trump is 100% with the Bannon-Rebekah Mercer mania to dismantle government entirely.
You can bet Bannon-Rebekah are not for government healthcare.
We have seen that already when Trump sacrificed every vestige of healthcare in the AHCA to placate the Freedom Caucus anti-government radicals. And Trump's budget, his tax reform, his appointments, his weakening of regulations of all kinds, all these actions, show Trump is 100% with the Bannon-Rebekah Mercer mania to dismantle government entirely.
You can bet Bannon-Rebekah are not for government healthcare.
1
"The president...may consider changing course and working across party lines to develop support for universal access to Medicare." Would that this were possible; Trump doesn't care nearly enough about the millions who would benefit to make it so.
The ACA isn't perfect but the proposed AHCA would have been a disaster. The GOP could have gotten a lot further if they paid attention to what their constituents were saying about needed fixes instead of that death-to-Obamacare nonsense. Better luck next time!
Finally, perhaps, we will get to where we should have been 50 years ago--a sensible health care coverage for all. If we can get the insurers out of the system, and all their unnecessary costs, we can provide better coverage at a lower cost, as mr rapatoul suggest in his comment below.
2
"...early studies suggested that losses would have been concentrated among people who voted for President Trump. "
So what's the problem? They would get exactly what they voted for, wouldn't they? Exactly.
So what's the problem? They would get exactly what they voted for, wouldn't they? Exactly.
The AMA and the American health-care industry will never stand for a "Medicare for All" plan that mandates lower costs for care and services. Consequently, the tax burden necessary to finance "American Medicare for All" will be ruinous. Turning the USA into France sounds like a great idea until you figure out what it will cost.
1
This isn't going to happen. Trump wants whatever sounds good at a given moment as long as it gets him applause. The far-right libertarians don't believe that government has a role in securing health care for its citizens (or to put it more cruelly, they don't believe that those who can't pay for health care deserve it). No room for compromise there.
2
Are Americans willing to pay the higher taxes associated with Universal Medicare? Look at the amount of Medicare tax deducted from your most recent paycheck and then multiply it by, say 4 or more. Is this acceptable to you? Second point, will all physicians accept the lower reimbursements of Medicare or will they refuse to take these patients? Doctors expect a certain amount of income in order to pay for their medical training, and beyond that are used to being wealthy.
We are not Europe and socialized healthcare is a bad fit in this country absent a complete overhaul of the existing system and an ability to persuade Americans to pay much higher taxes and convince doctors to accept lower reimbursements. Who in this administration has the ability to sell this new plan to America? Tick tock.
We are not Europe and socialized healthcare is a bad fit in this country absent a complete overhaul of the existing system and an ability to persuade Americans to pay much higher taxes and convince doctors to accept lower reimbursements. Who in this administration has the ability to sell this new plan to America? Tick tock.
2
Doctors are not "used to being wealthy." That is a false narrative. Doctors have struggled essentially penniless and with necessity of taking out loans for 11-18 years before beginning practice. But one problem is that, even with a mix of insured patients, few uninsured, Medicare and Medicaid, 35 to 60 cents of each dollar received by the office has to go towards overhead, with high malpractice insurance, required attendance at meetings...often out of town, personnel, rent, and sometimes the expensive electronic health records equipment.
Medicare reimbursement to doctors is pathetic (here's an example for you...neurosurgeon (having trained 16-18 yrs) does patient's history and physical exam, operates on a malignant brain tumor, takes care of the patient for...as an example...5 days and nights in the ICU, 9 days on the hospital floor, shepherds the patient and family through chemotherapy and radiotherapy...as a part of the 90 day "global" package paid by Medicare. Medicare allows (and doctors by law can charge no more) $1,760, pays 80% of this; the patient has a supplement for the remaining 20%.) So how much lower do you believe reimbursement to doctors be? BTW...that reimbursement is less than half of the doctor's overhead.
Already doctors regulate the number of Medicare patients they schedule. They have to, to keep their offices financially afloat.
And Medicaid reimbursement is worse...often below overhead. Ask CA about narrow networks.
Medicare reimbursement to doctors is pathetic (here's an example for you...neurosurgeon (having trained 16-18 yrs) does patient's history and physical exam, operates on a malignant brain tumor, takes care of the patient for...as an example...5 days and nights in the ICU, 9 days on the hospital floor, shepherds the patient and family through chemotherapy and radiotherapy...as a part of the 90 day "global" package paid by Medicare. Medicare allows (and doctors by law can charge no more) $1,760, pays 80% of this; the patient has a supplement for the remaining 20%.) So how much lower do you believe reimbursement to doctors be? BTW...that reimbursement is less than half of the doctor's overhead.
Already doctors regulate the number of Medicare patients they schedule. They have to, to keep their offices financially afloat.
And Medicaid reimbursement is worse...often below overhead. Ask CA about narrow networks.
2
As a Canadian living four months a year in the US I am so grateful for our single payer system. One feature that is not often mentioned is that my doctors do not have to phone anyone for permission to perform any procedure. In the US system this bureaucratic step wherein doctors need to get the okay over the telephone from some insurance employee sitting at a desk seems so crazy.
12
The bottom line is definitely the total cost of health care in the US. Certainly Obamacare did not address this. It is outrageous that Americans spend double every other developed country with results that are not better. I am sure that there is some common ground here. Conservatives want to lower cost and liberals want to increase the services. Somewhere there is a point where the two sides can "meet."
3
Thank you for this great article and for placing it in the Business section. A single payer model makes good fiscal sense and both parties should appreciate this and embrace it.
Nothing would invigorate our Labor force and society more than to afford everyone access to a basic level of health care, independent of employment and class!
Our government can do it!
Nothing would invigorate our Labor force and society more than to afford everyone access to a basic level of health care, independent of employment and class!
Our government can do it!
6
It seems that we are heading inexorably toward a single payer system, but it will be anything but easy. Even with the Medicare payroll tax supporting eligibility and providing part of the funds to pay for it, the program is heading toward insolvency. With universal coverage, there will have to be new funding mechanisms and they won't be cheap. When there's a single purchaser of medical services (monopsony), we can expect intense political conflict over how much doctors and other medical personnel will be allowed to earn. Expect strikes of healthcare workers.
My fear is that Medicare for all will really be Medicaid for all.
My fear is that Medicare for all will really be Medicaid for all.
1
Trump is too much of a narcissist to reach across party lines. It's his way or the highway. Reaching across party lines and changing what he (alone) thought was a great health care plan would be a change his tiny mind may not be able to handle. Non partisan cooperation is how it should be, but our system of government is currently so corrupted by lobbyists and the money they pass out, alleged criminal acts by both parties, advisers and cabinet appointments who may or may not be corrupt, that it's almost impossible for Congress to do anything for the benefit of the citizens of this country.
1
The first President to ask for single-payer government funded healthcare was Teddy Roosevelt. Unfortunately the AMA was against it then; now they would love it. Think how streamlined billing would be. Think how corporations would save money on not having to insure there workers. No insurance company can compete with the cost, efficiency and fairness of Medicare.
The problem we have, however, is that our politicians, on both sides of the aisle, are in the pockets of the insurance and drug companies. And unfortunately Trump, now that he is President, could not care less about the people who elected him and is beholden to the corporate moguls he drained from the swamp into his cabinet.
The problem we have, however, is that our politicians, on both sides of the aisle, are in the pockets of the insurance and drug companies. And unfortunately Trump, now that he is President, could not care less about the people who elected him and is beholden to the corporate moguls he drained from the swamp into his cabinet.
6
It's inevitable. Loss aversion policy will ultimately Trump the conundrum health issue. Medicare for all will happen. It may have a different name, but it will happen. Perhaps we can make mexico pay for it..?
4
Medicare for all would be great, but it isn't even close to the Ryan-McConnell plans for our future, nor Trump's. The Ryan-McConnell idea of healthcare is an ad campaign to make tax cuts for the rich palatable to voters. The Trump idea of healthcare is a symbol of his success; its content is meaningless except as a stepping stone.
Trump is sure that whatever the plan contains, he can sell it as "step one" toward heaven on Earth. In the meantime "step one" can be used to enlist the Freedom Caucus in his execution of the Bannon-Mercer campaign to dismantle government.
Trump is sure that whatever the plan contains, he can sell it as "step one" toward heaven on Earth. In the meantime "step one" can be used to enlist the Freedom Caucus in his execution of the Bannon-Mercer campaign to dismantle government.
1
This is is a great idea. A dream really that could come true.
Matched with a system like Kaiser, it works perfectly.
It's fully operational already and could scale up easily. The providers already treat it like it's their bread and butter. Let's make some bumper stickers and stick with the idea. It would solve this problem and what politician could say a bad word about Medicare and live to tell about it?
Matched with a system like Kaiser, it works perfectly.
It's fully operational already and could scale up easily. The providers already treat it like it's their bread and butter. Let's make some bumper stickers and stick with the idea. It would solve this problem and what politician could say a bad word about Medicare and live to tell about it?
11
This article also fails to address the huge cost of educating future doctors, which adversely incentives doctors to charge more for their services and order more expensive procedures. As a nonclinical health worker, I do not fault clinicians for choosing higher paying sub specialities or wanting to maximize profits. If I worked my butt of through 4 years of med school, had crippling student loans, followed by low-paying years of residency working 80 hours a week, I'd want to maximize my income too. Any future healthcare reform should include governent subsidized medical school and increasing residency spots for critical specialities (primary care, geriatrics and palliative care). Our taxes already fund residency programs, why not medical schooling too?
17
We run a single payer system that is twice the size of Canada's and just a little smaller than England's National Health Service, and France's and Germany's systems. It has a public option (parts A&B) private options offered on an open exchange market (Part C), and a drug program (Part D). And if that is not enough you can buy supplemental health insurance. It has operated for over 50 years and is rated among the top insurance programs by both patients and doctors. And it is call Medicare! Why are we trying to invent a workable health care system when we already have something that has been developed through years of bipartisan debate and is considered a great success by seniors? All it takes is to change eligibility from being 65 years old or disabled to all include U.S. citizens and residents. It should be a no-brainer.
18
Medicare for all with the option for additional supplementary insurance from BCBS is an efficient and cost effective strategy that has provided me and many seniors in Kansas with competent and effective medical care. It's simple and without fanfare. Our former Governor Kathleen Sebelius who was also Kansas Insurance Commissioner as well as Obama's Secretary of Health and Human Services could offer consultation for Trump. She is quite competent and could lay out this option out for Trump. Regrettably, his arrogance would spoil the moment and that option would be destroyed.
6
Many people have been pushing for Medicare for all for at least the last ten years, since before the ACA was enacted. It would not put health insurance companies out of business, because they could be hired to do the processing. They would get paid without taking risk.
Healthy Americans will cut the costs of medical care more than any other single factor. Life expectancy will go up since people will see doctors sooner when ability to pay is not a factor. Cancer, heart disease and other mortality rates will go down.
Healthy Americans will also be healthy workers, which is very good for the economy.
Meanwhile, America would be Great in a way we've never been before. We would affirm the value of every individual in our country by making sure basic health care is provided.
Healthy Americans will cut the costs of medical care more than any other single factor. Life expectancy will go up since people will see doctors sooner when ability to pay is not a factor. Cancer, heart disease and other mortality rates will go down.
Healthy Americans will also be healthy workers, which is very good for the economy.
Meanwhile, America would be Great in a way we've never been before. We would affirm the value of every individual in our country by making sure basic health care is provided.
5
When codgers like myself tell you about the good old days, listener beware. We of a certain age have great recollections of our youth, at least we who have had great childhoods.
But we can not expect the same criteria to be applied today. The world has changed. We know more, so simply putting our heads in the sand and refusing to believe scientists because we want to relive our youth, to somehow spite the advances of progress, make no sense.
It is impossible to turn back the clock. When it comes to healthcare we can't go back, not when modern marvels of medicine have enabled our military to save near-death wounded Marines on the battlefield. But with these medical miracles come an enormous expense. Not only the expense of high-tech machines, but the post-op expense of keeping someone in their Twenties who has no limbs, and cannot breathe on their own, alive, for the next half century. That takes a lot of money, a whole lot.
The alternative is unacceptable. And so, we take the good, the expensive medical advances, with the bad, the enormous amount of money (taxes) it takes, to make this life-saving health care available.
And the only way to do that is universal health care for all Americans. Pick a plan adapted from any one of those successful plans which have been operational for decades, and get it passed into law. It will deliver to US all is what we should want: better health care for less.
DD
Manhattan
But we can not expect the same criteria to be applied today. The world has changed. We know more, so simply putting our heads in the sand and refusing to believe scientists because we want to relive our youth, to somehow spite the advances of progress, make no sense.
It is impossible to turn back the clock. When it comes to healthcare we can't go back, not when modern marvels of medicine have enabled our military to save near-death wounded Marines on the battlefield. But with these medical miracles come an enormous expense. Not only the expense of high-tech machines, but the post-op expense of keeping someone in their Twenties who has no limbs, and cannot breathe on their own, alive, for the next half century. That takes a lot of money, a whole lot.
The alternative is unacceptable. And so, we take the good, the expensive medical advances, with the bad, the enormous amount of money (taxes) it takes, to make this life-saving health care available.
And the only way to do that is universal health care for all Americans. Pick a plan adapted from any one of those successful plans which have been operational for decades, and get it passed into law. It will deliver to US all is what we should want: better health care for less.
DD
Manhattan
9
As far as I can tell, pretty much everyone on Medicare loves it.
In a way, I'd hate for Donald Trump to have his name attached to the simple, brilliant step of putting single-payer system into effect--but I'd resign myself to this for the good of our nation.
Now we have mediocre healthcare (except for the extremely wealthy, of course) and pay way too much for it. Let's listen to our doctors and hospitals and other medical professionals and get Medicare for everyone in the US.
In a way, I'd hate for Donald Trump to have his name attached to the simple, brilliant step of putting single-payer system into effect--but I'd resign myself to this for the good of our nation.
Now we have mediocre healthcare (except for the extremely wealthy, of course) and pay way too much for it. Let's listen to our doctors and hospitals and other medical professionals and get Medicare for everyone in the US.
16
When I was self-employed (1975-2002) I paid for my own health insurance. But the cost started really going up in the late 90s, from $6,000 to $8K to $10K to $12K... Eventually, I could barely pay for it. I was saved only because I went on MediCare.
13
Our present healthcare reimbursement system can be thought of as a giant employment program for people who have nothing to do with making you feel better. A single payer system will generate huge savings at the expense of healthcare billing employees (and their counterparts in the insurance companies). They will have to find new jobs after single payer takes effect. The billing office employee skill sets may not be transferable to other jobs without retraining.
15
The savings from the inefficiencies of the current system would be available as spendable income for many, many people. These people would spend that income, creating even more jobs than those that would be lost.
1
This article explains the inevitable failure of the free market to rein in health care costs and still give our citizens the coverage for the care they need. Inevitable because health care does not meet requirements of a free, perfectly competitive market. It also does an excellent job of explaining how a single payor system would solve most of the problems created by trying to use a free competitive market solution where the market can't be free and competitive.
One important issue was not discussed, and that is the enormous amount of money spent by insurance companies trying to "cherry-pick" their customers. In our current system, insurers are strongly motivated to find a way to get only the healthiest customers on their plans, and have the sickest go to other companies. That keeps their expenditures low, and is the most important factor in their profitability. They spend an enormous amount of time and money on this, and it would be completely eliminated by a single-payer system
One important issue was not discussed, and that is the enormous amount of money spent by insurance companies trying to "cherry-pick" their customers. In our current system, insurers are strongly motivated to find a way to get only the healthiest customers on their plans, and have the sickest go to other companies. That keeps their expenditures low, and is the most important factor in their profitability. They spend an enormous amount of time and money on this, and it would be completely eliminated by a single-payer system
7
We couldn't get a single payer solution when the Dems controlled everything and ended up with ACA. Now with Reps controlling it all, there is no chance that an expanded government program will have any chance whatsoever. The politics of it all make it virtually impossible. This is just wishful thinking. It may be he "right" thing to do, but what is right these days is of little consequence.
5
On the contrary, now that Americans are used to federal involvement in our health care---and more accepting since many millions now have health care available to them which was previously lacking---they will be more likely to accept and indeed welcome a single payer system which all other developed Western countries have put in place.
****A Connecticut physician
****A Connecticut physician
13
I hope you're right, but down here in a deep Red state that rejected Medicaid expansion, I'm not so confident.
It's difficult to disagree with arguments for a single-payer system on the economic merits, not to mention the moral ones - unless you are an insurance company, a politician that takes campaign contributions from insurance companies, the top officers and stockholders of American corporations, or a neoliberal ideologue that opposes the principle of universal medical care as a human right. Unfortunately that pretty much covers almost the entire leaderships of both the Democratic and Republican parties and the business class they represent. If left in it's present form as a for-profit capitalist enterprise the current diseased medical system will continue to worsen and will not cure itself. That's the realistic political diagnosis. The prognosis and treatment? Since there is little sympathy for Medicare for all among the American ruling class and it's political representatives ordinary working people will have to organize a politically independent mass movement to demand universal medical care or we will continue to remain sicker and poorer than our counterparts in every other developed country. Only the pressure of our own mass direct action, not naive reliance on politicians, will get us the health care we need.
5
How about a gradual inclusion in Medicare? First lower the age to 60 years, then 55 years. This would have the advantage of moving the more likely to be ill folks to medicare. The rest of the population should then have lower premiums. What would that cost?
16
If you only move those most likely to need expensive care, the cost increases dramatically. It would be hard to get a political body to say yes.
1)Gradual inclusion from old to young is very expensive compared with starting at the youngest (newborns), who require much less medical care generally, and so may be added at significant rates. 2)But gradual isn't necessary if it doesn't include insurance companies and their need/desire for profit unconnected with actual medical care. And 3) However, our present Medicare presently only covers about half of seniors' care, which most younger people don't realize.
Millions of retirees over 65 paid into the Medicare system for almost all of our work lives . In addition our employers also paid a percentage of our earnings in as well. When we retire we pay a monthly premium and most of us carry a supplemental policy to cover what Medicare doesn't pay.
My biggest concern is that making Medicare available to all even those who have not paid into the plan will drain away the resources of those who paid in the past and are paying now. We have already seen that there are people who have purposely limited their income in order to qualify for subsidies. Our local paper wrote of a woman who'd quit her job to become a part time Yoga instructor and was receiving a $400 subsidy on her $424 policy under the ACA. There are an estimated 2 million people scamming the system in this fashion. I recall Nancy Pelosi thinking this was great. People would under the ACA be able to pursue their passions like photography and art without having to keep a day job just to have insurance.
I would fight this tooth and nail if it in any way jeopardizes my care because the government didn't budget enough money to cover the costs and has to ration care until the new budget starts up. This already occurs in the European health care systems.
My biggest concern is that making Medicare available to all even those who have not paid into the plan will drain away the resources of those who paid in the past and are paying now. We have already seen that there are people who have purposely limited their income in order to qualify for subsidies. Our local paper wrote of a woman who'd quit her job to become a part time Yoga instructor and was receiving a $400 subsidy on her $424 policy under the ACA. There are an estimated 2 million people scamming the system in this fashion. I recall Nancy Pelosi thinking this was great. People would under the ACA be able to pursue their passions like photography and art without having to keep a day job just to have insurance.
I would fight this tooth and nail if it in any way jeopardizes my care because the government didn't budget enough money to cover the costs and has to ration care until the new budget starts up. This already occurs in the European health care systems.
2
Medicare For All doesn't mean Medicare For Free. Obviously, people under 65 would need to pay for coverage, and workers' Medicare deductions would be higher to cover the costs of the expanded program. It's just a matter of actuarial science to figure out just how much everyone needs to pay in.
However, don't forget that the other side of the equation is that they don't have to pay premiums to the private insurance companies any more. It's not just a tax increase to without offsetting insurance savings, and if it's done right, the per capita cost should be much lower, given the single payer's ability to negotiate prices, and the extremely reduced sales and administrative costs.
However, don't forget that the other side of the equation is that they don't have to pay premiums to the private insurance companies any more. It's not just a tax increase to without offsetting insurance savings, and if it's done right, the per capita cost should be much lower, given the single payer's ability to negotiate prices, and the extremely reduced sales and administrative costs.
8
I didn't mean to imply that it would be free but there are many people out here who do not work such as those living on the streets. I read recently of a "undocumented" person from Mexico had had nearly 300 emergency room visits and over 140 X-Rays. There are plenty of crime victims as in Chicago who don't work but get medical care when they are shot.
Premiums will have to go up to coverall this since the hospitals won't have to be writing them off.
Premiums will have to go up to coverall this since the hospitals won't have to be writing them off.
We already pay for those people through higher insurance premiums, higher local taxes for hospital districts, higher property taxes, etc., some of which current Medicare recipients are paying in addition to their own premiums and supplement premiums.
By capturing the paid premiums of all of the new additional insureds at a more efficient administrative cost and because providers will no longer have to "write off" costs for delivered services, the best projections by health care economists indicate that Medicare will still be solvent at current premium rates.
By capturing the paid premiums of all of the new additional insureds at a more efficient administrative cost and because providers will no longer have to "write off" costs for delivered services, the best projections by health care economists indicate that Medicare will still be solvent at current premium rates.
4
"... loss aversion...[a] robust finding in behavioral science...the pain of losing something...is much greater than the pleasure of having gained it..."
1. There is no pleasure meter. So how do you measure? Preference ranking is no measure of pleasure--it just ranks preference. But sometimes people prefer what's less pleasurable.
2. Pleasure is not an isolable feeling; it hypostasizes "pleasant" -- an aspect of other feelings; indeed it's a term of aesthetic evaluation. They can feel good (or bad); but there is no one feeling that makes them all feel good (Aristotle).
3. Pleasure is not the opposite of pain in its primary sense. Aches and pains (dull or sharp) are locatable--on or in your body--normally where the trauma is--except for referred and phantom pain. It is a good sensory capacity (without it you must smell burning to pull fingers out of fire); it just feels bad.
Pleasure is not locatable--except as an aspect of other feelings--like scratching itches.
4. The extended sense of 'pain' is not locatable--e.g. depression feels bad--but not in some place. It's like 'unpleasant'. But aversion is not the measure of 'unpleasant' anymore than desire measures pleasant/feels good.
5. "Loss aversion" is hardly a discovery of behavioral science--let alone "robust." It's a truism by definition--a pleonasm. Loss/gain imply harm/benefit. We are averse to harm.
6. But loss can seem worse than not having the gain--an illusion--like overvaluing wealth/health when poor/ill.
1. There is no pleasure meter. So how do you measure? Preference ranking is no measure of pleasure--it just ranks preference. But sometimes people prefer what's less pleasurable.
2. Pleasure is not an isolable feeling; it hypostasizes "pleasant" -- an aspect of other feelings; indeed it's a term of aesthetic evaluation. They can feel good (or bad); but there is no one feeling that makes them all feel good (Aristotle).
3. Pleasure is not the opposite of pain in its primary sense. Aches and pains (dull or sharp) are locatable--on or in your body--normally where the trauma is--except for referred and phantom pain. It is a good sensory capacity (without it you must smell burning to pull fingers out of fire); it just feels bad.
Pleasure is not locatable--except as an aspect of other feelings--like scratching itches.
4. The extended sense of 'pain' is not locatable--e.g. depression feels bad--but not in some place. It's like 'unpleasant'. But aversion is not the measure of 'unpleasant' anymore than desire measures pleasant/feels good.
5. "Loss aversion" is hardly a discovery of behavioral science--let alone "robust." It's a truism by definition--a pleonasm. Loss/gain imply harm/benefit. We are averse to harm.
6. But loss can seem worse than not having the gain--an illusion--like overvaluing wealth/health when poor/ill.
1
The best thing Obamacare did was to open people up to what it's like to have health care. It had to work within the confines of our current system, but that was the only possible way. The fact that the ACA became law after literally decades of attempts is a miracle.
Obamacare was never perfect; it was always going to need tweaks and adjustments.
If the republicans had spend half as much time and effort fixing the problems instead of trying so hard to destroy it, we'd be there already.
Obamacare was never perfect; it was always going to need tweaks and adjustments.
If the republicans had spend half as much time and effort fixing the problems instead of trying so hard to destroy it, we'd be there already.
15
There are two other dimensions of a single-payer system that have not received a lot of attention. First, if such a system was created, it would involve combining the current Medicare, Medicaid, military health, parts of the VA, and other Federal health care programs into a single pool which would cover more than 50% of all health expenditures. According to the Tax Policy Center, in 2015 the Federal government spent more than $980 billion on health care plus another $260 billion on tax deductions for health care ( http://www.taxpolicycenter.org/briefing-book/how-much-does-federal-gover.... The Centers for Medicare & Medicaid Services estimates it as covering more than 50% of all health care expenditures.
Thus, already the Federal government is the biggest single health care payer. Single-payer would involve these expenditures being applied to everyone rather than just those on Medicare and Medicaid with people being responsible for the remaining part via supplemental insurance.
Second, if a single payer system is adopted, employer based health care would become cheaper for both employers and employees. This would be equivalent to a huge tax cut for employers since their expenditures on health insurance would become a lot cheaper.
Single-payer is a policy that both moderate Republicans and Democrats could accept, but it needs to be sold in terms that the politicians understand. Tax cuts and universal coverage are the concepts to do this.
Thus, already the Federal government is the biggest single health care payer. Single-payer would involve these expenditures being applied to everyone rather than just those on Medicare and Medicaid with people being responsible for the remaining part via supplemental insurance.
Second, if a single payer system is adopted, employer based health care would become cheaper for both employers and employees. This would be equivalent to a huge tax cut for employers since their expenditures on health insurance would become a lot cheaper.
Single-payer is a policy that both moderate Republicans and Democrats could accept, but it needs to be sold in terms that the politicians understand. Tax cuts and universal coverage are the concepts to do this.
8
An Easy Way To Lower Health Care Costs For All
When I retired early my company continued to provide health insurance with a personal premium I paid plus an employer subsidy. However I was required to enroll in Medicare at age 65. Interestingly, the premium costs (Medicare + my supplemental + employer subsidy) was essentially unchanged as was the coverage. What changed ? First all, there were no more “preferred providers”, I could use nearby clinics, doctors, and hospitals as well as bigger medical centers far away - all in my network! But, most importantly Medicare established much lower allowed charges by hospitals and doctors. (Perhaps our president has heard that Medicaid allowed fees are 40% to 60% of the absurd higher costs initially billed by medical providers. Large insurers don’t do quite as well but still pretty good, I’ve heard.) So just incorporate the requirement that Medicare sets ALL fees into pending health care laws and cut everyone costs in half. And then establish a single payer non-profit plan to administer these insurance for these costs.
When I retired early my company continued to provide health insurance with a personal premium I paid plus an employer subsidy. However I was required to enroll in Medicare at age 65. Interestingly, the premium costs (Medicare + my supplemental + employer subsidy) was essentially unchanged as was the coverage. What changed ? First all, there were no more “preferred providers”, I could use nearby clinics, doctors, and hospitals as well as bigger medical centers far away - all in my network! But, most importantly Medicare established much lower allowed charges by hospitals and doctors. (Perhaps our president has heard that Medicaid allowed fees are 40% to 60% of the absurd higher costs initially billed by medical providers. Large insurers don’t do quite as well but still pretty good, I’ve heard.) So just incorporate the requirement that Medicare sets ALL fees into pending health care laws and cut everyone costs in half. And then establish a single payer non-profit plan to administer these insurance for these costs.
2
It is clear is that both sides of this purported debate step away from any responsibility by calling our present system "Obamacare".
There really is no confusion in the halls of power. Money talks and everything else walks.
If the term "Affordable Care Act" was in general use all enrolled would know it as a misnomer. Any measure short of universal health care is cover for the sickness is profit industry which runs the show today.
There really is no confusion in the halls of power. Money talks and everything else walks.
If the term "Affordable Care Act" was in general use all enrolled would know it as a misnomer. Any measure short of universal health care is cover for the sickness is profit industry which runs the show today.
2
But if Taxpayers find out that Government can actually be of benefit, they will only clamour for more. Better to sink as much as possible into the Military's Defense contractors so they never get a taste of what Government taxes could actually do to improve everybody's lives.
6
This idea of American exceptionalism prevents us from looking around at every other wealthy nation and asking: "What have they figured out that we haven't?"
Sorry, folks, we don't have the best medical care in the world. In fact, our stats are pretty poor and heading downward. Consider: we have the highest maternal/infant deaths among wealthy nations and worse--those deaths are rising in a small select group (us, S. Sudan and the Congo among a few others). We are one of the few nations in which white male deaths are rising. Then consider that we pay twice the amounts others pay in these countries for worse outcomes.
The bottom line: for-profit private insurance charges the highest premiums the market will bear while providing the most minimal treatment they can get away with-- in the name of fiscal responsibility. For-profit means we, as patients, are a solely means to their end.. A man who pays for insurance all his life, never goes to the doctor, then dies suddenly of a heart attack is a great outcome for the insurance company--all profit, no expenditure. Sure, he might have lived longer if he had gotten checkups, taken blood pressure meds, etc, but that would have been money paid out by the insurance company from his premiums from that point onward. Medicare does not have the same incentive to cheer in those situations.
Sorry, folks, we don't have the best medical care in the world. In fact, our stats are pretty poor and heading downward. Consider: we have the highest maternal/infant deaths among wealthy nations and worse--those deaths are rising in a small select group (us, S. Sudan and the Congo among a few others). We are one of the few nations in which white male deaths are rising. Then consider that we pay twice the amounts others pay in these countries for worse outcomes.
The bottom line: for-profit private insurance charges the highest premiums the market will bear while providing the most minimal treatment they can get away with-- in the name of fiscal responsibility. For-profit means we, as patients, are a solely means to their end.. A man who pays for insurance all his life, never goes to the doctor, then dies suddenly of a heart attack is a great outcome for the insurance company--all profit, no expenditure. Sure, he might have lived longer if he had gotten checkups, taken blood pressure meds, etc, but that would have been money paid out by the insurance company from his premiums from that point onward. Medicare does not have the same incentive to cheer in those situations.
9
In 2015, while vacationing in Canada my husband had a stroke. I can attest to the cost efficiencies of a government run health care system such as Canada's compared to our outrageously expensive care in America.
The ambulance for his transport to hospital was $450. If we had been Canadian citizens it would have cost $150. Compare that to a $3500 ambulance transport my husband required five years previous.
The ER in Canada asked for cash payment for an ultrasound day of his stroke. I was horrified thinking what such a test would cost in US. We were charged $100. I laughed, partly because of the stress I was experiencing, but told the hospital tech to please take my money before they changed their minds. Compare this $100 charge to what easily would have been in excess of $1,000 in my area of California.
The five days in hospital in Canada in the world class McGill University Health Center was $20,000. That included hospital, ER, physical therapists, ambulance! If lucky in our area of California that may have covered one day.
When we returned home it was a nightmare navigating through our Anthem Blue Cross administrative paper work. Fifty page faxes and registered mails went missing. Refunds owed back to us took months and numerous phone calls exceeding 30 minutes each time we would call.
Give our household the option to buy into a Medicare for all Public Option!
The ambulance for his transport to hospital was $450. If we had been Canadian citizens it would have cost $150. Compare that to a $3500 ambulance transport my husband required five years previous.
The ER in Canada asked for cash payment for an ultrasound day of his stroke. I was horrified thinking what such a test would cost in US. We were charged $100. I laughed, partly because of the stress I was experiencing, but told the hospital tech to please take my money before they changed their minds. Compare this $100 charge to what easily would have been in excess of $1,000 in my area of California.
The five days in hospital in Canada in the world class McGill University Health Center was $20,000. That included hospital, ER, physical therapists, ambulance! If lucky in our area of California that may have covered one day.
When we returned home it was a nightmare navigating through our Anthem Blue Cross administrative paper work. Fifty page faxes and registered mails went missing. Refunds owed back to us took months and numerous phone calls exceeding 30 minutes each time we would call.
Give our household the option to buy into a Medicare for all Public Option!
13
Medicare does not cover medical services provided outside the US.
Why does single payer not happen when it's obviously the only way healthcare costs can be tamed, as we can easily see around the world in other countries. The simple act of providing healthcare for all our citizens would make a major difference in narrowing income inequality and it would provide a healthier workforce for a stronger United States.
Come on, it's a no-brainer.
Come on, it's a no-brainer.
14
This is a straightforward discussion, but it repeats one argument which I think is significantly off, which is that single payer systems result in lower costs due to their ability to negotiate more favorable rates. I suspect that the primary cause of our apparently high provider costs is the uncertainty of reimbursement itself. Providers naturally tack on a very high premium to deal with very variable payment practices of different insurers, to say nothing of the uninsured.
If you happen to be fortunate enough to have Blue Cross coverage, you can observe this on any explanation of benefits. The discounts in my part of the world are upwards of 80% to 90%. I submit that this is not so much due to Blue Cross's negotiating prowess as to the certainty of payment.
When we finally get this collectively through our heads, we will get Medicare for all and promptly see our costs fall in line.
If you happen to be fortunate enough to have Blue Cross coverage, you can observe this on any explanation of benefits. The discounts in my part of the world are upwards of 80% to 90%. I submit that this is not so much due to Blue Cross's negotiating prowess as to the certainty of payment.
When we finally get this collectively through our heads, we will get Medicare for all and promptly see our costs fall in line.
8
I disagree. The hospital bill is greatly inflated. Depending on what price an insurance co. has negotiated to pay, that is the price paid plus the percentage of co-pay by the patient. In other words, the original bill has nothing to do with the expected amount of payment. However, if a patient has no insurance, he will receive the original inflated bill and be on the hook for that whole amount. The insurance co. is not responsible for what the patient does not pay--the hospital is the one trying to recover that from the patient.
Yes, the hospital bill is inflated due to bills unpaid--but we ALL end up paying for unpaid emergency treatment when the emergency room is used as a last-resort doctor.
Medicare has a huge ability to negotiate medical prices across the board because they represent a huge number of patients. Right now our insurance companies individually negotiate their prices for medical care and their ability to negotiate is predicated upon the number of patients they represent. And companies negotiate with the insurance companies based on the number of employees who will be covered.That is the difficulty for the self-employed. They have no negotiating power with anyone and their insurance deals show it.
Yes, the hospital bill is inflated due to bills unpaid--but we ALL end up paying for unpaid emergency treatment when the emergency room is used as a last-resort doctor.
Medicare has a huge ability to negotiate medical prices across the board because they represent a huge number of patients. Right now our insurance companies individually negotiate their prices for medical care and their ability to negotiate is predicated upon the number of patients they represent. And companies negotiate with the insurance companies based on the number of employees who will be covered.That is the difficulty for the self-employed. They have no negotiating power with anyone and their insurance deals show it.
3
This may be why President Trump did not seem particularly bothered by the defeat of the bill. Of course, people would eventually find out that their health insurance coverage got worse under the AHCA if it had passed. And his supporters blame Congress for its defeat far more than they blame him. The strategy now seems to be to sabotage the ACA through executive actions such as declining to enforce the individual mandate and refraining from encouraging people to sign up for insurance, so ACA problems gradually worsen and Democrats can then be blamed.
Medicare for all, with reasonable cost controls on providers is the way to go.
Medicare for all, with reasonable cost controls on providers is the way to go.
1
I would love to have a national health program, but I have some interim ideas --1) Skip "Medicare for All" - it is run by the federal government, is burdened with ridiculous rules and costs, and everyone hates its terrible inefficiency. Instead, let's have 2) Medicaid for all -- you'll need some federal rules (which we already have) to be sure every state provides benefits to everyone, but the system already exists and in Colorado, at least, is wonderfully efficient and flexible. Except for one problem - 3) Permanently raise the rates paid to providers to an average of those paid by private insurers so providers won't feel penalized by taking Medicaid patients, and 4) Keep the system the same for those making under 133% of the federal poverty level, but let those with income above that buy-in on a graduated premium scale dependent on income. This already exists but is limited to those under 65 who are working and have a disability -- get rid of that and offer it as an option on the ACA Exchange if you don't want to buy a commercial plan, and 5) offer plans where the primary care provider is paid a monthly fee (these already exist as "concierge" plans), so they don't have to bill insurance, and the insurance plan would be a "wraparound" product to cover out-of-office costs (specialists, imaging, labs, hospital, therapies) - it's called "direct primary care", and 6) Dump the entire VA/Tricare system - and every single veteran gets no-premium, no-cost Medicaid for life.
3
that sounds good to me....it's gotta be better than the nonsense that currently exists...
why couldn't the GOP of come up with something nice like this, and not their nasty evil plan....?
why couldn't the GOP of come up with something nice like this, and not their nasty evil plan....?
How do you suppose this would work in states which refused to incorporate Medicaid expansion under the ACA?
Not in Texas. Or Arkansas. Or many other Red States.
Our state government is mean, vindictive and petty. Gutting Medicaid is their goal, and our health outcomes show it.
Our state government is mean, vindictive and petty. Gutting Medicaid is their goal, and our health outcomes show it.
As a physician for 37 years and a practice manager of one of the largest groups in US, let me share a physicians opinion. In the past Medicare paid the least and now most commercial insurers are a % of Medicare. The gap is very narrow and in some case they pay less . Medicare has administrative burdens built in to measure quality which are driving docs a bit nuts but they should improve with time. Medicare approves tests in general , while the commercial carriers require physicians to call and argue with other physicians about the need for tests. The idea is to make it a hassle so you will think twice next time you need to order one. Medicare "costs" 4% of monies paid out to administrate (they may get free rent so this could be a bit low ) whereas commercial carriers charge 20%. Medicare was a bit slower to approve new technology but that is getting better. So if you want competition allow an adult age 50 or older to " buy into " Medicare for a premium of 6% ( or even 8-10 %) . Make it optional and let's make it the true not for profit purchase option. That's competition. A for profit model should demonstrate a competitive reason to buy it
8
Hubs & I’ll be 55 this year. We'd be able to retire Sept 1 IF we could buy in to Medicare, with a surcharged premium. In a heart beat.
But, with as much uncertainty as there is right now, we're not giving up our $250 a month $2800 deductible employer coverage. We'll keep funding our HSA (with a $1000 catch-up now that we're 55), and hope Congress gets their act together ...
But, with as much uncertainty as there is right now, we're not giving up our $250 a month $2800 deductible employer coverage. We'll keep funding our HSA (with a $1000 catch-up now that we're 55), and hope Congress gets their act together ...
Dems need to stay steadfast. Trump has been pegged a loser on his first major initiative, mind you, with a majority in both Houses of Congress.
Trump's so-called qualities which endeared him to angry, paranoid zealots are the exact same traits which we Trump Haters despise every utterance out of his ugly mouth. Since Trump descended his faux gold escalator and railed against Mexico, we have seen nothing, nothing, which would earn him our support. Trump's candidacy, like his TrumpRyanCare bill, was Dead On Arrival. The only reason Trump sits in the White House is due to the outpouring of hateful Whites who see Trump as their White Knight come to save the day for White America. Trump is their last gasp at bringing back their version of what they view as when America was great: when everyone looked like them, acted like them, worshiped like them, and thought like them. The problem for them is they are a rapidly dying breed. So much so that they could only manage to get three million fewer votes than Hillary Clinton. Except for the Electoral fluke, Trump would have lost, even with all that White Flight Fright Vote.
Come next year Dems need to make inroads on Congress. But in 2020 all those who were vigorous about Barack Obama need to back whomever the Dems picked, I repeat, whomever, including the most qualified candidate in my lifetime, Hillary Clinton.
DD
Manhattan
Trump's so-called qualities which endeared him to angry, paranoid zealots are the exact same traits which we Trump Haters despise every utterance out of his ugly mouth. Since Trump descended his faux gold escalator and railed against Mexico, we have seen nothing, nothing, which would earn him our support. Trump's candidacy, like his TrumpRyanCare bill, was Dead On Arrival. The only reason Trump sits in the White House is due to the outpouring of hateful Whites who see Trump as their White Knight come to save the day for White America. Trump is their last gasp at bringing back their version of what they view as when America was great: when everyone looked like them, acted like them, worshiped like them, and thought like them. The problem for them is they are a rapidly dying breed. So much so that they could only manage to get three million fewer votes than Hillary Clinton. Except for the Electoral fluke, Trump would have lost, even with all that White Flight Fright Vote.
Come next year Dems need to make inroads on Congress. But in 2020 all those who were vigorous about Barack Obama need to back whomever the Dems picked, I repeat, whomever, including the most qualified candidate in my lifetime, Hillary Clinton.
DD
Manhattan
2
i feel your pain and frustration, enjoyed your slamming of Trump.
it's so well deserved.
it's so well deserved.
1
I prayed that I could survive Blue Cross long enough to reach Medicare age. I had no major health issues, but my annual medical expenses rose from $7,000 to $20,000 due to copays, deductibles, and "reasonable and customary" changes from the private health's imaginary doctor's office. Blood tests and biopsies had hundreds in hidden copays. I'm doubled up in ER passing blood and a kidney stone. The nurse wants the $300 ER copay up front.
With Medicare it all ended. No more bills from the labs, lab technicians, the janitor at the lab, or the courier who handled the biopsies and blood samples. All of my friends were shocked when Medicare kicked in and everything was covered. It's a simple solution. The private insurance employees can pick tomatoes, m dig coal, and clean hotel rooms.
With Medicare it all ended. No more bills from the labs, lab technicians, the janitor at the lab, or the courier who handled the biopsies and blood samples. All of my friends were shocked when Medicare kicked in and everything was covered. It's a simple solution. The private insurance employees can pick tomatoes, m dig coal, and clean hotel rooms.
5
"With Medicare it all ended. No more bills from the labs, lab technicians, the janitor at the lab, or the courier who handled the biopsies and blood samples."
I'm on Medicare and receiving radiation treatments for prostate cancer. I am paying for blood tests, for the lab where the blood is drawn and copays to all the doctors I am seeing. I paid partially for the biopsy, the chemo and female hormones. In addition I will owe 20% of what Medicare allows for the 44 radiation treatments.
I must have had the wrong Medicare for the last 11 years.
I'm on Medicare and receiving radiation treatments for prostate cancer. I am paying for blood tests, for the lab where the blood is drawn and copays to all the doctors I am seeing. I paid partially for the biopsy, the chemo and female hormones. In addition I will owe 20% of what Medicare allows for the 44 radiation treatments.
I must have had the wrong Medicare for the last 11 years.
1
same sort of thing for me....at one point i was paying almost 1/3 of my total income JUST to pay my blue cross premiums...then i got medicare...i feel wealthy now !!
The issue isn’t just “single payer for all” because this may not represent an improvement over what we have now if we continue for profit medicine with health insurance companies managing access to health care.
Bush privatized part of the Medicare system with Medicare Advantage in 2002. The Advantage program is a “single payer system” but the health insurance companies run it and continue to profit from it. It costs about 20% more than standard Medicare and is helping bankrupt Medicare.
If a “single payer” along these lines is adopted, it would mean that health insurance companies would still be the ones negotiating with providers, running the system, and setting prices. Nothing would really change. This is NOT the single payer system we want. We DO NOT want a for profit health care system—and we don’t need health insurance companies--period.
I also understand that one of the compromises when Medicare was passed was that it not cover everything so that people would need a supplemental policy to have decent coverage. That policy would have to be purchased from; you guessed it, private for profit health care companies. Those policies cost as much as standard medicare.
Look at HR 676--It's pretty good. I would add one new provision; if we are going to cover everyone we need to train more providers. People will be displaced by doing away with for profit medicine. We need to help pay for people to be educated to become the medical providers we will need.
Bush privatized part of the Medicare system with Medicare Advantage in 2002. The Advantage program is a “single payer system” but the health insurance companies run it and continue to profit from it. It costs about 20% more than standard Medicare and is helping bankrupt Medicare.
If a “single payer” along these lines is adopted, it would mean that health insurance companies would still be the ones negotiating with providers, running the system, and setting prices. Nothing would really change. This is NOT the single payer system we want. We DO NOT want a for profit health care system—and we don’t need health insurance companies--period.
I also understand that one of the compromises when Medicare was passed was that it not cover everything so that people would need a supplemental policy to have decent coverage. That policy would have to be purchased from; you guessed it, private for profit health care companies. Those policies cost as much as standard medicare.
Look at HR 676--It's pretty good. I would add one new provision; if we are going to cover everyone we need to train more providers. People will be displaced by doing away with for profit medicine. We need to help pay for people to be educated to become the medical providers we will need.
3
An overwhelming majority of our citizens favor the Medicare for all approach. It would save trillions of dollars by simply implementing a system that focused on healthcare and not a bottom line.
This has to be abundantly apparent to our chosen representatives , but they turn a deaf ear to common sense in favor of lining their pockets with the legal graft paid to them by insurance company and corporate lobbyists. Thanks to recent decisions by five corporate apologists disguised as Supreme Court Justices , such payoffs have been rendered legal by the startling revelation that money is now a form of free $peech. Citizens United and McCutcheon stand for the proposition that this nation of ours is for sale to the highest bidder and place few , if any , real restraints on the dark money crowd that purchases our politicians and determines government policy. The Brothers Koch and their creation known as Alec are the prime example of denying global warming , resisting single payer health care , destroying unions and eliminating the people's power to bargain for fair salaries and decent working conditions. Alec also promotes such idiocy as the so called ' Stand Your Ground Laws ' as well as Murder Inc. also known as the NRA.
There is no question that the Supreme Court has unleashed the Golden Rule. To wit : them that's got the gold , rule. Money characterized as free $peech favors only the super wealthy elite and destroys any concept of a real commonwealth.
This has to be abundantly apparent to our chosen representatives , but they turn a deaf ear to common sense in favor of lining their pockets with the legal graft paid to them by insurance company and corporate lobbyists. Thanks to recent decisions by five corporate apologists disguised as Supreme Court Justices , such payoffs have been rendered legal by the startling revelation that money is now a form of free $peech. Citizens United and McCutcheon stand for the proposition that this nation of ours is for sale to the highest bidder and place few , if any , real restraints on the dark money crowd that purchases our politicians and determines government policy. The Brothers Koch and their creation known as Alec are the prime example of denying global warming , resisting single payer health care , destroying unions and eliminating the people's power to bargain for fair salaries and decent working conditions. Alec also promotes such idiocy as the so called ' Stand Your Ground Laws ' as well as Murder Inc. also known as the NRA.
There is no question that the Supreme Court has unleashed the Golden Rule. To wit : them that's got the gold , rule. Money characterized as free $peech favors only the super wealthy elite and destroys any concept of a real commonwealth.
8
In today's politics Democrats stand mostly for negatives in most voter's minds--or stand for nothing at all. They almost never show the courage of conviction or the determination Republicans show. So here is their issue and now is their time : stand up and run on "Medicare For All". The outcome of such a campaign promise cannot be any worse than where they stand in the public eye now.
1
An idea whose time has come. The cost savings alone to providers alone, who would know instantly what was covered and how much was paid, wiould reduce their administrative costs significantly, allowing for lower prices. And universal coverage would take the huge burden off our businesses, allowing them to hire workers more freely. When you drive down the highway and see advertisements for hospitals on huge billboards, that advertising money is money that is coming out of the health care pot, and not providing a single band aid to a patient. Similarly multimillion dollar salaries to health care execs who treat not a single patient,
It's is time that Americans, who pay twice what other citizens of other countries pay for their better health care, demand better value for their dollars.
It's is time that Americans, who pay twice what other citizens of other countries pay for their better health care, demand better value for their dollars.
4
I am astounded by all the people who talk about medical consumers comparing healthcare costs. Have any of you actually tried to? It's impossible!
I have private insurance, and was told by a doctor I needed a certain procedure. So I called the provider to see what it would cost me. I was told that was confidentical information. I called my insurance company. They too told me it was secret.
I pointed out that once I had the procedure, I would be billed for it and so, would know this "secret" information. I simply wanted to know what it would cost me BEFORE incurring the charge.
After several hours of equally insane conversations with multiple people at my doctor's office and my insurance provider, I gave up. How on earth does our current healthcare system justify forcing patients to incur responsibility for payments while having no idea what they will be? Do I walk into Target and find out what something will cost only after they charge my card? Who thinks this is reasonable?
I have private insurance, and was told by a doctor I needed a certain procedure. So I called the provider to see what it would cost me. I was told that was confidentical information. I called my insurance company. They too told me it was secret.
I pointed out that once I had the procedure, I would be billed for it and so, would know this "secret" information. I simply wanted to know what it would cost me BEFORE incurring the charge.
After several hours of equally insane conversations with multiple people at my doctor's office and my insurance provider, I gave up. How on earth does our current healthcare system justify forcing patients to incur responsibility for payments while having no idea what they will be? Do I walk into Target and find out what something will cost only after they charge my card? Who thinks this is reasonable?
35
I've run into the same problem.
I am receiving radiation treatments for prostate cancer. The 44 treatment regimen is standard.
I called Blue Cross and asked what was the usual cost and she couldn't tell me. I am going to be responsible for 20% of what Medicare approves so I'd like to be prepared. I've already paid most of my deductible for the year so it's not as bad as it sounds.
I called the Radiologist and asked what they billed Medicare for the treatments and was told $100,000 but she wouldn't tell me how much Medicare allowed.
What goes on here? Why is all of this a big secret?
I am receiving radiation treatments for prostate cancer. The 44 treatment regimen is standard.
I called Blue Cross and asked what was the usual cost and she couldn't tell me. I am going to be responsible for 20% of what Medicare approves so I'd like to be prepared. I've already paid most of my deductible for the year so it's not as bad as it sounds.
I called the Radiologist and asked what they billed Medicare for the treatments and was told $100,000 but she wouldn't tell me how much Medicare allowed.
What goes on here? Why is all of this a big secret?
1
I think a version of this will come sooner or later ie or something similar to it but not soon.
The earliest it will come is in 2018 if democrats win a super majority in the house and senate which is not likely.
Saving that, more simple majorities and a democratic president would get it in 2020.
Barring a minor miracle don't expect any republican or Trump to go for it.
The earliest it will come is in 2018 if democrats win a super majority in the house and senate which is not likely.
Saving that, more simple majorities and a democratic president would get it in 2020.
Barring a minor miracle don't expect any republican or Trump to go for it.
1
"In France, for example, a magnetic resonance imaging exam costs $363, on average, compared with $1,121 in the United States; an appendectomy is $4,463 in France, versus $13,851 in America. These differences stem largely from the fact that single payers — which is to say, governments — are typically able to negotiate more favorable terms with service providers."
The system in France is entirely different from the US. Doctors and hospital administrators do not make huge salaries, drug companies do not spend hundreds of billions of dollars testing new drugs, hospitals don't have marble floors and free wi-fi, malpractice insurance doesn't cost $400K a year. The whole system is different from the ground up, because they never had the enormous revenues that they do in the US.
Now would it really be practical to change the system in the US? Doctors, hospitals, and drug companies have committed to huge expenses. The revenue that take in goes out in costs, as everyone gets paid. If the revenue drops sharply, they won't be able to make the payments they are contractually obliged to make. They simply can't take big cuts without enormous pain.
The system in France is entirely different from the US. Doctors and hospital administrators do not make huge salaries, drug companies do not spend hundreds of billions of dollars testing new drugs, hospitals don't have marble floors and free wi-fi, malpractice insurance doesn't cost $400K a year. The whole system is different from the ground up, because they never had the enormous revenues that they do in the US.
Now would it really be practical to change the system in the US? Doctors, hospitals, and drug companies have committed to huge expenses. The revenue that take in goes out in costs, as everyone gets paid. If the revenue drops sharply, they won't be able to make the payments they are contractually obliged to make. They simply can't take big cuts without enormous pain.
4
Jonathan...the rest of the civilized world (and not so civilized world...Rwanda has a $12 national health plan) has done it.
Do it slowly, over time, phase it in, to ease the burden.
Do it slowly, over time, phase it in, to ease the burden.
1
Poor them, really! (sarcasm hint)
the ghost in the machine is compensation that specialist physicians receive from doing to much or unnecessary procedures and tests.This conduct generate additional cost throughout the health care "system". I have alway wonder why folks like the author don't emphase this foundational cost generator.
3
Mr. Frank makes some excellent points. One he does not make is that some form of Medicare for all would bring a measure of fairness to the healthcare system.
As one who has had to purchase coverage for more than 20 years, typically with deductibles of $5,000 or even $10,000 to keep premiums affordable, it is a bit vexing that healthcare insurance remains a largely untaxed benefit for employees of government and larger businesses.
Government and corporate employees basically are "free riders." Medicare for all would help change that disparity, although I'm skeptical whether the existing leadership in Congress or the White House has the vision and good sense to pursue it.
As one who has had to purchase coverage for more than 20 years, typically with deductibles of $5,000 or even $10,000 to keep premiums affordable, it is a bit vexing that healthcare insurance remains a largely untaxed benefit for employees of government and larger businesses.
Government and corporate employees basically are "free riders." Medicare for all would help change that disparity, although I'm skeptical whether the existing leadership in Congress or the White House has the vision and good sense to pursue it.
7
What is unfair? You apparently chose not to be an employee of the government or a large corporation and one of the costs of that decision is expensive healthcare. It is crazy that you want to blame or penalize others just because you don't like a result of your own decision.
1
If we can enroll everyone in one program it would be a national unifying experience. It also would take the Medicaid burden off the states so the states could focus on other needs like infrastructure. It is a great idea.
5
A single payer plan would also take the administrative burden off employers, freeing up dollars to be spent on becoming more competitive. Additionally, employees would no longer stay employed just for health coverage. This increased labor mobility would spur more start-up firms, and more innovation.
5
Another problem with a health care system with multiple payers is complexity. I don't think the drafting problems that have burdened the ACA, including the subsidy that was lost in the district court's ruling House v. Burwell (now on appeal), and were reported in the AHCA are due entirely to poor drafting. It is very difficult to describe accurately all of the ways that federal and state contributions can offset the cost of different insurance policies for different classes of insured.
For many reasons, not limited to overwhelming complexity, we are learning that there are only two choices: an employer/group-based market with a secondary market in individual policies or a one-payer system.
For many reasons, not limited to overwhelming complexity, we are learning that there are only two choices: an employer/group-based market with a secondary market in individual policies or a one-payer system.
2
A way to transition to Medicare for all would be to allow Americans to buy into Medicare instead of enrolling in private ACA exchange plans. Expanding Medicare to those 50 and older would also help the ACA individual marketplaces as it would remove the older Americans from the community rating pool that raise costs for all.
Medicare already allows people to buy their own coverage as some older Americans don't have the work credits to be eligible - so there is a mechanism. Generally, the cost of Medicare is affordable versus the ACA exchange plans, although there are important differences in actuarial value. Lower-income individuals to use their tax credits to subsidize those payments.
A free-market spin on this would be to only allow buy-ins to Medicare Part C, the privately run plans by insurance companies, which would allow some cost controls (they are all managed care). Expanding to cover the 50 market would be required of all insurance companies with Medicare Part C plans. This would maintain the insurance companies share of the overall market, and in fact bring the major insurance companies back to covering the population covered by the exchanges (UHC, Aetna all have robust Medicare Part C offerings) as well as satisfying those who want to contain health cost growth.
Medicare already allows people to buy their own coverage as some older Americans don't have the work credits to be eligible - so there is a mechanism. Generally, the cost of Medicare is affordable versus the ACA exchange plans, although there are important differences in actuarial value. Lower-income individuals to use their tax credits to subsidize those payments.
A free-market spin on this would be to only allow buy-ins to Medicare Part C, the privately run plans by insurance companies, which would allow some cost controls (they are all managed care). Expanding to cover the 50 market would be required of all insurance companies with Medicare Part C plans. This would maintain the insurance companies share of the overall market, and in fact bring the major insurance companies back to covering the population covered by the exchanges (UHC, Aetna all have robust Medicare Part C offerings) as well as satisfying those who want to contain health cost growth.
6
A man of Jefferson's intellect must have understood the irony when he penned these famous words: "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights . . ." I chuckle every time I read them because nothing could be less self-evident than that people are created equal or that they are born with any inherent rights. Hannah Arendt was probably closer to the truth when she suggested that rights are human creations, with their existence dependent on convention, culture, and the social institutions that establish and defend them. Nevertheless, Americans still have a long habit of arguing over what is and isn't a "right." Healthcare is the latest football to be kicked around on this artificial turf of universal rightism. Americans would be wise to avoid these pointless arguments and instead recognize, that right or not, healthcare is something that any compassionate society would not deny any of its members. When we acknowledge this, the challenge simply becomes how to ensure that every American, when ill or injured, gets the care he or she needs. Given that private insurers must always remain solvent, the only way to do that is to have the government fund—or at least be funder of last resort for—all our healthcare. Forget about whether healthcare is a right or not. If we are to be a compassionate society, the moral imperative is that we introduce some form of single payer.
24
You're right. The morality and necessary compassion for a modern society requires provision of health care. And i would submit that, if you want the most productive, (and cash flow maximizing) economic system, you'd want to provide health care to all for the same reasons we provide for the "common defense."
Universal coverage would be a great triumph for the President, Like President Nixon in China, he could get it done. It would meet President Trump's campaign agenda - better coverage for more people at lower cost. It would serve the health establishment by allowing fair reimbursements for services. It would satisfy Liberals by providing care for the poor and underserved. And it might even bring in the staunch conservatives by allowing smaller government - we could start by eliminating Medicaid, Medicare, the VA and several other government entities at a savings of perhaps a trillion or so $ per year. This is just the type of deal we elected Mr. Trump to broker. He could then go before the country from a position of strength and say "I just saved the country a trillion dollars a year. I'm going to spend it on infrastructure, a wall and tax cuts for all." The only losers would be big Pharma, high paid lobbyists, their flunkies in Congress and some government workers. Come on Mr. Trump, think bigly and out of boxly and be a great President.
8
"This difference does not mean that private insurers are evil. It’s a simple consequence of a difference in the relevant economic incentives."
The most understated, hollow - if not cowardly - way to admit that there are services that big gubmint is vastly better positioned to implement than the public sector.
And it is more than fair to call companies, when their goals of increasing revenues and profits is diametrically opposed to the pursuit of life/health of their customers, "evil."
In the industry, of course, there are plenty of evil entities. The trick here is to do something that no one seems willing or able to do - police the industry.
The most understated, hollow - if not cowardly - way to admit that there are services that big gubmint is vastly better positioned to implement than the public sector.
And it is more than fair to call companies, when their goals of increasing revenues and profits is diametrically opposed to the pursuit of life/health of their customers, "evil."
In the industry, of course, there are plenty of evil entities. The trick here is to do something that no one seems willing or able to do - police the industry.
6
The current definition of "fiduciary responsibility" for large corporations seems to be that the ONLY function of a corporation is to MAXIMIZE its return to its shareholders -- no matter how many customers, workers or innocent bystanders are killed, maimed, poisoned or cheated.
If corporations are "people", as claimed by Mitt Romney and the Supreme Court of the United States, that definition of "fiduciary responsibility" _IS_ evil.
If corporations are "people", as claimed by Mitt Romney and the Supreme Court of the United States, that definition of "fiduciary responsibility" _IS_ evil.
Bravo! The health care marketplace is extremely complex, and this article highlights a few of the problems. The most important may be the lack of market transparency. It is ironic that, the factions of the political spectrum that ignore this the most, are in the party that champions the market the most.
8
The advantage of MediCare for all to employers should not be overlooked, yet it usually is. Every employer and business lobby in the country should be putting the full-court press on for MediCare for all. Health care coverage is a huge additional cost for employers—and is prohibitively expensive for small employers. Larger employers who offer health care insurance would see a substantial increase in profits if the costs are externalized to MediCare, and small employers could rest easier knowing their employees are finally covered. This amounts to a huge tax break for employers, people with the mandate, and those who pay out of pocket. Negotiating lower drug prices, mandating that hospitals be not for profit, and combining all government financed health care such as the VA, Worker's Compensation, and the Children's Healthcare Insurance Program (CHIP), should reduce the cost of health care substantially and offset the increased numbers of people covered. What are we waiting for?
49
America is the only leading economy which does not test the effectiveness of medical procedures. Unlike every other big country, we simply pay for what doctors say is the usual or customary practice.
As a result, about 2/3 of American medical procedures actually performed are either useless or actually harmful. For the political story, read the book Confidence Men by Ron Suskind. It tells the story of what happened when the subject was raised in the Obama administration. It is a tale of massive greed.
The opposite approach, used by all other large countries, is called Evidence Based Medicine. It saves about 50% of medical costs and saves many lives.
To see what else we should do watch Comedy Party Platform on YouTube (2 min 9 sec). Keep in touch. [email protected]
As a result, about 2/3 of American medical procedures actually performed are either useless or actually harmful. For the political story, read the book Confidence Men by Ron Suskind. It tells the story of what happened when the subject was raised in the Obama administration. It is a tale of massive greed.
The opposite approach, used by all other large countries, is called Evidence Based Medicine. It saves about 50% of medical costs and saves many lives.
To see what else we should do watch Comedy Party Platform on YouTube (2 min 9 sec). Keep in touch. [email protected]
4
These statistics are greatly exaggerated. The overall number of medical procedures per capita in the US is similar to the numbers in Europe and Japan.
Our real problem is that each medical procedure in the US costs three times as much as the same procedure in Europe.
Our real problem is that each medical procedure in the US costs three times as much as the same procedure in Europe.
2
Many people who are not covered by insurance are mostly low income and not getting the Medicaid extension. They do not get as many procedures per capita as those with good coverage. Also, those on more limited coverage may skip procedures because they have a large co-pay. Per capita spread over the whole country skews the results.
2
Trump has no interest in Medicare for all, and even if he did, Congress would never pass it now. We need to improve upon the ACA by introducing a public option first. It would create a government run program that could gradually become stronger and stronger until profit based insurance companies would either compete or be phased out of the system. It could utilize the Medicare system of administration and non-profit status to increase efficiency, and be funded as insurance companies are now under the ACA. It would bring young people into the system and gradually reduce the reluctance of Americans to have the government administering the healthcare system. We also need to regulate drug costs, like all other countries do, beginning with Medicare. We should also eliminate drug advertising, which would not only reduce drug costs, but also have the advantage of eliminating the annoying drug commercials. There is no reason Americans should pay three times what people in other countries pay for drugs. The main reason other countries pay so much less for their medical care is that their governments regulate the costs of medical care. Doctors, hospitals, and other providers make less money in other countries because of the regulation. Making significant changes in the healthcare system will be met with enormous resistance from drug companies, insurance companies, medical device manufacturers, doctors, and other medical providers. Gradual change has a chance to make improvements now.
23
proposal for affordable universal coverage
Everyone is given a basic health care policy (private or public) with income/age adjusted premiums. Optional upgrades are available but no one can choose to be uninsured or not pay premiums managed by IRS through tax withholding and returns. Universal coverage is achieved without socialized medicine, without higher taxes, without eliminating private insurance, without eliminating choice of coverage and providers, and without death spiral of higher premiums when lower risk individuals choose to be uninsured, but with lower premiums and more competition from insurers as risk pool spreads to everyone with Social Security number.
Everyone is given a basic health care policy (private or public) with income/age adjusted premiums. Optional upgrades are available but no one can choose to be uninsured or not pay premiums managed by IRS through tax withholding and returns. Universal coverage is achieved without socialized medicine, without higher taxes, without eliminating private insurance, without eliminating choice of coverage and providers, and without death spiral of higher premiums when lower risk individuals choose to be uninsured, but with lower premiums and more competition from insurers as risk pool spreads to everyone with Social Security number.
2
Jim Auster:
Unworkable and you have a considerable number of gaps in your poposal. Insurance companies are just another business that happen to sell health insurance as their product line whose ultimate mandate is to maximize profits for their shareholders. Competition is a "non-sequiter". In order to provide the most inclusive and least costly form of healthcare for ALL of its citizens, ALL of the other western industrialized nations that have universal healthcare in one form or another determined decades ago that the insurance companies could only be part of the system if, only to sell supplemental plans not covered by the basic government plan or tightly regulated. It could not work any other way and it won't in America either.
By the way, in these countries in which you seem to have problems with the archaic term "socialized medicine", they refer to it as "universal health care",
never "health insurance". Clearly, you still haven't figured out the difference.
Unworkable and you have a considerable number of gaps in your poposal. Insurance companies are just another business that happen to sell health insurance as their product line whose ultimate mandate is to maximize profits for their shareholders. Competition is a "non-sequiter". In order to provide the most inclusive and least costly form of healthcare for ALL of its citizens, ALL of the other western industrialized nations that have universal healthcare in one form or another determined decades ago that the insurance companies could only be part of the system if, only to sell supplemental plans not covered by the basic government plan or tightly regulated. It could not work any other way and it won't in America either.
By the way, in these countries in which you seem to have problems with the archaic term "socialized medicine", they refer to it as "universal health care",
never "health insurance". Clearly, you still haven't figured out the difference.
14
I agree, my proposal is a modification of ACA system based on private insurance which unfortunately at this point is still a necessary political compromiset to a government run universal healthcare like Medicare.
It's really not that complicated. For insurance premiums to be affordable you need to have the pool as large and diverse as possible. Virtually every other country has figured out this makes it an ideal candidate for a tax funded universal benefit.
"Medicare for All" would add huge numbers of healthy young individuals, which would lower premiums for everyone, including those youthful subscribers when they too get older. This would address the major remaining concerns with the ACA - affordable premiums, and reducing the need for subsidies.
As a 3rd party candidate who hijacked the Republican party, Trump is in a unique position to drive this, since he is not an ideologue but a narcissist who needs his ego stroked. Taking this position to create truly Universal Healthcare is something Trump could actually use to become a revered historical figure in American history, instead of the joke he been so far.
"Medicare for All" would add huge numbers of healthy young individuals, which would lower premiums for everyone, including those youthful subscribers when they too get older. This would address the major remaining concerns with the ACA - affordable premiums, and reducing the need for subsidies.
As a 3rd party candidate who hijacked the Republican party, Trump is in a unique position to drive this, since he is not an ideologue but a narcissist who needs his ego stroked. Taking this position to create truly Universal Healthcare is something Trump could actually use to become a revered historical figure in American history, instead of the joke he been so far.
21
I, like you, have thought that Trump's need for constant adoration might drive him to do what the the masses need and want. I hope he will be humbled by what he lost last Thursday. Bernie Sanders is currently #1 in approval ratings of any politician in the country. Imagine if Trump reached out to Bernie Sanders about single payer system. John Conyers has introduced a single payer bill in the House and Bernie is expected to file same in the Senate. If Americans continue to call, attend town halls, storm offices, maybe single payer system will pass.
There is not case that I would accept for Medicare for all, except as an option with those that choose it pay the entire cost without any subsidy. How about Medicaid for all under the same conditions.
Medicare has much better bargaining potential and is more advanced with medical management to keep costs down. Medicaid is fragmented and has a very diverse base of members and programs which make it a more complicated management entity and riskier in terms of performance variability. Medicare is a far better option for all, but why use it for all? Just use it for the people who want to by into it and treat that group like any insurance product: law of large numbers makes it a rational product to manage. It will likely also have lower administrative costs than most commercial insurors which will bring premiums down, at least for high-risk people who join. Medicare also has more experience with managing complex cases as many of the elderly present with multiple chronic diseases.
7
"These differences stem largely from the fact that single payers — which is to say, governments — are typically able to negotiate more favorable terms with service providers."
The reason for lower premiums is not just due to negotiating power. More importantly, in the current system it is in the best interest of insurers to have expensive medical care, as that will automatically increase their premiums.
The reason for lower premiums is not just due to negotiating power. More importantly, in the current system it is in the best interest of insurers to have expensive medical care, as that will automatically increase their premiums.
1
It will??? Several years ago when the local hospital wanted more money my insurance threatened to remove them from our network. That is proof that you are not correct, at least not totally. And if say everyone only gets Medicare prices many will either quit or stop taking that insurance. Taking only cash is a coming trend.
A single-payer (Medicare for all) system is, in my opinion, the best way our nation could go. I know it's hard for many folks in our Capitalist Democracy to get behind such a Socialist notion, but some areas (health care, education, and prisons, for example) aren't suited to the almighty Free Market. As for me, I am a proud ObamaCare recipient who happens to live in an area (Knoxville, TN) that is down to one insurer on the ACA Marketplace. So why am I so proud of the ACA? When I left work in 2012 to take care of my Dad, who has Alzheimer's, I was turned down by EVERY insurance company even though I have never been sick and never even met my deductible in the 26 years I had employer-provided insurance. Apparently being a middle-aged woman who is a little overweight is a "pre-existing condition". I went a year without health insurance: a nightmare for someone like me. However, the Pre-Existing Condition Insurance Program (PCIP) of the ACA kicked in, and boom, I had insurance. Gone were the fears that my assets could be wiped out with a cancer diagnosis or a car wreck. Frankly, TrumpCare scared me, especially when they eliminated the Essential Benefits provision. Health care without prescriptions and hospitalization (and 8 other critical components) isn't true coverage. The ACA isn't perfect, and if we can't have a single payer system, I expect lawmakers to do the right thing to shore up, and expand, the ACA Marketplace.
18
How about we dip our toe in, partly to string out disruption of perhaps a few hundred thousand jobs in the private insurance industry? People aged 50-65 (the ages when those who lose a job have about a zero per cent chance of finding a new job that is comparable in pay and benefits) who do not have insurance through an employer would have the right to buy into Medicare through the exchanges -- with premiums pegged to cost for coverage and additional administration and subject to the same tax credit subsidies as other policies (i.e., no tax support). No budget hit whatsoever.
I'm guessing the Republicans who were unwilling to support the cruelty in the Ryan-Trump "plan" -- the compassionale conservatives -- might find it difficult to oppose that form of Medicare-for-All -- as an option for older Americans who do not yet qualify for regular Medicare.
I'm guessing the Republicans who were unwilling to support the cruelty in the Ryan-Trump "plan" -- the compassionale conservatives -- might find it difficult to oppose that form of Medicare-for-All -- as an option for older Americans who do not yet qualify for regular Medicare.
5
Let any state that wants to make such an experiment be free to do so. Note that Oregon tested if having insurance improved health and found only mental health improved and that only because folks worried less about not having insurance. And some of those you mention get to be on Medicare through being disabled so data exists already.
How does "subject to the same tax credit subsidies as other policies" translate to no tax support and no budget hit. An essential element of the existing structure is a substantial subsidy -- whether you view that as good policy or not, it costs lots of tax dollars.
Under the rules of ACA they can. In fact Vermont ha s already passed single payer legislation, CA is looking at it as is MA.
1
"Consumers simply cannot make informed quality comparisons in this industry."
I doubt that is the primary the reason competition failed. In many states and counties, there was little or no choice, especially in rural counties. Competition requires a level playing field and many competitors. Regulation levels the field (e.g. easy to understand terms), breaking up monopolies provides the latter.
I'm 100% for single payer, but expect disappointment while monopolies still rule us all.
I doubt that is the primary the reason competition failed. In many states and counties, there was little or no choice, especially in rural counties. Competition requires a level playing field and many competitors. Regulation levels the field (e.g. easy to understand terms), breaking up monopolies provides the latter.
I'm 100% for single payer, but expect disappointment while monopolies still rule us all.
2
Medicare for all is a wonderful idea - but NOT NOW. Republican operatives for the Top 1% Global Financial Elite Robber Baron/ Radical Religion Good Old Boy's Party/ Predatory Capital Corporate Cabal will not do anything to reduce costs and Medicare for all will bankrupt us and further enrich them.
WE must purge all their operatives OUT of OUR governments at all levels right now and put people who want to preserve/restore democracy in America back in place before any laws are allowed BY US to be passed to further enrich the Robber Barons and destroy OUR lives.
WE must purge all their operatives OUT of OUR governments at all levels right now and put people who want to preserve/restore democracy in America back in place before any laws are allowed BY US to be passed to further enrich the Robber Barons and destroy OUR lives.
4
Donald Trump is fundamentally dishonest and/or mentally ill. A premise of the article is that Trump knows what he is doing in a substantive sense. To the contrary, the only thing Trump wants is to have people praise him and he lies about everything because he could care less about being accurate, honorable, or what the substance is of any decision. Whatever he does, he just tells people it is is beautiful, wonderful, the best. At some point, even the people who voted for him will realize he is a know nothing who could care less about anyone but himself. Then he will be impeached because he cannot tell the difference between reality and fantasy.
13
"Then he will be impeached because he cannot tell the difference between reality and fantasy."
Is that an impeachable offense? Think Ronald Reagan, second term.
Is that an impeachable offense? Think Ronald Reagan, second term.
If Medicare for all is paid for through payroll taxes as they are presently structured it becomes a means for transferring wealth from the relatively poor and healthy, the young, to the relatively well off and sick, the old. I don’t see this as social justice. Therefor although I believe in Medicare for all how it is paid for is the hard part. Is it paid out of general tax revenue, is the increase in payroll taxes only applied to the companies contribution and not to the workers contribution, or something else.
We have made getting started in life increasing difficult for our youth. We have increased the cost of education so they are burdened with loans, we have eliminated pensions, so they now have to save more of their income so that they can retire, and with the ACA we have burdened them with paying for the health care of the older and wealthier.
We have made getting started in life increasing difficult for our youth. We have increased the cost of education so they are burdened with loans, we have eliminated pensions, so they now have to save more of their income so that they can retire, and with the ACA we have burdened them with paying for the health care of the older and wealthier.
1
What you say is ridiculous. If the tax is based on the employees salary, it is cost to the company of employing that employee. When companies reckon up the cost of each employee, of course they count it.
In corporate MIS, when you are computing departmental compensation expenses, you count everything - FUI, SUI, and FICA, travel expenses, how much 'free' coffee each employee drinks, gym membership discount, the company's 401K contribution, the rental value of each cubicle, the works.
In corporate MIS, when you are computing departmental compensation expenses, you count everything - FUI, SUI, and FICA, travel expenses, how much 'free' coffee each employee drinks, gym membership discount, the company's 401K contribution, the rental value of each cubicle, the works.
Medicare for all yes .... what gets me is that We have no problem paying for endless wars and defense spending and that stupid Wall
I agree . I suspect the people cheering Medicare for all are unemployed and not subject to the possibility of paying a much higher Medicare tax.
While the way we pay for health care in the US is a problem, the bigger issue is the total amount we pay for health care. In the US, 17% of GDP goes to healthcare, compared to around 10% for most of the developed world. At most, 1-2% could be cut by reducing administrative costs. As virtually every study shows, health care expenditures in the US are higher because (1) we do more procedures, tests, etc. and (2) we pay providers more for those procedures.
Yes, we could provide everyone with health care through a single payer system, but unless we want dramatically higher taxes (for everyone, not just the "rich") a single payer system will need to have rationing and price controls - which is what much of the rest of world does.
Yes, we could provide everyone with health care through a single payer system, but unless we want dramatically higher taxes (for everyone, not just the "rich") a single payer system will need to have rationing and price controls - which is what much of the rest of world does.
1
I suspect where we will end up is Medicaid for all, with private insurance (like Medicare supplemental plans) making up for the deficiencies in Medicaid for those who can afford it.
So everyone gets some minimum level of coverage, but if you want excellent health care, that will be reserved for those who can afford it. This is not unlike what Canada has today. Everyone has basic health care, but access to specialists frequently have long waiting lists. Those who can afford it come to the US for immediate care.
So everyone gets some minimum level of coverage, but if you want excellent health care, that will be reserved for those who can afford it. This is not unlike what Canada has today. Everyone has basic health care, but access to specialists frequently have long waiting lists. Those who can afford it come to the US for immediate care.
2
If coming to the U.S. is the escape valve that makes the Canadian system tolerable (and I suspect that it is), what would be the escape valve for the U.S. is we emulated the Canadian system?
As an American who lives in Canada and has direct experience with both systems, I can say that at least in the Toronto area my wait times for care are similar to those I experienced in the US (Boston area)—and actually even shorter for many services. I don't know of a single person who has gone to the US for care. I do hear it happens occasionally for certain elective procedures where wait times might be longer, but most Canadians have no desire to rack up giant medical costs in the US when healthcare is free—and generally quite good—here.
13
As a Canadian, I would ask you to find out more about our system because what you are saying about wait times is not really factual. If a person has symptoms that indicate a life threatening condition -- for example, stabbing chest pains -- he or she will be admitted to hospital immediately and given every possible test to address a possible heart attack or other serious condition. However, when symptoms are not life threatening (as determined by a primary care physician),, a person will wait their turn to see a specialist. Yes, we sometimes gripe and complain, but accept waiting because it means that priority is being given to someone with a more urgent need.
8
The single payor idea is unpalatable for the nation. Government's role is to take on needs in the national interest that are too big for the private sector (e.g., defense, infrastructure). The segment of the population that has been uninsured and requires expensive services to get to optimal health has proven to be too big for the private sector.
Medicare has become the nation's state-of-the-art health plan. Beneficiaries are in the plan for life - unlike commercial plans where beneficiaries change every 2-3 years - so Medicare can take a long-term view. Medicare also has tremendous negotiating power over providers, pharma companies, etc. Medicare, not Medicaid which is much more fragile, needs to offer a plan for those beneficiaries that commercial plans do not want to cover. This is a more rational solution than high-risk pools and Medicaid, and allows beneficiaries to pay a moderate premium in exchange for a managed health plan either through traditional Medicare or a cost-shared Medicare Advantage plan where Medicare and a commercial plan would co-manage the beneficiary and the cost overruns. The plan would include mandated benefits. Beneficiaries could elect a commercial plan when they have stabilized, or they can stay in the Medicare or Medicare Advantage plan. This relieves private plans of high-risk beneficiaries, provides a high-quality option for uninsured and difficult-to-insure, reduces the cost of commercial premiums and allows the private sector to adapt later.
Medicare has become the nation's state-of-the-art health plan. Beneficiaries are in the plan for life - unlike commercial plans where beneficiaries change every 2-3 years - so Medicare can take a long-term view. Medicare also has tremendous negotiating power over providers, pharma companies, etc. Medicare, not Medicaid which is much more fragile, needs to offer a plan for those beneficiaries that commercial plans do not want to cover. This is a more rational solution than high-risk pools and Medicaid, and allows beneficiaries to pay a moderate premium in exchange for a managed health plan either through traditional Medicare or a cost-shared Medicare Advantage plan where Medicare and a commercial plan would co-manage the beneficiary and the cost overruns. The plan would include mandated benefits. Beneficiaries could elect a commercial plan when they have stabilized, or they can stay in the Medicare or Medicare Advantage plan. This relieves private plans of high-risk beneficiaries, provides a high-quality option for uninsured and difficult-to-insure, reduces the cost of commercial premiums and allows the private sector to adapt later.
"Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong. There are many points of detail where those wishing to preserve the competitive system and those wishing to super-cede it by something different will disagree on the details of such schemes; and it is possible under the name of social insurance to introduce measures which tend to make competition more or less ineffective. But there is no incompatability in principle between the state’s providing greater security in this way and the preservation of individual freedom."
- Friedrich Hayek, "The Road to Serfdom"
- Friedrich Hayek, "The Road to Serfdom"
4
Written in 1944. Irrelevant today when healthcare is infinitely more complex ("Who knew healthcare could be so complicated?"). A lot like the right to bear arms which was proposed before the US had a standing military. If you understood my suggestion, it was not that the State take over healthcare - it was to provide a stopgap until the private sector could catch up, if it can catch up in its present form. If people who make free choice among plans end up "voting" to take the Medicare benefit, then the private sector loses out. But this option does not replace the private sector...unless the private sector is not up to the task. My guess is that commercial insurance needs to face up to a period of creative destruction. The US spends more on healthcare per year than the GDPs of all but 3 countries (China, Japan, Germany) in the world. More than the GDP of the entire continent of Africa! Average cost of care in the US is over twice the OECD average and we are in the bottom 20%for lifespans and major morbidity indicators. The private sector and unmanaged medical care delivery have failed us and continue to compromise our global competitive position. Only a sucker would continue to fund that model.
2
I disagree the federal government should do only those things in the constitution first. Then instead of our current idea that congress can by a majority vote determine what is "common good" make it two thirds with periodic re votes.
Professor Frank provides an excellent case for a single-payer alternative to both Trumpcare and Obamacare. It is a little misleading, however, to suggest that prices would go down for medical procedures because of the government's negotiating power. While that may be true for the prices of drugs and medical devices, the situation in dealing with providers, hospitals and physicians, is different. Price negotiations would flow from the fact that single-payer insurance would eliminate billions in administrative expenses spent by providers who have to deal with the profit-driven multi-payer commercial insurance world, the armies of billing and coding clerks employed by hospitals, the clerks in physician offices who must deal with complex requirements of insurance providers including pre-approval, and even physicians themselves, who spend on average of one-sixth of their day on insurance-related documentation and paperwork, 4X more than their counterparts in Canada.
Once this wasteful overhead is gone, "negotiations" with providers would be driven by the actual cost of care. Excessive pay for hospital executives and artificially inflated pricing for some specialty practices and diagnostics may be affected, but the reimbursement levels to providers for primary care and most necessary institutional services would stay intact.
Once this wasteful overhead is gone, "negotiations" with providers would be driven by the actual cost of care. Excessive pay for hospital executives and artificially inflated pricing for some specialty practices and diagnostics may be affected, but the reimbursement levels to providers for primary care and most necessary institutional services would stay intact.
7
It would? There are not such in Medicare? I recently started Medicare and had my initial physical under that plan. Not paid for due to not being coded properly. They also though a car accident I had several years ago should be paying. Whatever issues we have with insurance would continue with Medicare for all, they would be slightly reduced but we could get that other ways. There are about 30K official codes, what a stupid waste that is.
1
The cobbled together system is why healthcare is so complicated in the U.S. Who knew? Congress has written laws to specifically benefit individual segments of the insurance sector to the detriment of sensible, orderly delivery of services and fair compensation to doctors, hospitals, labs, etc. The idea that "free market" capitalism can fix all this mess is absurd on every level. Only lobbyists and fools believe this nonsense, and yes, I mean Ryan and the republicans.
6
So as usual the answer is to remove the government entirely other than to mandate no monopoly and pricing transparency.
Designing a national health insurance system is difficult because the U.S. still treats health care insurance like a private market commodity instead of a social service. Health insurance is targeted not to medical need, but to the ability to pay and private profit. Markets are good for some things, but they are not a good way to distribute insurance for health care.
This country tolerates very large disparities in income, material possessions, and social privilege that are consequences of our capitalist economy. Those inequalities should not be used to deny some of our citizens essential services because of their income or social status. One of those services is health care insurance. Education, clean water and air, equal justice, public health/epidemiology, crime protection, etc. all are public responsibilities. Let's acknowledge the same thing for insuring health care. Providing these essential services to all Americans helps ensure that we remain cohesive and optimistic...... and strongly affirms that when it comes to vital needs, we are one community, not 330 million separate individuals competing with one another. With adequate health care insurance for all, we celebrate that we are a single nation. A single-payer, "Medicare for All" health insurance system still remains the best and most equitable choice for the USA.
This country tolerates very large disparities in income, material possessions, and social privilege that are consequences of our capitalist economy. Those inequalities should not be used to deny some of our citizens essential services because of their income or social status. One of those services is health care insurance. Education, clean water and air, equal justice, public health/epidemiology, crime protection, etc. all are public responsibilities. Let's acknowledge the same thing for insuring health care. Providing these essential services to all Americans helps ensure that we remain cohesive and optimistic...... and strongly affirms that when it comes to vital needs, we are one community, not 330 million separate individuals competing with one another. With adequate health care insurance for all, we celebrate that we are a single nation. A single-payer, "Medicare for All" health insurance system still remains the best and most equitable choice for the USA.
12
Having lived in France many years, I can tell you that the main reason costs are lower is that salaries are lower for doctors, surgeons, nurses etc... . Adopting a single payer system will not lower these immediately but over time.
However, as stated in the article, a single payer has no profit margin, no big advertising budget, no fat salaries for it's top executives multiplied by dozens of insurance firms. Also, a single payer has economies of scale. Doctors, hospitals, labs etc... deal with one payer, so the process is automated and streamlined. There are no paper forms. Health care providers do not have to deal with dozens of insurance companies each with their own rules and paper work. Insurance companies do not have to deal with hundreds of health care suppliers each with its own way of doing things.
Finally, a single payer negociates prices and standards of care. In America, health care professionals have insentives to prescribe un-necessary tests and to use the most expensive procedures, supplies, tests because they get paid on a cost plus margin basis. So the higher the cost, the higher their profit.
America has by far the most expensive health care in the world, nearly twice the share of gdp versus the average for developped countries, and by no means the best health care. And in spite of that, 17% of americans have no insurance. That rate for other developped countries is close to 0%. Finaly, many americans live with the worry of losing coverage.
However, as stated in the article, a single payer has no profit margin, no big advertising budget, no fat salaries for it's top executives multiplied by dozens of insurance firms. Also, a single payer has economies of scale. Doctors, hospitals, labs etc... deal with one payer, so the process is automated and streamlined. There are no paper forms. Health care providers do not have to deal with dozens of insurance companies each with their own rules and paper work. Insurance companies do not have to deal with hundreds of health care suppliers each with its own way of doing things.
Finally, a single payer negociates prices and standards of care. In America, health care professionals have insentives to prescribe un-necessary tests and to use the most expensive procedures, supplies, tests because they get paid on a cost plus margin basis. So the higher the cost, the higher their profit.
America has by far the most expensive health care in the world, nearly twice the share of gdp versus the average for developped countries, and by no means the best health care. And in spite of that, 17% of americans have no insurance. That rate for other developped countries is close to 0%. Finaly, many americans live with the worry of losing coverage.
9
No not over time unless we do as others and import cheap doctors from foreign countries. That is both an ethical problem and dangerous according to me.
Most Americans support improved, expanded Medicare for all, aka single payer. So does most of the medical profession, along with hundreds of labor and business groups. 3 American automobile manufacturers released public statements that it was better for them to have their operations in Canada instead of the U.S. because the Canadian single payer system is so much better for businesses. And our own Congressional Budget Office said that it was the most cost effective way to provide quality health care to all Americans.
If there's any advantage to Trump's more maverick-style characteristics, let it be this - real universal health care through the best of what we already have. On the "dark side" of this debate, however, I'm not sure the answer is reaching across the aisles to Democrats since so many take money from the health insurance industry, just like a number of Republicans like Ryan and McConnell. It would have to involve the more independent members or associates of the various teams.
Clearly, though, the age of health insurance is over. Time for the industry to go; their business life cycles is over and it's up to them how gracefully this happens - how they gracefully they go. The United States must join the rest of the modern 21st century world in providing guaranteed quality health care to everyone.
If there's any advantage to Trump's more maverick-style characteristics, let it be this - real universal health care through the best of what we already have. On the "dark side" of this debate, however, I'm not sure the answer is reaching across the aisles to Democrats since so many take money from the health insurance industry, just like a number of Republicans like Ryan and McConnell. It would have to involve the more independent members or associates of the various teams.
Clearly, though, the age of health insurance is over. Time for the industry to go; their business life cycles is over and it's up to them how gracefully this happens - how they gracefully they go. The United States must join the rest of the modern 21st century world in providing guaranteed quality health care to everyone.
37
Agree Toni .... as long as health care is a profit making proposition... we will never get Medicare for all ...
The Insurance industry needs to move on to another profit making endeavor...
The Insurance industry needs to move on to another profit making endeavor...
1
As an American expat in France, I benefit from the French version of single payer, Carte Vitale. This is the same as a medicare for all program from birth to death that America will hopefully now adopt after the failure of Ryan's health proposal.
Currently, medicare is not available to any American living outside the US who is over 65. All this will change if wisdom and common sense prevail by bringing medicare to all Americans.
Let us all wish ourselves bon courage!
Currently, medicare is not available to any American living outside the US who is over 65. All this will change if wisdom and common sense prevail by bringing medicare to all Americans.
Let us all wish ourselves bon courage!
20
The great commie fighter Nixon opened the doors to Communist China. Clinton destroyed welfare and balanced the budget. Now Trump and Medicare for everybody?!
The irony is so thick you can't cut it with a blowtorch.
The irony is so thick you can't cut it with a blowtorch.
8
I hope this article is right. This sequence has paved the way for a Medicare for All system which makes the most sense. Here's hoping!
9
Well, Medicare-for-All sounds kind of strange here, not likely from Trump.
(Thanks Prof. Frank for trying to be a better angel of Trump's nature.)
(Maybe Ivanka or Jared Kushner will read your article, and get an idea.)
It certainly sounds quite surreal, but this is a surreal administration.
(And if it happens, Kellyanne Conway will make it all sound just so natural.)
(Thanks Prof. Frank for trying to be a better angel of Trump's nature.)
(Maybe Ivanka or Jared Kushner will read your article, and get an idea.)
It certainly sounds quite surreal, but this is a surreal administration.
(And if it happens, Kellyanne Conway will make it all sound just so natural.)
3
Medicare is a fantastic negotiator - looking at the table of medical procedures, average list prices, and negotiated Medicare reimbursements provided by the CMS (link below), the amount paid by Medicare to medical providers as full compensation for medical services is on average just 36% of the asking price. That's right in line with the French vs US MRI and appendectomy costs - their cost is roughly 1/3 what ours is. And from the annual report provided by the CMS on heathcare costs in the US, the government-run programs (Medicare, Medicaid, ChIP, ...) are more efficient - have less overhead - than private insurers.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren...
https://www.cdc.gov/nchs/hus/
Summarized with graphs in Health Care Funding in the US, https://jsevy.com/wordpress/index.php/health-care-funding-in-the-us/
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren...
https://www.cdc.gov/nchs/hus/
Summarized with graphs in Health Care Funding in the US, https://jsevy.com/wordpress/index.php/health-care-funding-in-the-us/
8
Medicare For All is best solution and can be implemented by lowering the age that citizens qualify by one year each year, while also raising the Medicare payroll tax .25% every year, until the tax is 5%. Note that the current rate is 2.9% and employers pay 50%, leaving employees with a miniscule tax of 1.45%.
Citizens also need to accept there will be rationing, as there is in every country with a single payer system, so there will no longer be $500,000 spent on useless and painful treatments in the last three months of life, which is the major costs of Medicare.
And, most importantly, this medical care must only cover US citizens, as providing care for seven billion people on this planet would bankrupt this country, just as happened to dialysis clinics closed after being forced to provide 'free' care to illegal aliens.
Citizens also need to accept there will be rationing, as there is in every country with a single payer system, so there will no longer be $500,000 spent on useless and painful treatments in the last three months of life, which is the major costs of Medicare.
And, most importantly, this medical care must only cover US citizens, as providing care for seven billion people on this planet would bankrupt this country, just as happened to dialysis clinics closed after being forced to provide 'free' care to illegal aliens.
5
No, use other than payroll taxes, at least fir a good portion of the financing, and let us not forget that the financing needs will be remarkably lower, remember, less overall.
But I want to remind people that the real facts are that lower income people draw for fewer years on these old age related needs than wealthy people. So use the income tax it is abetter match to the benefits received (including recognizing that the value of health to the wealthy may indeed be perceived by them to be more valuable to them and this contributes to pricing inflation that once again makes the price of health care services higher for everyone else).
So finance should be related to utilities over time and the income tax regime is the broadest and best match - not payroll taxes.
And why does it make sense looking at the data about wage stagnation over decades to place burdens artificially on the incidence of labor? I for one want to lower these to improve our international competitiveness, to improve the liklihood of increasing domestic employment, and maybe even help wage and salary earners to get paid more proportionately (which plainly also affects the revenue productivity of income and payroll tax regimes).
But I want to remind people that the real facts are that lower income people draw for fewer years on these old age related needs than wealthy people. So use the income tax it is abetter match to the benefits received (including recognizing that the value of health to the wealthy may indeed be perceived by them to be more valuable to them and this contributes to pricing inflation that once again makes the price of health care services higher for everyone else).
So finance should be related to utilities over time and the income tax regime is the broadest and best match - not payroll taxes.
And why does it make sense looking at the data about wage stagnation over decades to place burdens artificially on the incidence of labor? I for one want to lower these to improve our international competitiveness, to improve the liklihood of increasing domestic employment, and maybe even help wage and salary earners to get paid more proportionately (which plainly also affects the revenue productivity of income and payroll tax regimes).
The US has the most severe rationing of healthcare services in the first world. Don't think so? What do you call all of those people that can't afford their copays, deductibles and out of pocket maximums so they forgo needed care? Shouldn't be too hard for those folks to adjust, eh?
Single payer for all is the most responsible, patriotic, and prudent course as our country seeks to provide a decent standard of public health care.
45
Assuming that you think the federal government should provide such, many don't.
The ACA was actually the Republican Heath care plan. It came from the Heritage Foundation. When the Democrats adopted it, the Republicans had to disown it because they must oppose Democrats no matter what.
Now, what do you know? The Republicans have no sensible plan, because they have disowned their own plan and there is no reasonable alternative on the right.
However, once the ACA is gone, the only alternative that can work is Medicare for all. Medicare is wildly popular with it's recipients, including me.
It will be painful for a few years, but we should embrace this. Medicare for all was always the best plan and now it looks like we will eventually get it.
Democratic candidates should begin chanting this over and over. They will steamroll the Republicans with this.
Now, what do you know? The Republicans have no sensible plan, because they have disowned their own plan and there is no reasonable alternative on the right.
However, once the ACA is gone, the only alternative that can work is Medicare for all. Medicare is wildly popular with it's recipients, including me.
It will be painful for a few years, but we should embrace this. Medicare for all was always the best plan and now it looks like we will eventually get it.
Democratic candidates should begin chanting this over and over. They will steamroll the Republicans with this.
6
So everything Republican is a good idea? It was tried in Mass. and failed that should have been the end of this foolish idea.
Can I reprint this on the editorial page of the Wall Street Journal?
5
Both parties depend on corporate billions to run, thus big insurance/pharma, big oil, big banks can set the parameters of policy. The media avoids explaining how h/c systems abroad work, keeping US voters in the dark. That's just fine for the h/c industry and the lawmakers who need its money. US pundits/ politicians don’t want to stick their neck out and cite international standards of h/c.
Thus ACA didn’t regulate Big Insurance profits, it used our tax $ to maintain them. Abroad, it’s accepted for govts to negotiate medical prices. Here it's off the table—even political poison. Even this column makes only a few brief generalities re other countries.
Lack of discussion of h/c abroad lets our politicians spin the facts to suit them. Health care fake news dominates, so our max-profit system can't be challenged with real facts on how other capitalist democracies cover ALL citizens for less % of GDP than we spend. .
This is what our liberal economists and the media avoid discussing.
Start dates and type of universal h/c--- partial list.
From truecostblog.com.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
United Kingdom 1948 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Arab Emirates 1971 Single Payer
Denmark 1973 Two-Tier
France 1974 Two-Tier
Australia 1975 Two Tier
Italy 1978 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
Israel 1995 Two-Tier
US 2014 Insurance Mandate
Thus ACA didn’t regulate Big Insurance profits, it used our tax $ to maintain them. Abroad, it’s accepted for govts to negotiate medical prices. Here it's off the table—even political poison. Even this column makes only a few brief generalities re other countries.
Lack of discussion of h/c abroad lets our politicians spin the facts to suit them. Health care fake news dominates, so our max-profit system can't be challenged with real facts on how other capitalist democracies cover ALL citizens for less % of GDP than we spend. .
This is what our liberal economists and the media avoid discussing.
Start dates and type of universal h/c--- partial list.
From truecostblog.com.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
United Kingdom 1948 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Arab Emirates 1971 Single Payer
Denmark 1973 Two-Tier
France 1974 Two-Tier
Australia 1975 Two Tier
Italy 1978 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
Israel 1995 Two-Tier
US 2014 Insurance Mandate
6
Yes none of those single payers have our diversity. And those insurance companies are not that profitable, look to say Apple or Google for real profitable companies.
This is fantastic. I got a glimpse of a few of these when TR Reid did Sick Around the World documentary.
Diversity, are you kidding me? Do some homework on the subject for a change.
Medicare for all is an excellent idea. I've used it for over 10 years,quite satisfactorily with 3 major surgeries for which I didn't pay a dime, save for reasonable monthly premiums. The surgeries would have cost $90,000.
And, please stop referring to health insurance and Social Security as 'entitlements'. They are a necessary part of living in a civilized wealthy country and should be regarded as important as national defense -- even cheaper, as they don't require bombs and tanks and boots on the ground.
And, please stop referring to health insurance and Social Security as 'entitlements'. They are a necessary part of living in a civilized wealthy country and should be regarded as important as national defense -- even cheaper, as they don't require bombs and tanks and boots on the ground.
11
Better to do Medicaid for all. That retired people who have had a lifetime to plan feel entitled to stigma free Medicare when poor children need to make do with stigmatized Medicaid is immoral. It is better if those receiving safety net services not feel entitled. They should want to and plan to provide for themselves and their families. Medicaid as a safety net is a better vehicle for this than Medicare.
1
Medicare is a National Program.
Medicaid is administered by each state with different program rules for each.
Most people in Medicare is at least 65 years old (born before 1952).
In 1952, most households were still single income households. Medicare will not start for 13, 14 years. Rosa Parks will be arrested 3 years later for refusing to go to the back of the bus. It will be 17 years before Woodstock and the Summer of Love happened.
As for planning, the plan was to work, pay into Social Security and Medicare thru payroll taxes. Retire at 65, collect a pension, Social Security and have health insurance til you die.
Medicaid is administered by each state with different program rules for each.
Most people in Medicare is at least 65 years old (born before 1952).
In 1952, most households were still single income households. Medicare will not start for 13, 14 years. Rosa Parks will be arrested 3 years later for refusing to go to the back of the bus. It will be 17 years before Woodstock and the Summer of Love happened.
As for planning, the plan was to work, pay into Social Security and Medicare thru payroll taxes. Retire at 65, collect a pension, Social Security and have health insurance til you die.
1
Yes, Medicaid for all.
Jonathan Swift agrees though he only agrees if the republican party's workfare applies to everyone.
So moms, kids, nursing home residents, better get a job, or you dont get healthcare.
Good thinking, solves a lot of problems. And think how lucky you will feel to have a job then, no matter what it pays.
Jonathan Swift agrees though he only agrees if the republican party's workfare applies to everyone.
So moms, kids, nursing home residents, better get a job, or you dont get healthcare.
Good thinking, solves a lot of problems. And think how lucky you will feel to have a job then, no matter what it pays.
Medicare for all? Not a chance in this Republican controlled Congress that wants tax cuts, not tax increases, fewer safety net expenses, not more, and smaller government, not bigger government programs.
Let them stew in their juices for a while. Then propose a market based (i.e., exchanges) solution that cuts the personal income taxes on the wealthy in Obamacare to 1.8%, leaves the taxes on companies in place, eliminates the employer tax expenditure, replaces the Medicaid expansion with a tax credit that covers 95% of premium and 95% of out-of-pocket expenses, provides subsidies to youth (up to age 29 but only in the exchanges) and provides AHCA level subsidies to the losers under Obamacare.
The exchange markets will have huge enrollment with lots of young, healthy enrollees, which will attract insurers and hold premiums down. Employers will be out of the health coverage business, eliminating their tax deduction will cover expansion of subsidies and a tax cut for the wealthy and employee job lock will end. Insurers will have the market leverage to negotiate prices with health care providers and drug manufacturers.
Taxes on the wealthy will be lower, government's role will be smaller, the solution will be a private market-based approach, yet more people will be covered, competition will be strengthened and pricing will be competitive.
Let them stew in their juices for a while. Then propose a market based (i.e., exchanges) solution that cuts the personal income taxes on the wealthy in Obamacare to 1.8%, leaves the taxes on companies in place, eliminates the employer tax expenditure, replaces the Medicaid expansion with a tax credit that covers 95% of premium and 95% of out-of-pocket expenses, provides subsidies to youth (up to age 29 but only in the exchanges) and provides AHCA level subsidies to the losers under Obamacare.
The exchange markets will have huge enrollment with lots of young, healthy enrollees, which will attract insurers and hold premiums down. Employers will be out of the health coverage business, eliminating their tax deduction will cover expansion of subsidies and a tax cut for the wealthy and employee job lock will end. Insurers will have the market leverage to negotiate prices with health care providers and drug manufacturers.
Taxes on the wealthy will be lower, government's role will be smaller, the solution will be a private market-based approach, yet more people will be covered, competition will be strengthened and pricing will be competitive.
Right under the constitution states can have whatever system they desire, such has failed once and been rejected once. Both times by progressive states due to the massive costs of such programs. Otherwise go for it in your state, leave mine out of it.
Insurers already have the market leverage to dictate prices with providers, drug manufacturers and hospitals.
Everyone should be covered, not "more people." Everyone, i.e. all citizens.
There is an opening here for Democrats to work with reasonable Republicans on a new program. There are many ways this could go. Single payer is only one of them. Expansion of health care savings accounts, some loosening of required services, some compromise on financial contribution by Medicaid recipients, maybe even a separate government-assisted program for persons with high-cost diseases, maybe even a separate publicly-funded primary care system for the poor. There are options out there that conceivably could be enacted in a bipartisan way. When Boehner allowed that he was replaced and Ryan may suffer the same fate, but from time to time, Congress has to enact legislation.
What kind of financial contribution makes sense. Medicaid cuts off at $16,400/1 person, $22,100/2 persons. Those numbers looks okay unless you live in a high price area like California. Medicaid is a publicly funded primary care system thru state and federal dollars. All disease is high costed. An ER visit will cost $3-5k/visit. Each day of admission into the Hospital cost $10k. I once had a relative expend $250k in an 18 month period for 3 hospital admissions. The last figure did not include post hospitalization Dr's visits or ongoing medications.
Think epipen. 600 for a set of 2. The defense was that the pricing wasn't meant to be borne by a patient but by the insurance company (insurance pool, those who pay for insurance).
Considering all that. How much do you think should go into that Health Savings Account ?
Think epipen. 600 for a set of 2. The defense was that the pricing wasn't meant to be borne by a patient but by the insurance company (insurance pool, those who pay for insurance).
Considering all that. How much do you think should go into that Health Savings Account ?
2
Trump had suggested that his next step will be tax reform. So, since he couldn't give the health care industry many, many revenue enhancement by scrapping a perfectly good, and working Affordable Health Care Act, he will de-regulate the industry, eliminating many of the key provisions, such as contraceptive and maternity for women, equal premiums for men and women, removing the cap on "administrative expense", and he will eliminate the ratio, requiring premiums to be no more than three times those of the younger customers.
Doesn't he realize that, when less and less people sign-up for ACA, due to his blowing it up from the inside, the young will drop-out too, because standard private insurance will be better. The final result, however, will be that many more people--young and old--will begin just going to ERs, without insurance.
Then property taxes will go up, some hospitals, that cannot afford to treat the mass of uninsured patients, will close altogether, or just the ERs.
If there is still Health Care for anyone, Medicaid, Medicare and Social Security, in that order, will be on Paul Ryan's hit list. A good Catholic Boy!
https://thetruthoncommonsense.com
Doesn't he realize that, when less and less people sign-up for ACA, due to his blowing it up from the inside, the young will drop-out too, because standard private insurance will be better. The final result, however, will be that many more people--young and old--will begin just going to ERs, without insurance.
Then property taxes will go up, some hospitals, that cannot afford to treat the mass of uninsured patients, will close altogether, or just the ERs.
If there is still Health Care for anyone, Medicaid, Medicare and Social Security, in that order, will be on Paul Ryan's hit list. A good Catholic Boy!
https://thetruthoncommonsense.com
3
He will do some of these things, but we need to eliminate the requirement for the ER to see everyone, just real emergencies like severe car accidents. Then provide by the states urgent care facilities with much lower costs.
1
There is no way a single insurer will work in the US. The physicians, pharmaceutical companies and health insurance providers are too powerful to push this through. Cheaper healthcare cost means each of them will make less money - and they will fight tooth-and-nail to oppose that. Talk about loss aversion - this will be the mother of all loss aversions for these three groups.
12
Don't forget the charity hospital systems and their seven and eight figure salaries for administrators. Even Michelle Obama was paid $350,000 per year for a part time job. Big medicine is not going to give up their goodies willingly.
1
I don't think this problem will be solved for a long time, because Insurance is a fairly easy way to collect money without paying out nearly as much as most buyers believe they do.
In the meantime, the money keeps piling up.
In the meantime, the money keeps piling up.
1
Unfortunately the deficient design of the Affordable Care Act does not prevent tens of millions from remaining uninsured and does not prevent unaffordable out-of-pocket expenses for many of those who are insured. The Republican proposal would have only made these much worse.
In contrast, an improved Medicare for all would make coverage of everyone automatic and would control costs by more patient-friendly administered pricing which would not expose patients to unaffordable cost sharing.
Congress has just rejected a model that would have taken us in the wrong direction. It’s now time to seriously consider moving in the right direction with the highly successful model that Robert Frank suggests - a well designed, single payer improved Medicare for all.
In contrast, an improved Medicare for all would make coverage of everyone automatic and would control costs by more patient-friendly administered pricing which would not expose patients to unaffordable cost sharing.
Congress has just rejected a model that would have taken us in the wrong direction. It’s now time to seriously consider moving in the right direction with the highly successful model that Robert Frank suggests - a well designed, single payer improved Medicare for all.
11
I’m on Medicare and it’s great. However, many in the Republican Congress complain at how expensive this “Entitlement” is, and continually offer ways to reduce or kill it.
Consider that the only individuals on Medicare are 65 years or older, about 60 million. That age group has a much greater need for health care and as they approach the end of life their medical costs spike even further. Just imagine though if all 316 million American citizens were on Medicare for all. Costs would plummet by adding all the younger and healthier generations.
It makes so much sense but I doubt seriously whether I’ll see something like a Single Pay health program in my lifetime.
Consider that the only individuals on Medicare are 65 years or older, about 60 million. That age group has a much greater need for health care and as they approach the end of life their medical costs spike even further. Just imagine though if all 316 million American citizens were on Medicare for all. Costs would plummet by adding all the younger and healthier generations.
It makes so much sense but I doubt seriously whether I’ll see something like a Single Pay health program in my lifetime.
16
The cost for the elderly are not going to decline because younger people are added. So the $10,000 per person amount that is paid out of general revenue for the 55 million current participants does not diminish.
To put the remaining population on Medicare would cost $2 trillion.
To put the remaining population on Medicare would cost $2 trillion.
1
But the $2 trillion would be more than offset by the elimination of health insurance premiums. Taxes would, of course, rise, but less than the reduction in insurance premiums. As a Canadian I consider myself lucky to have largely worry free health care without the burden of thousands of dollars for private insurance premiums (and attendant red tape). My taxes are not particularly burdensome.
5
As a physician in private practice, mostly hospital based, for 17 years I have come to the conclusion that baseline Medicare for all with the option to purchase secondary insurance is the only way. I have reached the end of my rope with private, publically traded, for profit health insurancecompanies who continually deny claims, force me to obtain pre certifications and advance approval for most of my medical decisions and who impose enormous administrarive costs on me.
With Medicare I make a medical decision, treat my patient, submit my claim and get paid electronically in 30-45 days.
These companies add little or nothing to the provision of healthcare. Period.
With Medicare I make a medical decision, treat my patient, submit my claim and get paid electronically in 30-45 days.
These companies add little or nothing to the provision of healthcare. Period.
251
Medicare overpays claims by 30%. Of course providers like it.
I do not claim to know what we should do.
I do claim to know that continuing with what we are doing today to finance our healthcare system would be madness: We are already spending close to $1 out of every $5 in our economy on healthcare and costs are continuing to rise every year.
We are cheating ourselves and spending money that could pay for trillions of dollars of other things we need by our current voluntary overspending.
I do claim to know that continuing with what we are doing today to finance our healthcare system would be madness: We are already spending close to $1 out of every $5 in our economy on healthcare and costs are continuing to rise every year.
We are cheating ourselves and spending money that could pay for trillions of dollars of other things we need by our current voluntary overspending.
3
"Medicare for all" is my dream too, a guy can dream, can't he? But we may be taking this only-Nixon-can-go-to-China fantasy too seriously. Especially with Donald Trump. There is only one person he cares about, most certainly not the average Joe needing healthcare. Perhaps we should count our blessing 14 million people won't be losing insurance next year.
To be clear, ACA is not perfect. And sometimes it may even be bad and bureaucratic in some situations when compassion is called for. However, had the Republicans been so conscientious about America's healthcare, they would have come to the table to improve on ACA in any of the past 7 years.
We should remind ourselves, AHCA failed not because the Republicans were concerned about those 14 million people losing insurance next year. Instead, they torpedoed the bill because they deem 24 million people losing insurance in a decade is not draconian enough.
The twin program of Medicare and Social Security may require some tweaking but the Republicans really want to scuttle them, not expanse them, in case people didn't get the memo
To be clear, ACA is not perfect. And sometimes it may even be bad and bureaucratic in some situations when compassion is called for. However, had the Republicans been so conscientious about America's healthcare, they would have come to the table to improve on ACA in any of the past 7 years.
We should remind ourselves, AHCA failed not because the Republicans were concerned about those 14 million people losing insurance next year. Instead, they torpedoed the bill because they deem 24 million people losing insurance in a decade is not draconian enough.
The twin program of Medicare and Social Security may require some tweaking but the Republicans really want to scuttle them, not expanse them, in case people didn't get the memo
13
Well since the failed bill was not the final step who knows how many would actually loose access to health care (note insurance is not care).
It's a fact that only a government-managed health care system can 1) cover everyone and 2) lower costs. (I say "fact" because almost all 35 OECD countries do so, with the glaring exception of the not-so-exceptional USA. )
The 2nd most important role of government (after national security) should be to provide for the health and well-being of its citizens. A healthy citizenry is more productive and creates a richer, stronger country.
Unfortunately we have a history of "rugged individualism" that leads many conservatives to feel the government should not take care of its people. (Greed and racism also play a role.)
The social and economic benefits of universal health care would be enormous. Yes it would mean no more CEOs of insurance companies and hospitals with salaries in the millions. The higher paid doctors would have to get by with less (but they'd still be at the top of the economic ladder.) There rich would have to pay higher taxes.
But the country would be so much better off. Imagine never having to worry whether you or a family member can afford to see a doctor, no matter what happens to you or your job.
It's a sweet idea. Maybe we will do it one day.
The 2nd most important role of government (after national security) should be to provide for the health and well-being of its citizens. A healthy citizenry is more productive and creates a richer, stronger country.
Unfortunately we have a history of "rugged individualism" that leads many conservatives to feel the government should not take care of its people. (Greed and racism also play a role.)
The social and economic benefits of universal health care would be enormous. Yes it would mean no more CEOs of insurance companies and hospitals with salaries in the millions. The higher paid doctors would have to get by with less (but they'd still be at the top of the economic ladder.) There rich would have to pay higher taxes.
But the country would be so much better off. Imagine never having to worry whether you or a family member can afford to see a doctor, no matter what happens to you or your job.
It's a sweet idea. Maybe we will do it one day.
9
It is not a fact that there is only a single solution to medical cost reduction. Only someone who is an ideologue would make such a statement.
it may be the best possible outcome for ObamaCare to remain unchanged. It s going to fail on its own within three years, and then any Republican solution will be superior.
it may be the best possible outcome for ObamaCare to remain unchanged. It s going to fail on its own within three years, and then any Republican solution will be superior.
But it will be changed. No longer will full time be 30 hours, no longer will many things be considered essential that are not, lots of regulations will be changing, and insurance companies are leaving areas. Eventually perhaps progressives will learn but maybe not after all they live in an alternative reality.
Compared to the rest of the world, clearly it is you that is living in the alternate reality.
I'm now starting to believe that Medicare for All is the way to go. Health care was a mess before President Obama. The Affordable Care Act (ACA) attempted to fix the problem and did in some areas. I recalled a fellow worker that was getting laid off before the ACA. She had a bout with cancer and couldn't get insurance. So the pre-existing part of the ACA helped her.
The subsidies helped some people not all.
The Republicans (I'm a Republicans) are failing at their promise to help lower the costs of health care. They now have the Democrats laughing at them for their failure. I'm seriously considering switching to Independent.
So it appears that Medicare of All is the only way to get this under control. Having your Medicare monthly cost tied to your income is extremely fair. Plus think about all the young healthy people paying into Medicare and hardly needing medical care.
Isn't there something about having more people in the pool makes it cheaper?
Let's face it, insurance companies are not non-profit when it comes to medical insurance. The executives of these companies want their huge salaries and bonuses.
Yep, Medicare for all is the way to go. I believe Hillary campaigned on people over 55 buying into Medicare. I liked that.
Plus the will of the people can cancel out all those groups that would oppose it. Those 13 groups like the Freedom Caucus, etc. that WmC mentioned can be outnumbered by the American voter.
The subsidies helped some people not all.
The Republicans (I'm a Republicans) are failing at their promise to help lower the costs of health care. They now have the Democrats laughing at them for their failure. I'm seriously considering switching to Independent.
So it appears that Medicare of All is the only way to get this under control. Having your Medicare monthly cost tied to your income is extremely fair. Plus think about all the young healthy people paying into Medicare and hardly needing medical care.
Isn't there something about having more people in the pool makes it cheaper?
Let's face it, insurance companies are not non-profit when it comes to medical insurance. The executives of these companies want their huge salaries and bonuses.
Yep, Medicare for all is the way to go. I believe Hillary campaigned on people over 55 buying into Medicare. I liked that.
Plus the will of the people can cancel out all those groups that would oppose it. Those 13 groups like the Freedom Caucus, etc. that WmC mentioned can be outnumbered by the American voter.
58
I wish more people would have listened to Hillary Clinton and her good ideas, like buying into Medicare, instead of believing all the politically motivated trash talk about her. We would be a lot better off right now, and like Arnie Schwarzenegger said, we would be able to sleep better at night.
We are in for a rough 4 years.
We are in for a rough 4 years.
2
Excellent article, and having worked in the healthcare industry in the 1980s into 2000 I've said this many times. The real solution to the American healthcare quagmire is universal coverage just like Canada and England. Many healthcare providers scream "Socialized Medicine!" but all other solutions from fee-for-service to managed care have failed. I don't think Trump will be the president to bring this about due to his greed and incompetence, but it has to happen sooner or later.
45
Australia has universal health insurance for all citizens and permanent residents, also called Medicare. The government-owned insurer sets rebates for various medical services. Doctors can charge the government-see rebate, in which case, there is no co-payment. Alternatively, doctors can charge their own fees, which the patients pay up front, and the insurer then pays the patient the rebate. Claims are electronically submitted and take 12 hours to 3 days to pay. Patients choose their family doctors, who in turn, refer to specialists.
If doctors provide very early or late appointments (e.g. 6:30 AM or 8:00 PM), they would usually bill more for these services (i.e. there would be a co-pay). It's a fee-for-service model, in which doctors are paid more to do more, and thus different to episode-of-care models, or the UK-based capitation model, where the GP is paid according to the number of patients registered with them.
It bemuses me when the Australian system is referred to as 'socialised medicine'. As a doctor, I'm incentivised to work longer or provide additional services, under our system. (I accept that fee-for-service models are subject to overservicing - but statistical methods to detect outliers.)
The Australian system is quite different to the UK, Canadian and various European systems. Universal insurance or universal healthcare doesn't come in one single model that suits all societies.
If doctors provide very early or late appointments (e.g. 6:30 AM or 8:00 PM), they would usually bill more for these services (i.e. there would be a co-pay). It's a fee-for-service model, in which doctors are paid more to do more, and thus different to episode-of-care models, or the UK-based capitation model, where the GP is paid according to the number of patients registered with them.
It bemuses me when the Australian system is referred to as 'socialised medicine'. As a doctor, I'm incentivised to work longer or provide additional services, under our system. (I accept that fee-for-service models are subject to overservicing - but statistical methods to detect outliers.)
The Australian system is quite different to the UK, Canadian and various European systems. Universal insurance or universal healthcare doesn't come in one single model that suits all societies.
24
Medicare for all is a great portion of achieving universal healthcare, if all other less wealthy country can do it, we can afford provide basic healthcare to all.
The second portion is to get rid of quota imposed by AMA to limit number of Medical schools and medical school enrollments, we graduate 20K medical school students and have over 30 residents slots each year, 10K are filled by foreign medical graduates, don't tell me Americans kids do not want to be doctors. This artificial quota system needs to be abolished so we have enough supply of doctors. Keep in mind that some doctors can afford not to take Medicare patients.....this will change when we have enough doctors.
Thirdly, we should still allow private insurance for individuals who wants and can afford it so people still have choices.
Medicare for all will also cure many ills Veterans Affairs currently have. Veterans has to go through all kinds of bureaucracy to seek outside care, this way, they can go wherever they want. eliminate waste there as well.
The second portion is to get rid of quota imposed by AMA to limit number of Medical schools and medical school enrollments, we graduate 20K medical school students and have over 30 residents slots each year, 10K are filled by foreign medical graduates, don't tell me Americans kids do not want to be doctors. This artificial quota system needs to be abolished so we have enough supply of doctors. Keep in mind that some doctors can afford not to take Medicare patients.....this will change when we have enough doctors.
Thirdly, we should still allow private insurance for individuals who wants and can afford it so people still have choices.
Medicare for all will also cure many ills Veterans Affairs currently have. Veterans has to go through all kinds of bureaucracy to seek outside care, this way, they can go wherever they want. eliminate waste there as well.
27
I have argued here that a suitable Republican plan would be to make everyone in the country eligible for Medicaid, the catch being that you have a monthly deductible equal to the difference between you family income and the welfare level, including say 1% of the value of your assets. (Nobody goes bankrupt for one month's medical bills is the idea.) This ought to be OK as it is basically like MediCal when Reagan was governor of California.
Medicare for all over the age of 50 would also be a huge step forwards.
If, as I suspect, Mr Trump meant what he said to his working class audiences in his campaign meetings he had to give the Republican Congress enough rope to hang themselves. They just did.
A different proposal, either a federalised Medicaid as outlined above, or a reduced age Medicare, would be really hard for Democrats to oppose and enough Republican governors and incumbents could probably use pressure get it through Congress.
Add cost-based regulation of hospitals, drugs, and devices and you'd have the basis of a rest-of-the-world system. Failing regulation, let the Medicaid/Medicare system negotiate prices, with NO personnel movement between the buying negotiators and the regulated businesses.
Medicare for all over the age of 50 would also be a huge step forwards.
If, as I suspect, Mr Trump meant what he said to his working class audiences in his campaign meetings he had to give the Republican Congress enough rope to hang themselves. They just did.
A different proposal, either a federalised Medicaid as outlined above, or a reduced age Medicare, would be really hard for Democrats to oppose and enough Republican governors and incumbents could probably use pressure get it through Congress.
Add cost-based regulation of hospitals, drugs, and devices and you'd have the basis of a rest-of-the-world system. Failing regulation, let the Medicaid/Medicare system negotiate prices, with NO personnel movement between the buying negotiators and the regulated businesses.
9
remember that Medicaid is partially federally funded as well, Medicare and Medicaid are both heavily involved CMS. so combine them and make it work for all.
Medicare for all INCLUDING members of Congress! They should be in the same boat as the rest of us.
66
Thoughts:
Ryan and many of the current Republican Party are more ideologues in their thinking and action than politicians. Politicians know and understand the necessity for compromise and accommodation. Ideologues reject both.
Donald Trump may be a good businessman. Baseball is not football. Governance is not business. To borrow from Theodore Roosevelt: You expect a man of millions to be worth hearing, but as a rule, they don’t know anything outside their own business.”
Per "loss aversion": "you never miss the water till the well runs dry"...
Ryan and many of the current Republican Party are more ideologues in their thinking and action than politicians. Politicians know and understand the necessity for compromise and accommodation. Ideologues reject both.
Donald Trump may be a good businessman. Baseball is not football. Governance is not business. To borrow from Theodore Roosevelt: You expect a man of millions to be worth hearing, but as a rule, they don’t know anything outside their own business.”
Per "loss aversion": "you never miss the water till the well runs dry"...
12
Although Medicare for all or Universal Care sound great, the reality under this administration is that it won't happen.
Let's start then with the Public Option. Those who opt for this pay a low premium and must seek care at government run facilities filled with board-certified doctors like me who just want to practice evidence-based medicine for a fair salary. These patients must agree to be entered into a centralized data-base so that outcomes can be analyzed. If they wish to have testing that is deemed unnecessary (like most MRIs), they can order the tests themselves and pay cash, with reimbursement if the test changes management. Prices for MRIs will come down.
This will require re-education of the average American. The first step will start in the schools where every child graduates with basic health understanding of diseases such as Diabetes, High blood pressure, Heart Disease, and how to read a lab test. Secondly, a reliable, standardized disease information resource must be created so patients can help manage their own conditions. For instance, if you had a heart attack and get home to realize that you're not on a beta blocker, when that is standard of care, you can question your doctor, reducing your risk.
Once private insurers see clients flocking to the Public Option, premiums will drop.
Let's start then with the Public Option. Those who opt for this pay a low premium and must seek care at government run facilities filled with board-certified doctors like me who just want to practice evidence-based medicine for a fair salary. These patients must agree to be entered into a centralized data-base so that outcomes can be analyzed. If they wish to have testing that is deemed unnecessary (like most MRIs), they can order the tests themselves and pay cash, with reimbursement if the test changes management. Prices for MRIs will come down.
This will require re-education of the average American. The first step will start in the schools where every child graduates with basic health understanding of diseases such as Diabetes, High blood pressure, Heart Disease, and how to read a lab test. Secondly, a reliable, standardized disease information resource must be created so patients can help manage their own conditions. For instance, if you had a heart attack and get home to realize that you're not on a beta blocker, when that is standard of care, you can question your doctor, reducing your risk.
Once private insurers see clients flocking to the Public Option, premiums will drop.
9
No. The public option does not require you to get care at a "government run" facility. The public option is simply a better way to pay the bill.
Patient outcomes are already analyzed now, so that wouldn't change. People can already pay cash (if their doctor agrees) for services their insurance won't approve, so that wouldn't change. Not sure where you are going with this, but you are incorrect.
Patient outcomes are already analyzed now, so that wouldn't change. People can already pay cash (if their doctor agrees) for services their insurance won't approve, so that wouldn't change. Not sure where you are going with this, but you are incorrect.
3
To my knowledge, no member of Congress has proposed that all House and Senate members should be denied access to the health care insurance they have via the U.S. federal government. Apparently they think they are well served by this government insurance. If, now, they wish to cut 24 million people from health care insurance, they can at least cut themselves off, too. They would then quickly begin to enjoy the fresh, bracing breezes of their "reform" and "freedom", sharing in some small way the personal responsibility they wish to provide to the citizenry and about which they have given ever so much care and wisdom these past few days.
22
Thank you for clearly defining why "free market enterprise" doesn't work with health care provision and purchases. My gripe for over thirty years is that not enough people are looking at the mechanics of the medical marketplace and just going on political policy dogma only.
Wasn't it Singapore that spent a couple years analyzing other countries health care systems before they created one that fit their culture? Seems like it would pay us to do the same huh?
Wasn't it Singapore that spent a couple years analyzing other countries health care systems before they created one that fit their culture? Seems like it would pay us to do the same huh?
6
Yes, Medicare for all will raise taxes. But when people actually see what they are getting for their money, they'll feel better about it. At the same time, end the employer tax break for funding employee health plans - just decouple those two things. Also, negotiate harder with specialists and drug companies over pricing. The thing is, we ALREADY pay the cost of poor health, in our schools, our jails, our work force. Let's agree that healthy people are a common good for the republic...unless Republicans WANT us sick and poor. Then we should kick them out of power.
19
You’ve read the mood exactly right.
1
There is no opening for Medicare for all, republicans who are opposing this first step want even less spending, they and most other republicans will never accept Medicare for all.
1
According to data compiled by the PNHP and others, once the wasted administrative overhead and profits of private health insurance companies are factored in, won't the overall national spending on health care actually decrease, while coverage increases to 100%? I know they can say it's "job-killing," but insurance-for-all would fulfill Trump's promise, and any deficit reduction should interest the conservatives.
If the Republicans want to save their party and really make it "great" then universal healthcare is the way to go. But first they have to make the insurance companies and their fat money shape up!
5
Oh brother! Let's forget for a moment that Trump's hand picked train wreck to lead the Department of Health and Human Services is Tom Price, sworn enemy of Medicare.
There's a better chance of spotting a dancing unicorn reading "The Art of the Deal" at the Lincoln memorial than your fantasy.
There's a better chance of spotting a dancing unicorn reading "The Art of the Deal" at the Lincoln memorial than your fantasy.
14
These guys are without shame.
6
The annual cost of health care could be cut 15% or $500 billion if private health insurance was added to socialized Medicare, which has high satisfaction even among elderly conservatives.
However that could lead to unemployment to 500,000 employees and 100s of millionaire executives and lobbyists, who donate millions to both parties to continue the corruption, greed, and overcharging.
However that could lead to unemployment to 500,000 employees and 100s of millionaire executives and lobbyists, who donate millions to both parties to continue the corruption, greed, and overcharging.
6
They can all enjoy those high-paying manufacturing jobs that Trump is going to bring back. Actually, many of them can work in the expanded Medicare bureaucracy, and the others can find some other socially-productive jobs.
Single payer already!
For the record it wasn't the profit motive that made American Medicine great, it was altruism, charity and compassion for the afflicted that lead good decent people to work for the betterment of all. Any financial benefit was incidental and not the primary driver.
Since the total profit model has taken hold in the US economy almost all good things have disappeared and the quality of what is left is awful.
In medicine you are literally rolling the dice with your life every time you go to a doctor or hospital.
For the record it wasn't the profit motive that made American Medicine great, it was altruism, charity and compassion for the afflicted that lead good decent people to work for the betterment of all. Any financial benefit was incidental and not the primary driver.
Since the total profit model has taken hold in the US economy almost all good things have disappeared and the quality of what is left is awful.
In medicine you are literally rolling the dice with your life every time you go to a doctor or hospital.
14
It would be amazing to see a single-payer system. For Republicans, it would mean that they actually DID something for Americans - in which case they might continue with their hold on Congress and the White House. Could Trump really make this happen?? Nah... He's brought more alligators to the swamp than he's brought buckets to drain it.
12
How about you start one in your state, it was sort of tried in Mass. and failed massively.
1
Western Europe and Canada.
3
Umm, I'm not certain what you are talking about. Romneycare was passed in Massachusetts in 2006 and did pretty well. The ACA was so similar to Romneycare that the Mass system became one of the independent state implementations of the ACA. If you are talking about the resolution in 1986 to set up a single-payer system, it was never implemented. Given that, I cannot understand how it could have failed massively.
Germany has a market-based system somewhat like the ACA. From people I have talked to, it seems to be well-liked and a lot less expensive than the free-for-all we had before the ACA. It seems ironic that when the Republican state legislatures refused to cooperate with the ACA the practical result was to greatly expand Medicaid, which is single-payer.
Germany has a market-based system somewhat like the ACA. From people I have talked to, it seems to be well-liked and a lot less expensive than the free-for-all we had before the ACA. It seems ironic that when the Republican state legislatures refused to cooperate with the ACA the practical result was to greatly expand Medicaid, which is single-payer.
51
The mistake most make is the assumption that this is about good governance. In that case it would be paramount to seek solutions that work for problems that actually exist.
The Trump ascendancy is nothing more or less than a smash and grab. Surprised that he actually won but willing to take advantage that the owners of our democracy permitted the thug to smash our barriers to thuggery he and his will now grab up everything they can (tax breaks, jurist selection, emoluments and personal advantage).
He and his care not if anyone gets good healthcare or even minimal human respect. It is all about what he can make off with without going to jail.
The Trump ascendancy is nothing more or less than a smash and grab. Surprised that he actually won but willing to take advantage that the owners of our democracy permitted the thug to smash our barriers to thuggery he and his will now grab up everything they can (tax breaks, jurist selection, emoluments and personal advantage).
He and his care not if anyone gets good healthcare or even minimal human respect. It is all about what he can make off with without going to jail.
8
If you drive a car you are required to have auto insurance, the pool is large enough to protect everyone at what is supposed to be a reasonable rate, I am not sure the latter is true but in the comparison of health insurance if only bad drivers were required to buy auto insurance the rates would move dramatically upward. The effect is the same for health insurance, if only the less healthy are buying insurance the rates will of course increase radically, if everyone buys insurance the cost necessarily experiences downward pressure.
A single payer system would eliminate much of the overhead produced by the insurance industry, which in my opinion is a thinly veiled scam which preys on societies most vulnerable, while reducing the costs of care by benefits of preventative medicine. The very idea of competition in a free market is rediculous it relies on the integrity of individuals who are attempting to create profit and, as shown by historical precedent, profit and integrity are indeed stange bedfellows.
A single payer system would eliminate much of the overhead produced by the insurance industry, which in my opinion is a thinly veiled scam which preys on societies most vulnerable, while reducing the costs of care by benefits of preventative medicine. The very idea of competition in a free market is rediculous it relies on the integrity of individuals who are attempting to create profit and, as shown by historical precedent, profit and integrity are indeed stange bedfellows.
10
Car insurance is a good analogy of why everyone must be mandated to have insurance. California's car insurance rates were skyrocketing in the 80's because it wasn't a requirement to have insurance. The insurance companies predictably had covered themselves from uninsured drivers by requiring those with insurance to pay "uninsured motorists" coverage. As the rates went up, people dropped out of the insurance pool. When car insurance was required, rates stabilized.
The same will be true with health insurance. It is disingenuous to say people shouldn't be required to have health insurance. It does need to be affordable.
The same will be true with health insurance. It is disingenuous to say people shouldn't be required to have health insurance. It does need to be affordable.
3
Indeed, with a National Single-Payer Health System established and enacted in the U.S. our Government would be finally able to level the playing field and negotiate more favorable terms with leading health service providers. Maybe Trump could use his so-called "Art of the Deal" tactics where they really count! He would gain some huge points fast.
24
And how many providers would quit, go bankrupt, etc.
I'm a provider. The current insurance reimbursement system is a staggeringly burdensome mess. Ending middleman (insurance company) profit will not bankrupt me. I take Medicare now.
88
The main problem Trump faces in taking his own approach to healthcare is that the Bannon-Mercer team wants to dismantle all government. It's clear from Trump's appointments and his budget and his actions regarding government agencies that Trump subscribes to dismantling.
A genuine healthcare plan necessarily involves government rules and actions, and does not fit in with the dismantlement program. Trump won't try to solve the healthcare problem. The most he will do is try to rally his core supporters to support the facade of a plan.
A genuine healthcare plan necessarily involves government rules and actions, and does not fit in with the dismantlement program. Trump won't try to solve the healthcare problem. The most he will do is try to rally his core supporters to support the facade of a plan.
29
Donald: I hope that you or Ivanka reads it. Do It! Get Medicare for All as described here. This alone will earn you a permanent place in people minds and memories. Be your own master and show it to the republicans in the swamp
57
Trump most certainly doesn't read.
2
And the reason to oppose Medicare For All is? (silence...)
13
I hate to pop Robert Frank's bubble, but there are a number of reasons Medicare For All is simply not going to happen.
1) The Freedom Caucus.
2) The Heritage Foundation.
3) ALEC.
4) Americans For Prosperity.
5) The Koch brothers.
6) The Cato Institute.
7) The American Enterprise Institute.
8) The Hoover Institute.
9) The Mercatus Center.
10) The Manhattan Institute.
11) The Tea Party.
12) The Republican Party.
13) The American Medical Association (?)
1) The Freedom Caucus.
2) The Heritage Foundation.
3) ALEC.
4) Americans For Prosperity.
5) The Koch brothers.
6) The Cato Institute.
7) The American Enterprise Institute.
8) The Hoover Institute.
9) The Mercatus Center.
10) The Manhattan Institute.
11) The Tea Party.
12) The Republican Party.
13) The American Medical Association (?)
57
Why do these organizations' members hate Americans? Why are they deliberately cruel?
1
And there is a reason it could prevail. HUMANITY. Trump is falling really short in that department.
2
Q. How many actual working people do these clearly greedy business organizations represent?
A. Between slim and none
A. Between slim and none
3
Private alternative to government run single payer for universal coverage assigns everyone a basic policy with income/age adjusted premiums paid on IRS tax returns. Upgrades from basic coverage would be optional but no one can choose to be uninsured.
1
I have been advocating Medicare for ALL for years, because Medicare is great. Have you ever met anyone on Medicare who does NOT like it? And, you pay according to your income - those lucky ones with higher incomes pay more for Medicare (adjusted every year according to your previous year's tax return net income) and those with low incomes pay less. You buy supplemental private insurance based on what you want/need, so insurance companies have competitive products from which one can choose. And, Medicare is portable across all 50 states - and it does NOT depend on one's employment. It really is the only way to go.
136
Kiddie Kar Ryan has had 7 years to make good on his solemn promise to the nation as he bows his head in prayer and pledges allegiance we can see now there was nothing but boyhood dreams attached to his cheap performances in front of cameras.
9
Republicans always trot out the benefits of Capitalism to oppose government action; thus Ryan is for competition in the market place to lower health costs. But we haven't had Capitalism in decades and Ryan should know that.
We are under an Oligarchy.
If we had Capitalism, we would not allow mergers of powerful corporations, nor have the restrictions against negotiating drug prices, imposed by Big Pharma on the ACA, nor the dependence on only one company to produce simple medications as epinephrine. If we had free enterprise, surely we would see an upstart pharmaceutical company producing an epi-pen at near cost. After all, epinephrine is a well known generic medication with a very simple molecular structure.
The fact is, we are being robbed of health, life and money by giant, powerful corporations and the sooner we cut them down to size, the better we'll be as a nation and as individual, free peoples.
We are under an Oligarchy.
If we had Capitalism, we would not allow mergers of powerful corporations, nor have the restrictions against negotiating drug prices, imposed by Big Pharma on the ACA, nor the dependence on only one company to produce simple medications as epinephrine. If we had free enterprise, surely we would see an upstart pharmaceutical company producing an epi-pen at near cost. After all, epinephrine is a well known generic medication with a very simple molecular structure.
The fact is, we are being robbed of health, life and money by giant, powerful corporations and the sooner we cut them down to size, the better we'll be as a nation and as individual, free peoples.
42
A major advantage of a single payer system would be to eliminate the false separation between Medicaid and Medicare. Currently a Medicaid recipient is often enrolled in a program that isn't accountable for hospital and inpatient services, so they have no incentive to manage and minimize them. A single payer would have clear incentives to manage the total cost of care, integrating all phases of a patient, including chronic care, in-home, in-hospital and post-acute. The savings from that approach would dwarf the saving from any other reform of the healthcare system.
5
A Medicare For All Plan is too sensible. Single payer, government run with a good track record that lowers health cost using preventive care screening and economy of scale. Simply too sensible for the non-Darwinian live free or die folks
67
Many other nations have demonstrated the superiority in both outcomes and costs of a national system that covers essential disease care (and often more), over our historic unregulated profit over all nonsystem.
The ACA (aka Obamacare), in spite of its flaws, has demonstrated added value IN OUR COUNTRY, in terms of insurance coverage, over the previous non-system.
So it is clear that we have the capability to improve our disease outcomes and reduce costs in the disease care sector by implementing a universal coverage system.
The major barriers are (1) incompetent legislators due to a mix of ignorance, corruption and ideological fundamentalism and (2) incompetent citizens who employ beliefs and wishes rather than facts, logic and reflection in their positions on public policy.
I am optimistic that eventually after many unnecessary premature deaths and much suffering and financial pain, that the "scales will fall off peoples' eyes" and we will install an adequate universal system for essential disease care.
I am not optimistic that it will happen soon; the profits of the current nonsystem are too great.
The ACA (aka Obamacare), in spite of its flaws, has demonstrated added value IN OUR COUNTRY, in terms of insurance coverage, over the previous non-system.
So it is clear that we have the capability to improve our disease outcomes and reduce costs in the disease care sector by implementing a universal coverage system.
The major barriers are (1) incompetent legislators due to a mix of ignorance, corruption and ideological fundamentalism and (2) incompetent citizens who employ beliefs and wishes rather than facts, logic and reflection in their positions on public policy.
I am optimistic that eventually after many unnecessary premature deaths and much suffering and financial pain, that the "scales will fall off peoples' eyes" and we will install an adequate universal system for essential disease care.
I am not optimistic that it will happen soon; the profits of the current nonsystem are too great.
9
A cardiologist friend, a staunch conservative, commented that government can't afford to provide healthcare to all. I asked him, rhetorically, if it meant that poor people were supposed to die if they fell sick. He said, in principle, yes!!
I then asked him then why doesn't his party state this position clearly instead of beating around the bush and flimflaming its followers with virtues of market place. He was candid and intelligent enough to admit that such candor from his party would not get them any votes.
This is crux of the problem. One party doesn't want government to pay for healthcare of the poor. The other party does. The only way it can be done is by taxing those who can afford (to pay for the insurance premium of the poor) and requiring that everyone buys insurance (to avoid free rider problem by the healthy who avoid paying insurance until they end up in emergency room and make the rest of us to pick up the tab of their hospital bill). Obamacare was a step in the right direction. Trump/Ryan wealthcare is a decisive step backwards.
I then asked him then why doesn't his party state this position clearly instead of beating around the bush and flimflaming its followers with virtues of market place. He was candid and intelligent enough to admit that such candor from his party would not get them any votes.
This is crux of the problem. One party doesn't want government to pay for healthcare of the poor. The other party does. The only way it can be done is by taxing those who can afford (to pay for the insurance premium of the poor) and requiring that everyone buys insurance (to avoid free rider problem by the healthy who avoid paying insurance until they end up in emergency room and make the rest of us to pick up the tab of their hospital bill). Obamacare was a step in the right direction. Trump/Ryan wealthcare is a decisive step backwards.
132
You should have noted that the present government expenditures on health care--via Medicare, Medicaid, VA, Obamacare, CHIP, government employees' health care, tax credits/exclusions/deductions--are among the highest in the world, and are arguably sufficient as is to pay for the health care of everyone.
7
Yout friend thinks the "government can't afford to provide healthcare to all"
How then do so many other countries manage to do it? Maybe part of the problem is that your cardiologist friend makes too much money under the present system.
How then do so many other countries manage to do it? Maybe part of the problem is that your cardiologist friend makes too much money under the present system.
88
your friend the cardiologist is part of the problem. Ask him what he makes, versus what a colleague in England, France or Germany makes.
9
The only loss aversion the GOP cares about: losing their jobs. Let's help them with that. Medicare for ALL- 2020. Seriously.
140
To provide for the people or to provide for corporate America, that is the question - the answer is so obviously simple
44
This is unfair. Corporate America provides most of this nations healthcare through employee and family coverage. The wealthy will be the main beneficiary of Trumpcare's tax breaks.
1
A major step forward in universal coverage would be expanding Medicare to cover all those 50 or over. Since current Medicare premiums are deducted directly from Social Security, Medicare premiums are always paid now. A new funding mechanism would need to be created for premiums for those 50 to the age of SS (as it rises in current policy). This age pool should be healthier than those currently eligible for Medicare. The premium discrimination in the current GOP plan between this age group and younger people would be eliminated so this age group voter pool would not be "losing" a benefit.
A second step would be to cover all children for basic health care and catastrophic disease or injury coverage. This is an investment in future cost savings by preventing disease. It is what Pro-Life means.
The population left to be covered under any complicated private, for-profit plans would be healthy adults under the age of 50--most of whom could still be covered by employer based or individually purchased plans until the benefits of universal coverage (shown by the over 50 and child coverage) create enough pressure to extend universal health care to this age group as well.
The failure of the Republicans to work with Democrats so the Affordable Care Act (essentially a Republican program) works for the American people or to bring forward any acceptable replacement in 7 years has guaranteed universal coverage will happen once the old men standing in the way have left Congress.
A second step would be to cover all children for basic health care and catastrophic disease or injury coverage. This is an investment in future cost savings by preventing disease. It is what Pro-Life means.
The population left to be covered under any complicated private, for-profit plans would be healthy adults under the age of 50--most of whom could still be covered by employer based or individually purchased plans until the benefits of universal coverage (shown by the over 50 and child coverage) create enough pressure to extend universal health care to this age group as well.
The failure of the Republicans to work with Democrats so the Affordable Care Act (essentially a Republican program) works for the American people or to bring forward any acceptable replacement in 7 years has guaranteed universal coverage will happen once the old men standing in the way have left Congress.
46
The Old Men Standing in the way isn't Old. Paul Ryan is 47. Rand Paul is older at 54. He thought (AHCA) Repeal and Replace didn't go far enough AND dubbed it ObamaCare Lite.
The interesting thing is, given Trump's pathological craving for status and approval, he could go down in history as a visionary and a hero if he would champion Medicare for All.
We know it would be cheaper and more effective for the country, I am sure the insurance companies could find some other pockets to pick and it would abolish the job gridlock that keeps so many of us mature people hanging onto jobs we don't really want just to keep insurance. Entrepreneurism would boom, a great deal of market uncertainty would be gone forever, health systems could plan based on changing demographics and medical technology instead of beancounting, etc.
Instead a handful of greedy, evil, religio/superstitious mostly old white guys in Congress are going to roadblock this, probably for the rest of my lifetime, which could've been a lot nicer if I'd been able to sign up for Medicare this year. I am sure tens if not hundreds of millions of American citizens -- those of us paying the salaries of those old greedy white guys -- would agree.
Due to his slavish following of anarchists like that fool Bannon, Trump is missing the greatest opportunity to redeem himself and truly "make American great." What an imbecile.
We know it would be cheaper and more effective for the country, I am sure the insurance companies could find some other pockets to pick and it would abolish the job gridlock that keeps so many of us mature people hanging onto jobs we don't really want just to keep insurance. Entrepreneurism would boom, a great deal of market uncertainty would be gone forever, health systems could plan based on changing demographics and medical technology instead of beancounting, etc.
Instead a handful of greedy, evil, religio/superstitious mostly old white guys in Congress are going to roadblock this, probably for the rest of my lifetime, which could've been a lot nicer if I'd been able to sign up for Medicare this year. I am sure tens if not hundreds of millions of American citizens -- those of us paying the salaries of those old greedy white guys -- would agree.
Due to his slavish following of anarchists like that fool Bannon, Trump is missing the greatest opportunity to redeem himself and truly "make American great." What an imbecile.
118
Number one: Trump is all about money. That's it. He doesn't care if we have healthcare or not--as long as he makes money, he'll be a happy camper.
Number two: the Republican plan was merely a tasteful way thinning the deplorable herd so that people would not be able to afford healthcare insurance and hence would die prematurely, and more tastefully than in concentration camps.
Number three: congress not going to do a darn thing as long as The citizens United decision stands – – they are bought and paid for by big money and big money is who they are going to be beholden to.
Number four: Romney's 47% – – the deplorable's – – would be happy to not be forced to pay for healthcare, and would pleasantly go to their early graves , Continuing to support Trump till their dying breaths.
Number two: the Republican plan was merely a tasteful way thinning the deplorable herd so that people would not be able to afford healthcare insurance and hence would die prematurely, and more tastefully than in concentration camps.
Number three: congress not going to do a darn thing as long as The citizens United decision stands – – they are bought and paid for by big money and big money is who they are going to be beholden to.
Number four: Romney's 47% – – the deplorable's – – would be happy to not be forced to pay for healthcare, and would pleasantly go to their early graves , Continuing to support Trump till their dying breaths.
5
Medicare should be rebranded as a model of efficiency with Admin cost at 2%. Medicare For All would be the Ultimate Prize.
Expanding Medicare to 50, 55 y/o would be Fantastic.
I'd settle for Trump Repealing the law that Bans Negotiation of Medicare Prescription Drug Coverage.
Expanding Medicare to 50, 55 y/o would be Fantastic.
I'd settle for Trump Repealing the law that Bans Negotiation of Medicare Prescription Drug Coverage.
1
While I agree that Medicare for all provides the best solution. That said, Medicare is still a government-private partnership. I have supplemental insurance to cover the 20% Medicare does not. Some thought would be needed about that. Even Medicare Advantage coverage involves some deductible and co-payment provisions.
And taxes would go up substantially. In my experience, consumers are highly naive about this. They're bad at weighing the cost differential between the benefits of taxation as opposed to private insurance.
And taxes would go up substantially. In my experience, consumers are highly naive about this. They're bad at weighing the cost differential between the benefits of taxation as opposed to private insurance.
2
Wilton, please do not confuse the one worlders with the facts about United States Medicare.
Your Medicare bill is based on your previous year's income. And it is re-calculated every year. So your Medicare expenses go up as your income rises, but fall if your income should go down. What could be fairer? It is NOT employment dependent, so employers would save money and not have to offer health insurance as a benefit. It would be good in all 50 states so moving would not be an issue. MEdicare for All is the only way to go.
9
Medicare will NOT cover you if you are outside the USA and need medical services. That's when you should be supplemental insurance. So your "one world" comment is ill-informed.
4
Insurance companies also earn profits by being willing to take on risk. Policy holders are willing to pay a premium to offset that risk and so in a single payer model, that risk premium would disappear resulting in additional savings.
4
Medicare for all or Universal Healthcare is a standard in all other developed countries, the USA being the exception - even though we pay more than other countries per capita yet have higher death rates, infant mortality, etc.
The health and well being of US citizens is a national security issue and should be approached as serious as that. Therefore I propose we take 1/3 of the Defense Budget, roughly $194 billion to fund universal healthcare or Medicare for all. instead of fighting wars, building jets, bombers, aircraft carriers - all designed to destroyed lives - let's use the Defense Budget to protect lives.
This option would appeal to conservatives since it involves no new taxes or add to more deficit to our existing federal budget. It would certainly appeal to the rest of America who fear getting sick and losing their home and savings.
YES: Medicare for All paid for with the existing Defense Budget...
The health and well being of US citizens is a national security issue and should be approached as serious as that. Therefore I propose we take 1/3 of the Defense Budget, roughly $194 billion to fund universal healthcare or Medicare for all. instead of fighting wars, building jets, bombers, aircraft carriers - all designed to destroyed lives - let's use the Defense Budget to protect lives.
This option would appeal to conservatives since it involves no new taxes or add to more deficit to our existing federal budget. It would certainly appeal to the rest of America who fear getting sick and losing their home and savings.
YES: Medicare for All paid for with the existing Defense Budget...
167
Yes, Medicare for all. I concur that this is where we need to go. But slash the Military budget by one-third? That's the kind of negligent, utopian thinking this country engaged in prior to WWII. It left us woefully unprepared to face the reality of increasing militarization and threats from around the world. Remeber Pearl harbor? Think today about the huge increase in Chinese, North Korean, Russian and even Iranian militarization and provocations. Such a cut would be akin to removing the deadbolts from your doors, removing your alarm system, and believing that the flimsy little chain on your entry door will keep out intruders.
1
Wrong. NHS in the UK is financially failing.
https://www.theguardian.com/society/2016/nov/22/nhs-financial-problems-e...
Fixing real problems requires a strong grip on reality. The Democrats never do that, they never do the math.
https://www.theguardian.com/society/2016/nov/22/nhs-financial-problems-e...
Fixing real problems requires a strong grip on reality. The Democrats never do that, they never do the math.
Medicare-for-all has all kinds of advantages for health care consumers but faces enormous obstacles by the entrenched financial interests of insurance companies and health care providers.
But it is a proven model to control spiraling costs of employer provided insurance that make US workers less competitive in the global economy.
Expanding the hybrid Medicare Advantage plans to younger people funded by payroll deduction may be a solution that faces less industry opposition than traditional fee-for-service Medicare, while providing all important incentives for improving quality of outcomes.
The ACA has laid important groundwork through evidence based care enabled by electronic record keeping and better medical science in place of the old "Dr Knows Best".
But it is a proven model to control spiraling costs of employer provided insurance that make US workers less competitive in the global economy.
Expanding the hybrid Medicare Advantage plans to younger people funded by payroll deduction may be a solution that faces less industry opposition than traditional fee-for-service Medicare, while providing all important incentives for improving quality of outcomes.
The ACA has laid important groundwork through evidence based care enabled by electronic record keeping and better medical science in place of the old "Dr Knows Best".
4
You suggest "Expanding the hybrid Medicare Advantage plans to younger people funded by payroll deduction may be a solution that faces less industry opposition than traditional fee-for-service Medicare..." You are absolutely right that the insurers would love it. You just described Obamacare and they supported it wholeheartedly as long as the government covered the risk (as it did for the first 3 years and as does Medicare Advantage every year)
3
@Dennis Byron
Cape Cod
No he did not describe Obamacare which doesn't involve any payroll deductions. The mechanisms Obamacare uses to subsidize insurance provided on the exchanges or via Medicaid/Chip expansion are wholly different from used to fund Medicare advantage plans. Insurers incidentally are less enthusiastic about Advantage plans than they were now that the additional government subsidies have been reduced from the balmy days of Bush. Neither does the government cover the risk. It simply makes over to the insurer the Medicare deduction from SS plus a subsidy of now about 2% I believe and after that the insurer is on his own in calculating the risk and his payment schedule from the insured which is why there are many advantage plans on offer. You really are totally ignorant of this topic despite the pontificating.
Cape Cod
No he did not describe Obamacare which doesn't involve any payroll deductions. The mechanisms Obamacare uses to subsidize insurance provided on the exchanges or via Medicaid/Chip expansion are wholly different from used to fund Medicare advantage plans. Insurers incidentally are less enthusiastic about Advantage plans than they were now that the additional government subsidies have been reduced from the balmy days of Bush. Neither does the government cover the risk. It simply makes over to the insurer the Medicare deduction from SS plus a subsidy of now about 2% I believe and after that the insurer is on his own in calculating the risk and his payment schedule from the insured which is why there are many advantage plans on offer. You really are totally ignorant of this topic despite the pontificating.
4
John
I am surprised the NYT allows your unending personal attacks on people but no matter your bombast, you do not know what you are talking about. Of course Medicare involves payroll deductions (and income tax payments and SS deductions and large amounts of out of pocket). Who cares if the mechanisms are different; the result is the same. And government does cover risk in public Part C health plans just as it does in Obamacare
I am surprised the NYT allows your unending personal attacks on people but no matter your bombast, you do not know what you are talking about. Of course Medicare involves payroll deductions (and income tax payments and SS deductions and large amounts of out of pocket). Who cares if the mechanisms are different; the result is the same. And government does cover risk in public Part C health plans just as it does in Obamacare
1
If there is one thing we have learned about DJT, it is his prime motivation to display his interest in the welfare of the American public, not in delivering it.
13
Excellent financial and behavioral analysis of the matter.
5
I had my annual medical check-up at my doctor two days ago.
He advised I should get an ultrasound of my bladder and kidneys based on some symptoms, a routine ECG based on family history, a hearing test based on my age, a colonoscopy as the last was 7 years ago, and of course the standard blood and urine testing. ECG, blood and urine were done same day, (I had fasted), ultrasound yesterday, other tests are in a couple of weeks.
My out of pocket cost for all this - $0.00. The income tax I pay is based on my income, and has nothing to do with my good or bad health, or the health care I may require.
He recommended also the Prevnar-13 pneumonia vaccination, which I did have to pay for, total cost C$139 including taxes, as it is not (yet) covered by OHIP, our provincial health plan.
How does this not make sense in a civilized country?
He advised I should get an ultrasound of my bladder and kidneys based on some symptoms, a routine ECG based on family history, a hearing test based on my age, a colonoscopy as the last was 7 years ago, and of course the standard blood and urine testing. ECG, blood and urine were done same day, (I had fasted), ultrasound yesterday, other tests are in a couple of weeks.
My out of pocket cost for all this - $0.00. The income tax I pay is based on my income, and has nothing to do with my good or bad health, or the health care I may require.
He recommended also the Prevnar-13 pneumonia vaccination, which I did have to pay for, total cost C$139 including taxes, as it is not (yet) covered by OHIP, our provincial health plan.
How does this not make sense in a civilized country?
202
Then You may be Interested to know that most usa insurance plans DO cover prepaid vaccine....just saying
2
I already had a previous government paid pneumonia shot, but this is more advanced, covers 13 bacterial forms.
Not on the payment schedule yet.
I chose to get it.
Not on the payment schedule yet.
I chose to get it.
3
True. They also charge many thousands of dollars a year in premiums. If you are unlucky enough to have to go to the emergency room, the docs who treat you may likely not be in your network because most are contractors, and you will be responsible for paying them even though your policy says it covers emergency room and hospital costs. Just saying.
4
POTUS can not be bothered by getting into the specifics of HC in America 21st century since "it's so complicated". Tom Price, HHS Director, is vehemently opposed to any and all Federal involvement in HC. I fear the Medicare for All option, certainly the fairest of all plans, will not be available in my lifetime given the indifference espoused by the majority of GOP members to the common person's (their constituents) condition. As long as millions of Americans continue to vote against their best interests, we are stuck. Maybe we can improve this situation for children and grandchildren by electing moderate Republican and Democrats. Now where did they go??
8
Major misunderstandings about proposed non-Medicare health care reform and Medicare in this article lead to some false conclusions.
The CBO did not estimate that 24,000,000 people who wanted healthcare insurance would “lose” it. It estimated that 12,000,000 that didn’t want insurance in the first place would no longer have to buy it. Start with the real number – the actual 12,000,000 who felt they had to get the healthcare insurance under Obamacare and wanted it even with high premiums, absurd deductibles, and forced coverage of ‘maladies’ the person could not possibly contract – before applying loss aversion theory.
Which leads to the misunderstandings about United States Medicare by this author. Almost nothing the author says about U.S. Medicare is true. It is not single payer. It is run by insurance companies (all of whom are private--what does this so-called economist mean by private insurer?). Original U.S. Medicare experiences 30% fraud, waste and abuse according to its own supporters. The administrative cost of U.S. Medicare quoted here does not include that 30% nor the additional direct expenses borne by the SSA, IRS and other government groups to administer U.S. Medicare. Consumers of United States Medicare are not stupid as this author alleges. And it is an absolute lie that insurers that privately supplement Medicare (typically called Medigap) haggle over what they will pay on a beneficiary’s behalf.
When you start with false information, the result is false
The CBO did not estimate that 24,000,000 people who wanted healthcare insurance would “lose” it. It estimated that 12,000,000 that didn’t want insurance in the first place would no longer have to buy it. Start with the real number – the actual 12,000,000 who felt they had to get the healthcare insurance under Obamacare and wanted it even with high premiums, absurd deductibles, and forced coverage of ‘maladies’ the person could not possibly contract – before applying loss aversion theory.
Which leads to the misunderstandings about United States Medicare by this author. Almost nothing the author says about U.S. Medicare is true. It is not single payer. It is run by insurance companies (all of whom are private--what does this so-called economist mean by private insurer?). Original U.S. Medicare experiences 30% fraud, waste and abuse according to its own supporters. The administrative cost of U.S. Medicare quoted here does not include that 30% nor the additional direct expenses borne by the SSA, IRS and other government groups to administer U.S. Medicare. Consumers of United States Medicare are not stupid as this author alleges. And it is an absolute lie that insurers that privately supplement Medicare (typically called Medigap) haggle over what they will pay on a beneficiary’s behalf.
When you start with false information, the result is false
1
The waste abuse and fraud rate is no different with private insurers. There is is greater incentive not to cheat the government because there are much stricter penalties including jail terms for providers. Private insurers merely drop troublesome providers and spend significantly more to enforce their rules.
4
@Dennis Byron
Cape Cod
"It estimated that 12,000,000 that didn’t want insurance in the first place would no longer have to buy it."
Do stop these silly lies. The vast majority of the 12 million people who purchased coverage on the exchanges did so because they wanted it and would not have been able to obtain it without subsidies. Presumably, in your strange lexicon pregnancies, cancer and vascular diseases constitute maladies that the person could not contract
Cape Cod
"It estimated that 12,000,000 that didn’t want insurance in the first place would no longer have to buy it."
Do stop these silly lies. The vast majority of the 12 million people who purchased coverage on the exchanges did so because they wanted it and would not have been able to obtain it without subsidies. Presumably, in your strange lexicon pregnancies, cancer and vascular diseases constitute maladies that the person could not contract
22
Sorry, naysayer, but that is not correct. Read any SEC report on a publicly traded insurance company or a charity bureau report on a non-profit insurer. (There are no such things as private insurers; there is private insurance and public insurance but insurance companies are just insurance companies; the word private is somewhere between meaningless and misleading.) Their FWA percentage is usually under 5%.
1
Medicare for all is a pipe dream because of path dependence. Like it or not the current structure is one the US is stuck with in which the insurers play a major role, employ hundreds of thousands of people and not coincidentally have the savings of millions invested in them. Frank also oversimplifies the situation overseas. Most of these systems are in fact hybrids where yes the state acts as a single payer but delegates much of the patient contribution collection and general administration to insurance companies who are allowed to make profits which are capped. In fact capping, particularly of provider charges, largely accounts for the fact they cost around half that of the US system and are able to cover everyone.
5
Yes a highly regulated utility model is a good choice for the USA, so let's get on it and bridge this fatuous private public false dichotomy. Nobody wants a Canadian system in the us, but anything along lines ranging from U.K. To Taiwan to Switzerland will do....but any reform must cap profits....wall streets money should find some other way to make oversized profits other than exploit people's health.
5
@John Whitc
Hartford, CT
That is the only realistic route forward. Continuously harping on about single payer Medicare just muddies the water. It's never going to happen and we wouldn't want to happen in practice. And Wall Street is another red herring. Most of the money in these insurers comes from pension funds. Probably including yours.
Hartford, CT
That is the only realistic route forward. Continuously harping on about single payer Medicare just muddies the water. It's never going to happen and we wouldn't want to happen in practice. And Wall Street is another red herring. Most of the money in these insurers comes from pension funds. Probably including yours.
2
John, I suspect you mean to say "few Americans" rather than "nobody".
The Canadian system, although not without faults, affords every Canadian equal access to all the healthcare that is available. (Save cosmetic and other like procedures). Wait times can be greater than those (with access) in the USA. However, we do not have the great loss of investment to the 'fat cats' who own and run your US insurance services.
Also having a centralized single payer medicare system allows us much more influence over prices for surgical implants, medications, etc.
Imagine if your healthcare system was run like your military. Now you know how it works in Canada. Socialism at its finest.
The Canadian system, although not without faults, affords every Canadian equal access to all the healthcare that is available. (Save cosmetic and other like procedures). Wait times can be greater than those (with access) in the USA. However, we do not have the great loss of investment to the 'fat cats' who own and run your US insurance services.
Also having a centralized single payer medicare system allows us much more influence over prices for surgical implants, medications, etc.
Imagine if your healthcare system was run like your military. Now you know how it works in Canada. Socialism at its finest.
1
Medicare for all is by far the best solution for Americans, if not for insurers, powerful lobbyists or politicians.
We overpay tens of billions every year that we simply don't owe from improper denials of claims and overcharging from healthcare providers, both of which have become as common as the sun coming up in the morning.
As the owner of a healthcare advocacy, I could tell you countless stories of such abuses. In what other industry could you average a 50% - 80% billing error rate and not be held accountable by the government? Welcome to medical billing! If you appeal an improper denial of an insurance claim just once, 56% of the time the insurer will overturn it's own denial. Where else could you get away with that?
Why does this happen? Because all the insurer or the healthcare provider has to say is "oops, computer error". There are no government penalties. No enforced accuracy rates. Instead, patients make billionaires out of healthcare CEOs while they bankrupt their families.
Medicare for all? You've certainly got my vote!
We overpay tens of billions every year that we simply don't owe from improper denials of claims and overcharging from healthcare providers, both of which have become as common as the sun coming up in the morning.
As the owner of a healthcare advocacy, I could tell you countless stories of such abuses. In what other industry could you average a 50% - 80% billing error rate and not be held accountable by the government? Welcome to medical billing! If you appeal an improper denial of an insurance claim just once, 56% of the time the insurer will overturn it's own denial. Where else could you get away with that?
Why does this happen? Because all the insurer or the healthcare provider has to say is "oops, computer error". There are no government penalties. No enforced accuracy rates. Instead, patients make billionaires out of healthcare CEOs while they bankrupt their families.
Medicare for all? You've certainly got my vote!
278
The government allows a net 11% improper billing rate in its own Original Medicare fee for service program (administered by what leftists inexplicably call "private" insurance companies)? To pretend that problem would be solved by the government is not very thoughtful.
1
@Dennis Byron
Cape Cod
Improper billing (i.e. fraud) is endemic in governmental and employer provided insurance programs. Anyone with a brain in his head would understand this in area with total expenditures of over 3 trillion. The important number is the stop loss ratio which is basically the share of receipts consumed for operating the program. Insurers typically spend 18-20 % of their receipts on admin, management bonuses etc. (although some estimates put it higher) whereas the Medicare administration spends about 5%. There is no question but that the government is running Medicare more cheaply than private insurers run employer provided insurance (and I've signed off on the purchase of a lot of employer provided insurance). Unfortunately, your use of the comic book term "leftists" indicates you don't approach this subject in a reasoned mode but one of blind partisanship.
Cape Cod
Improper billing (i.e. fraud) is endemic in governmental and employer provided insurance programs. Anyone with a brain in his head would understand this in area with total expenditures of over 3 trillion. The important number is the stop loss ratio which is basically the share of receipts consumed for operating the program. Insurers typically spend 18-20 % of their receipts on admin, management bonuses etc. (although some estimates put it higher) whereas the Medicare administration spends about 5%. There is no question but that the government is running Medicare more cheaply than private insurers run employer provided insurance (and I've signed off on the purchase of a lot of employer provided insurance). Unfortunately, your use of the comic book term "leftists" indicates you don't approach this subject in a reasoned mode but one of blind partisanship.
16
Sorry but you are dealing with bad facts. You leave out all the costs of Medicare covered in other parts of the government, the profit of the Medicare contractors, and other factors in addition to net improper payments that drive Original Medicare's overhead north of 30%.
No insurance company lives with that overhead (can't under law anymore). For example, the net improper payment rate of the Medicare Part D program is 2%
No insurance company lives with that overhead (can't under law anymore). For example, the net improper payment rate of the Medicare Part D program is 2%
2
Frank should pay more attention to the news. Obviously Trump does not have the political leverage to pass a better and more progressive health care plan such as extension of Medicare - he can't even get support for the horrible plan that he endorsed because the right wing of the GOP thinks it's too generous.
Such a plan must be advocated and passed by Democrats. Why aren't they getting behind it now?
Such a plan must be advocated and passed by Democrats. Why aren't they getting behind it now?
18
@skeptonomist
Tennessee
What strange world do you inhabit? Trump has no interest in passing a better and more progressive one than that currently in place. He's trying to pass the GOP plan that will take insurance off 24 million people and funnel huge tax cuts to the wealthy.
Tennessee
What strange world do you inhabit? Trump has no interest in passing a better and more progressive one than that currently in place. He's trying to pass the GOP plan that will take insurance off 24 million people and funnel huge tax cuts to the wealthy.
54
1. How much does it cost the government to provide straight medicare right now on average to those who receive it?
2. How much have they on average paid into the medicare program?
3. How much would it cost to offer the plan to younger and presumably healthier patients?
I am really tired of the current medicare recipients against Obamacare and claim it is hurting their medicare which they "paid for".
It is a bit problematic in that medicare pays less than private health insurance to providers and many limit their practice to only have so many medicare patients. The hospitals and doctors would receive considerably less under this proposal and likely resist it fiercely.
Perhaps a new medicare program that paid 110% of traditional medicare fees would satisfy them.
Please try to answer my questions in a new column or on this page. Thanks