No chance of passage and will marginalize those democrats as as far left socialist. Good news for Trump and Republicans in 2018 and 2020. America is still a fundamentally a capitalistic free market society. Obama trying to swing the needle in the opposite direction is one of the colossal failures of his Presidency.
9
Kudos to the Dems for getting the dialogue going. Lost on the average Trump supporter, it seems, is the basic notion that one party is actually trying to do the hard work of governing and is leading the way toward some measure of progress. Why doesn't the Trump base understand this simple notion? Why do his supporters not notice that if you hear anything at all from the GOP and the White House, it's about helping rich people get richer and hang the rest of us. Why do they never notice that the Democrats are the lone legislators talking about things like how we can do better on health care, or get working people some kind of minimum-wage increase? It's a mystery to me, though of course the idiot Fox News and talk radio element is ultimately the answer.
60
Public option, "Medicare for All" - ANYTHING that gets rid of the greedy & inefficient so-called health insurance system we have now. Even with the ACA, companies can put their profits (and CEO pay) ahead of the health care of people. ENOUGH.
68
In 2012-13 I was gravely ill I spent TEN Months..in various hospitals and medical facilities.....I,.almost died three times. I had very good medical ins,BUT
There was a ton stuff that these crooks wouldn't pay for! ALL IN ALL
It cost me more than $40,000 cash during this mess!
I was 63 years old and they took my life's savings.
I was so lucky I didn't loose my house, my car!!!
40% of every Medical Dollar is BLOOD SUCKING PROFIT! $25 million per year for each CEO!
If we take out this profit....imagine the money that could go into real health care?
But the profiteers want a medical system based on the McDonalds Big Mac Drive thru window system model......cha- Ching!
I'm all in for Single Payer Health Care for America!
69
No. And hell, no. Enough of the incremental changes. This is just begging the GOP, and SOME courts, to throw up massive roadblocks. This WILL change a Five Year process into 30 Years, or Never. Forget what the Insurance companies want, or say. THEY are the primary problem, certainly not the solution. Medicare For ALL: 2020. Its Time.
45
I don't know what Gillibrand thinks a nonprofit public option would look like, the the late, lamented ACA health care co-ops are a cautionary tale. The ACA poured hundreds of millions into the co-ops, which got sucked dry by unbalanced risk pools of sick patients with high costs. That and a GOP Congress that reneged on the risk corridor deal.
6
Gillibrand is a bright lady. She will go far.. Probably lot farther than Hillary or Bernie. Just watch the company you keep kido!
8
Kirsten Gillibrand will be elected President of the United States in 2020, soundly defeating Mike Pence.
When she is we can all breath a sigh of relief and relish the Donald's passing into one of history's footnotes.
17
Medicare for All sounds great. How about Medicare for the Whole Body—including the teeth. I've never once heard Bernie utter the word "Dental." Out of pocket dental costs can cost more than major surgery. Americans teeth are a disgrace.
21
Plan, what plan? If you can't fund it then it's a pipe dream.
6
what about all the folks who work for the health care cartel, will they now be added to the unemployment line?
5
"But deep in its back pages is a more modest fallback plan."
Who is surprised that the Democrats are trying again to fool the public by promising a medical care plan that sounds great but is bound to fail.
4
Let's have a show of hands.. Who is against universal health or Medicare for all. Then let loose the Americans fury at them. That is the only way to get true universal care.
15
There goes Bernie Sanders again, the Pied Piper of healthcare. I am a supporter of health care for all, but I am not a fool. Giving Medicare equal to everyone who doesn’t have insurance is just a dangerous chimera, that has no chance of ever becoming law in Bernie Sander's lifetime or mine. It is just a distraction for the Democratic party to waste any energy on it. All that Bernie Sanders has done with it so far is have a significant affect on electing our sad depiction of president, Donald Trump.
Medicare for all Americans simply smells too much of Socialism, would cost too much, would weaken the medical profession and would significantly undermine the quality of health care we enjoy today. Once Congress was charged with paying for such a large program, the whittling would begin. It would be the Kansas school system. Slowly drained of financing. Doctors would come out fighting it's enactment. The health insurance industry, facing elimination, would put enormous financial resources at the disposal of whichever party opposed such an absurd proposal. As stated by someone in today's paper, healthcare represents eighteen percent of the gross domestic product. If you think immigration is a combustible issue, wait until you start tampering with the well-being of doctors and the health insurance industry by fundamentally altering the function of 18-percent of the gross domestic product. It is a sad fact that that Democrats would take a dive if this became their plank.
10
It is the right time for this healthcare law. The weaknesses of the Affordable Care Act are evident but the underlying premise is correct. Health care is a right. It is immoral that someone with money gets better healthcare than someone who is down on their luck. We need blind healthcare as well as blind justice. The ideas are not new as other respondents have pointed out. Lowering the Medicare age was part of Hilaries plan. Obama had wanted it included in the Affordable Care Act as well. The public option as the counter balance to the insurance companies that is sorely needed. We need to move on for the sake of all in society. Standards of care don't make sense in the current system. Unreachable technologies are just that. Crazy insurance plans that attain cost control by denying care have got to go. I understand that Medicare only covers 80% of care but this can also be dealt with as part of the transition. Eventually medical cost will come down as we understand how much things cost and then we can assign a value. If a drug/treatment doesn't work well it should be cheap right?? In the current crazy system there is no transparency. Thank you Bernie and all of the supporters.
17
If single payer is not good enough for Vermont, California, or Colorado, then it is certainly not good enough for me.
7
So long as all roads lead to single payer, phased approaches, among them, the public option, make great sense. Think of it as Medicare for more, upon passage of the bill and Medicare for All in, say, eight years.
Medicare as we know it, provides for supplementary private insurance. Does the Sanders Plan continue the practice, which would reduce costs to the government? Please inform us in detail, where the devil resides, as the article does to a considerable degree.
Does the Sanders Plan provide for importation of prescription meds from Canada? I know Sanders supports the measure but a number of Democrats, evidently addicted to political contributions from big Pharma, have wimped out. Please give us detail on how Medicare for All intends to cut the costs of prescription drugs.
25
Go Bernie, Go !
The transparency with which this bill is introduced, discussed and will be debated is such a stark contrast to the one that the McConnell plotted behind closed doors -- no wonder the 7-year republican effort crashed in a spectacular fail.
Go Bernie, Go !
51
Of course the US should have universal health care. Medicare for all sounds good to me.
It's fascinating to look at my Medicare statements and seeing how much the government refuses to pay! (From a recent statement: amount billed, $140.51; allowed amount, $14.90.)
But one person's cost is another persons earnings, and it's difficult to see how, in just four years, doctors, insurance executives, hospital administrators, pharmaceutical executives, and the rest would adjust to being less wealthy. And what about all the people who have paid to get themselves certified in medical billing? What would they do?
7
It will be a catastrophe with hospitals going bankrupt Aand massive layoffs
3
My mom has medicare but also has supplemental insurance- whats wrong with that system? Give everyone access to preventative care and allow different levels of private insurance for people who ant to pay for it... Can't we do something like this?
36
That's actually how it works in many countries, Aaron. Single payer does not mean the death of private insurance.
Covering everyone is the least a civilized, prosperous country can do. I'd like to think the United States falls into that category. But making basic healthcare a for-profit industry fails to make sense. Let private insurance serve other than dire, life and death situations and you have a rational combination of government and capitalist systems without the savagery of even the ACA.
33
We will need more doctors if this is to work, especially in rural communities. Have the supporters of the bill considered this at all? If so, what's the plan?
3
I'll always love Bernie, but Sen. Gillibrand always seems to have thought things through all the way, and provides comprehensive solutions that also make sense politically. She doesn't care what the dominant paradigm or the party line is- she makes up her own mind, takes a position and sticks to it. Independent in the truest sense of the word. The Democrats are lucky to have her, and if they don't invite her to be their next presidential candidate, and instead choose someone whom they think is more politically correct based on their internal polling (like the socially divisive flamethrower Kamala Harris) they're hopelessly lost.
32
Mr. Sanders' interview of Canadian doctor, Danielle Martin, on his radio show was excellent. The tone of that conversation, based on Mr. Sanders' questions to Dr. Martin was much more toward the desirability of a single payer health care system, perhaps modeled on the Canadian model. That would mean a taxpayer supported system with no need to argue with insurers about coverages and with a tremedous amount of leverage to get much better deals on drugs from big pharma.
All the patient does is produce their health card and the system pays the doctors; no dancing around and everyone gets health care as needed. Pretty simple idea, and it works in a great many countries. I guess Mr. Sanders is hoping that a lot of Americans will see the desirability of such a system, and will get behind him and offer his bill
their support.
With two such systems operating on a continent that we share, there is no good reason why the Canadian health care establishment and the American one couldn't join forces and get even better deals for their citizens and better service all around!
In Canada, as Dr. Martin pointed out, if any politician tries to present a two-tiered option, they get shut down immediately. Kellie Leitch , a candidate for the leadership of the Conservative Party of Canada, finished sixth in that contest. Two things that assured Leitch would not win were her stand on health care and her insistence that all immigrants be screened for their possession of" Canadian values".
41
Give me a break - lots of Canadians come to the States for treatment when they have any anything that`s really wrong with them.
6
Just FYI:
Medicare pays physicians miserably.
I, as an anesthesiologist, cannot make a living on what Medicare pays. Period, full stop. For those of you who think that physicians are overpaid, I have news for you. Medicare would pay me less than you pay your plumber or electrician.
I expect some agitated rebuttals, but that is the truth.
Some things, such as physician compensation, would need to be evaluated and adjusted. Facility fees, pharmaceutical expenses, medical device costs, ancillary services such as physical therapy, etc, should all be subject to scrutiny and re-assessment. In this country, pharmaceutical and medical device expenses are much, much higher than they are elsewhere.
Of course, some will advocate for health care that is delivered by non-physicians - nurse anesthetists, nurse practitioners, physicians assistants - as being of equal quality and lower expense.
In that regard, I say you should expect to get what you pay for.
However, I do believe that we as a nation should have universal health care, and we need to look no further than Switzerland to find a successful marriage of public and private insurance that is comprehensive, cost-effective, and affordable.
42
I support universal healthcare. I have no problem whatsoever with doctors being paid enough to make it worthwhile for them to stay in practice. I hate the entitlement to cheap labor, whether it's for fast food workers or physicians. I would guess - and you can correct me if i'm wrong - that there would be considerable savings in paperwork, unnecessary testing, and administrative personnel just for starters, that would offset many of the expenses that physicians incur as the system stands now.
26
In the US, the average income of a specialist MD is $240,000. In Switzerland, the average specialist MD earns $130,000. Would you consider this appropriate?
23
Average Medicare spending is about $12K per year per recipient.
For a buy-in, that would seem to indicate a price of about $1000 a month per person. You would also need supplemental coverage, say $250 a month, and drug coverage which runs from $15 to $100 a month.
11
Speaking as a Vermont constituent, Bernie has always talked a great talk but when it comes time to walk the walk, Bernie stands with the military-industrialists first. His support for Lockheed's budget-busting F-35 fighter jet and its basing in Burlington means the destruction of health and home values for thousands of his constituents. The working poor; working class; elderly; immigrant refugees, veterans, etc. The F-35 is turning entire neighborhoods in Vermont's most densely populated area into federally designated "not suitable for residential use" zone. Almost the entire city of Winooski; huge parts of South Burlington; Burlington; and Williston. Homes will no longer qualify for mortgage financing. Elementary schools; daycares; church's, etc., all under threat.
When Vermont Public Radio's Jane Lindholm asked Bernie why he refused to meet with even a single one of his constituents on this matter, he immediately changed the subject to pie-in-the-sky talk about student loans. Here, Bernie has a chance to actually walk the walk and make a difference in the lives of the people he is paid to actually represent, and he instead prioritizes Texas-based Lockheed-Martin. Even the Air Force didn't want it there and ranked Vermont as lowest choice because of negative environmental impact. Is Bernie's "Medicare for All" going to pay for new houses & moving costs for all of these people? Some of whom have lived in these neighborhoods their entire life?
22
I agree with and support a premium based national public "medicare-like " public option. It would simply replace or at least compete with the marketplace options already out there. I would supports smokers and the morbidly obese paying more as well.
In order to support a true government run single payer system, taxes will need to be risen dramatically on all Americans- that is how the other countries do it. So in Denmark, the top tax rate is 60%. The catch is that, unlike here in the US, a large percentage of the population pay that top rate.
In no country are there enough wealthy people to pay for healthcare for the entire country. The other thing that will happen is that a healthy growth sector of our economy ( health care) will become not so healthy. ( basically nearly eliminated). In addition, disposable income will greatly diminish or disappear for most Americans. No more new car purchases, fancy smart phones, expensive flat screens, frequent dinners out, going to the movies, concerts,and on and on. People simply won't have the money to do all these things due to the taxation rate.
This is only one consequence of a government run health care system. let us consider widely before we through it all away. People travel to the US from all over the world to get specialized health care. What do they know that we don't?
5
We're already spending over $10K per capita per year on healthcare. Diverting those funds into universal health care would go pretty far towards funding the whole thing. If costs could be brought down to something like they are in other countries with universal health care, there would be more than enough to cover the whole thing. Stop thinking of it as a giant new expenditure, it would be just a matter of using what we spend now more efficiently.
8
I disagree. I pay exactly $6000 a year for healthcare for a family of four. Deductible for each is $350 a year. My overall tax rate with standard deduction is about 13%. In Denmark, my tax rate would be 60%. 40% more in taxes for me is far more than 6000 plus Deductible exposure. And I am already paying Medicare taxes for free Part A coverage when I turn 65. Simply retiring won't lower my tax rate in Denmark. My retirement benefits would be taxed at 60% under our current system. Now I know you will want to through all kinds of comments about administrative waste, shareholders, CEO salaries and all of that ( and you would be right to a certain extent), but taking a huge chunk of our private sector economy and throwing it into the public sector should not be done blindly. At the end of the day, private sector dollars must be adequate to cover public sector expenses. Its already impossible for us; let us be careful not to make things substantially worse.
3
Canada has universal healthcare and the average middle-class Canadian does not pay 60% tax rate. I lived in Canada for 15 years and thought the health care was very good and never felt I was burdened with an outrageously high tax rate. Yes, taxes run higher there, but, you get a lot in return. And, yes, Canadians buy new cars, big tvs, fancy cell phones, and they even take vacations to poorer countries such as the US!
49
Here is what is wrong with the public option.
1. A lot of the waste in our system is due to administrative and compliance costs of private insurance companies. While these would be reduced for the people on the public option, they would remain for the vast majority.
2. You can be sure the insurance companies will find ways to attract, the young, the health and the well off, leaving the public option to cover the sick, the older, and the poor. This will drive up the costs of the private option negating the savings from greater efficiency. Then the Republicans will point to the failure of the public option just as they are now pointing to the failure of single payer in various states. (This was because states have to exempt so many people, what they can do is not really single payer.)
3. There is no clear path from the public option to a efficient universal system as there would with incrementally expanding the age for Medicare coverage.
The important thing is to get the politicians to admit the overwhelming data that show a universal, government run health care system would give everyone coverage, better care for all, and cost much, much less. Then we can find a way to work towards that goal.
13
The public/private options exist side by side successfully in Germany and Hong Kong. Just an FYI. A government run health care system will give coverage for all, but not necessarily better care for all. As far as cost, simply paying the same for drugs as other countries will lower our GDP percentage costs due to health care immediately from 18% to 13%, far closer to many countries than most people realize. Also, as US citizens, do we really think that government can run healthcare? Do we think that the VA is well run? It is a single payor governmental preview for us on a small scale. Why would a single payer only system be any better? where is the data to prove that?
11
Mark. I don't know about Hong Kong, but the German system, is not as you claim. For one thing Germany requires everyone to have health insurance. Salaried workers and employees below the relatively high income threshold of almost 50,000 Euros per year are automatically enrolled into one of currently around 130 public non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. The sickness funds are mandated to provide a unique and broad benefit package and cannot refuse membership or otherwise discriminate on an actuarial basis. That is quite different from letting most people sign up for private insurance in the US. Furthermore most of the wealthy that could opt out do not choose to do so. Less than 10% of the population do.
As for data, here is some:
Per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3
UK - 4 192.5
France - 4 600.4
Australia (similar obesity) - 4 708.1
Germany - 5 550.6
Denmark - 5 199.3
The Netherlands - 5 385.4
Canada - 4 643.7
Israel - 2 775.7
Switzerland (Highly regulated private insurance) - 7 919.0
http://stats.oecd.org/Index.aspx?DataSetCode=SHA
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
23
If we ever get to universal health care people will one day look back and be amazed that some Americans died because they couldn't afford health insurance.
Someone once said America always does the right thing, after trying everything else first. We'll see if we finally do the right thing with health care. Thanks to Bernie for keeping this issue front and center.
32
The process has begun. America as of today is not ready for Bernie's plan but within a relatively short time....four to eight yrs it will be.
Shore up ACA until we can join the rest of the civilized world and achieve quality, universal, affordable health care for all.
7
Often ignored when talking about the "enormous cost" of Medicare-for-all is that drug prices and other medical services could then be negotiated - a possibility specifically banned in ACA, a compromise required to get Obamacare adopted. Bernie is on the right track; the ONLY way we're going to get meaningful medical reform is to just to it all at once ("at once" meaning relatively quickly). You cannot change just one part of the system and expect it to work. The other thing often overlooked when Republicans talk about "massive tax increases" is that we ALREADY PAY massive taxes for medical care-not only Medicaid and the VA, but also the billions of dollars spent every year to care for those who don't have insurance. We don't (at least not yet) let people die in the streets. How do you think that "free" care is paid for? Ultimately, from public coffers. So, let's look at the whole thing and make a choice in favor of the maximum efficiency and efficacy. Medicare for all.
20
In order to raise spending on health care, we need to cut spending elsewhere. Everywhere in Europe one sees the effects of their view of government -- that its first job is to protect the well being of its citizens. There are wonderful recreational areas, fine school systems and childcare systems, maternal and paternal leave, longer vacations, good transportation systems, available wi-fi, and on and on. They have chosen to spend money on their citizens, not on the military, and it shows. We cannot have a bloated defense budget, the goal of which appears to be to control the whole world, and also provide healthcare for our citizens. I would prefer to take care of our citizens.
45
The sad thing is that in spite of all his great talk and introducing this bill, even Bernie Sanders is completely in thrall to the military-industrialists. Although the Vermont media has done a decent job of covering it (especially Burlington Free Press; Seven Days; and Vermont Digger), the national media has ignored Bernie's iron-clad support for Lockheed's budget-busting F-35 fighter jet and basing it in Vermont's most densely populated area. Bernie's support for this negatively impacts thousands of Bernie's constituents, whose health and home values are under attack thanks to extreme noise from the jets, turning their neighborhoods into federally designated "not suitable for residential use zones." Will no longer qualify for mortgage financing, etc.
Conveniently, real estate developers like Senator Patrick Leahy's cousin, covet this land and rezoning it for commercial purposes, and Sanders and Leahy have fully cooperated. Bernie Sanders has always talked a great talk but don't expect much to change when even a so-called "progressive" like Bernie puts military Keynesianism before the policies he pretends to care about, such as health care.
7
Bernie supports the F-35 being based with the Vermont Air National Guard, as does the rest of Vermont's congressional delegation. If the F-35 were banned, the Guard base would close. They are very aware of the adverse economic consequences of a base closure.
1
Take it out of the military budget. Problem solved...
2
Actually, if Americans weren't afraid of Europe, they might be open to looking into how many Universal Health Systems work in say Denmark, Sweden, England, Germany. In France too, it works well, but what hurts every system is the dishonesty inherent in many people, rich and poor alike, who take advantage of the system. Once that fact is swallowed (and it seems to be a tough one for Americans Republicans especially) universal health care does work. Remove Capitalism from the management of the system and it can work. It already does in so many other parts of the Federal Government. Americans have created a perverse, ideological argument against the most basic of human rights.
58
Little chance of passing, but at least the issue has made its first official appearance in the arena.
3
You got to start somewhere, what I don’t understand is why Canada and Australia and other countries can do it, but the greatest country in the world, that would be us, can’t do it.
31
Americans don't think healthcare is important - until they NEED healthcare.
10
This bill helps those without employer-provided health care (given my status, I will not need to change). It seems perfectly suited for those areas of the country when many voters simply cannot get anything decent and affordable. The Dems have an opportunity here to begin taking back some of the voters they lost after ignoring the rural people for several decades.
Will they blow it, or not? These bills have to be crafted to help those most in need, including those in the rural deep south, who don't like voting for City Dems.
16
That was the entire point of Sander's health care bill. He wants to start the debate now so the issue is front and center in the Democratic primaries. He's not shoving medicare down anyone's throat. He's staked out a position where he believes medicare is the best path towards single-payer but that's not the real goal. The real goal is to establish health care as a right in the public mind. Even a loss on medicare is a victory. The Clinton side will be forced into supporting a public option as the more conservative choice. Without Sanders, the public option would be considered extreme left again so we'd get something worse. We also might get lucky and actually adopt medicare for all. Stranger things have happened.
63
As a physician in private practice, I guarantee your health care dollar is better spent investing in the doctor patient relationship rather than costly overhead that pays the exorbitant seven figure salaries of hospital and insurance company CEO's, growing number of administrators (and shareholders who have nothing to do with your health ) who create meaningless work to waste drs time typing away to increase billing, while our focus during the visit should be improving your health . Let's go back to being healers again...growing pesticide free food in a clean environment, eating healthy and exercise will prevent a large number of our chronic diseases, so our population can become more productive.
214
Does your proposal imply limiting the number of medically unnecessary tests and treatments?
4
Thank you nycdr for your intelligent and principled response. When doc's speak, people will listen....
2
One problem as I see it is that much of government health insurance has its prices set by a panel of physicians, physicians not coincidentally among the highest paid in the developed world. I don't know how you can efficiently raise healthy chicks and chickens if the foxes are running the hen house. here is just one article on this shameful, corrupted process. Oddly enough, from the NY Times. https://well.blogs.nytimes.com/2011/09/22/how-one-small-group-sets-docto...
5
Total healthcare dollars spent on US physicians is 22% of healthcare dollars. Half goes to pay practice expenses, such as the salaries of other American citizens. So in an apples to apples comparison to let's say, Candaa, American doctors take home 10% of all healthcare dollars spent. How does this compare to other countries? Answer: I don't know. I can't find that type of comparative data anywhere. Yes US doctors make more money for the most part; but so do American factory line workers compared to Mexcian factory workers. productivity data show American doctors as seeing far more patients per day that many other countries, and more than all other countries. ( OECD data). Why? because they make money for doing more work. Take away that motive, and you have our VA system. No incentive for a doctor to do more. ( not meaning lower quality, just meaning lower productivity). We also have less doctors per capita than most countries, so in the end, something's gotta give. Foe example, if you are a psychiatrist in the US, you don't have to accept insurance because the demand relative to the supply is very high. So in a government decrease to psychiatry fees, they will simply not take insurance and make far more money. Do we really want our doctors to make less money for a savings of maybe 26 billion a year in a 3.2 trillion dollar annual system? It will make no difference. Let doctors make a buck. They deserve it far more than the other cogs in the health care machine.
Government insurance has nothing on the CEOs of private insurance companies.
Let's remember that Joe Lieberman killed off the public option into "Obama" (Heritage Foundation) Care at the last second. Remember that? Anyone? It was so long ago...
105
Remember it well! I was just pointing this out to someone the other day:
http://www.nytimes.com/2009/12/15/health/policy/15lieberman.html
2
I lean Left. If anything remotely resembling Bernie's (someone who's not even a Democrat) plan is taken too far by the Democrats, I am done with the party. Period.
I can understand, and support the public option. However, any citizen who wants additional care on top of the basic, Medicare-like plan should be allowed to buy their own private insurance to do so. (In fact, we now have Medicare Advantage, which is run by the private sector). End of story.
I would honestly recommend that the Democrats take a deep, long breath, take a step back, and hit the pause button on stupid, starting-point, negotiating ploys and instead focus on working out a serious plan that is carefully costed out. Anything else is irresponsible. And suicidal.
4
The way single-payer works in Spain is that everyone pays into government provided healthcare and are covered with no out of pocket costs except for some copays for medicines. Full coverage for most standard procedures and treatments are offered. This doesn't mean though that a person can't buy private insurance if they want what they consider to be the "perks" of private care. But they can't opt out of the national healthcare system. Private insurance is ,however, thus in the position of competing with the national system, which leads to competitive pricing on their part. I don't see why a similar arrangement wouldn't work in the US.
14
What the Dems are doing IS "focusing on working out a serious plan that is carefully costed out." That's exactly what all this is about. But the finish line cannot be crossed until you leave your mark and start running the race, and that's what they're doing. Suggest we support them, at the risk of being thrown to the GOP wolves who simply do not care whether people have health insurance or not. Geez. Isn't it obvious that the Dems are the ones doing the hard work of actual governing?
2
What about these facts, Wahtever?
All other industrialized countries have some form of universal government run health care, mostly single payor. They get at least as good care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person on average. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://stats.oecd.org/Index.aspx?DataSetCode=SHA
Some data:
Here are the per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3
UK - 4 192.5
France - 4 600.4
Australia (similar obesity) - 4 708.1
Germany - 5 550.6
Denmark - 5 199.3
The Netherlands - 5 385.4
Canada - 4 643.7
Israel - 2 775.7
Switzerland (Highly regulated private insurance) - 7 919.0
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
The WHO using a formula developed by The Harvard School of Public Health ranks our system as 38th in the world. (France & Italy are 1 & 2). This formula doesn't include costs. Bloomberg ranked countries' systems on efficiency which does include costs. We came out as 50th out of 55.
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
3
Giving people a choice between private insurance and public option makes sense to me.
16
Adding a public option to Obamacare would call the bluff of every Republican. It wouldn't force a single American into a government-run plan but would add choice and competition, especially in areas where very few insurers are offering Obamacare. All Democrats should be able to coalesce around this idea.
117
The public option would also call the bluff of every progressive. What if private insurers turn out to be better?
2
David, we have the numbers on that. We have private insurers and we have federal insurance in the form of Medicare and Medaid, as well as the VA (which also is the provider). In all cases, the federal program is much less expensive per procedure than the private insurance model. And that's just in this country. In other advanced economies, public guarantees of healthcare costs are much more cost effective than our hodgepodge system of private insurance. We spend 17% of GDP on healthcare, vs 11%, which is the highest of all other advanced countries.
15
David, in a left handed way you are making a good point. You can be sure the private insurers will construct their policies so that they will be better than the private option for some people, namely, the young, the wealth, and the healthy. That is why a public option is not a good idea.
BUT compared to the universal, government run systems of almost all other industrialized countries, a system based on private insurance stinks.
2
The single biggest political problem with getting to single payer is shifting from a premium-based system to a tax-based system, as Krugman notes, opening up "massive tax increase" attacks on politicians. That's why this transitional strategy is so important: let older people buy into Medicare and probably let younger people buy into Medicaid plans as part of the ACA, using the subsidies currently provided to insurance companies. Insurers may still be able to provide useful and competitive products (as they do with Medicare or in some European systems). At some point, employers will come to the table because the necessary payroll taxes to buy better health care will be cheaper than their premiums, and a tax-based system with some supplemental insurance--Medicare/Medicaid for all-- will be a reality. Thank you Kirsten Gillibrand for a winnable strategy!
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I lived in Britain for 8 years and met many people from all walks of life. They British are great complainers and will grouse about nearly anything, but in all that time I do not EVER recall anyone complaining about paying taxes to support the NHS. Many people would cheerfully have paid more.
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No one seems to mention in these articles about Medicare that only 80% of a medical expense is covered by Medicare so most people buy supplementary insurance to cover the last 20%. Also, most people purchase Part D drug insurance. These two coverages come from private insurance companies, Blue Cross, United Healthcare, etc. So the private companies are not totally going away with Medicare for all. The costs are much lower than purchasing individual insurance coverage from any private company, but Medicare is a mixture of public and private insurances. There is and will be plenty of competition for private companies to sell the supplementary policies.
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If you read any good coverage of Sanders' plan, you'll see that it expands coverage to fill the gaps you mention, as well as others (dental care, for one), eliminating the need for supplementary coverage.
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Really now. Bernie's "Medicare for all" bill is "costly? " What, private health insurance is a bargain? Your bias is showing—not to mention your need to do some further math.
Our catastrophic, irreparable, for-profit health care system wastes vast sums of money, and even an insured person could go broke after paying premiums, deductibles, coinsurance, and copays. And they are the fortunate ones compared to people who have no coverage at all.
Medicare for all would be significantly less costly, dramatically more efficient, and infinitely preferable to the current scheme. We would rather pay a reasonable premium for Medicare than pay an outrageous premium for private insurance that covers fewer things and provides fewer benefits. And don't worry about health insurance companies. They'll keep flush by processing Medicare claims for the government, and peddling supplemental insurance plans.
I know the media habit is to roll your eyes at crazy old Bernie and cluck that his grandiose plans cost too much money and are short on details, but try abandoning the narrative and thinking instead. Medicare for all makes perfect sense. It's long overdue.
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"Medicare for all would be significantly less costly".....The present cost of healthcare for the U.S. is about $3 trillion dollars annually. Just removing the middleman profit presently paid to the insurance companies would reduce the cost on the order of 10% to 15%. Do the math. I always thought Republicans were hell bent to save money? Go figure.
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To John:As a Canadian enjoying a public health care insurance plan, I was going to right an answer to the so-called "costly government insurance program". After I read your comment I can only say that I approve your message.
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https://www.washingtonpost.com/opinions/single-payer-health-care-would-h...
But the government’s price tag would be astonishing. When Sen. Bernie Sanders (I-Vt.) proposed a “Medicare for all” health plan in his presidential campaign, the nonpartisan Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it.
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Call it the: Returning Individual Human Rights Plan. ---- Healthcare is included in Human Rights. So is food, housing, clothing, education, protection from violence, equality. If people had what they were supposed to have when they were born, then...... Hey, who stole my Individual Human Rights?
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Medicare for All is itself a fallback compromise by world standards. The simple logic of economic efficiency dictates that eventually we will expand Berniecare to a system like the UK's NHS, and get rid of the wasteful privatization of hospitals etc.
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A public option would be a good start toward more affordable, universal coverage. But we should also start reducing the Medicare age gradually, perhaps initially to 60 or 62. People in the 60-64 age group are paying the highest premiums under the Affordable Care Act. And they are often pushed out of corporate jobs, due in part to the high costs of insuring that age group.
We also need to make sure all children and pregnant women are covered, preferably at the federal level, through a Medicare/Medicaid hybrid. When this coverage is at the state level, too many are left out. Our maternal mortality rate in the country is shamefully high, and needs to be addressed as a public health crisis.
There are many ways these changes could be paid for, including a slight increase in the Medicare withholding tax combined with an additional tax bracket for higher earners. We could also close the carried interest loophole. The main thing is for Democrats to have a plan to gradually get to universal coverage, and communicate that plan to voters in a coherent way that emphasizes fairness.
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There’s also the question of what it would mean for current beneficiaries of Medicare/Medicaid.
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It would mean lower costs to the elderly as the insured pool increases to include younger and healthier Americans, who use less medical services. That, in fact, is what every other civilized country does, and why in every other civilized country healthcare costs a fraction of what it does in America.
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Younger and "healthier" Americans do not use less medical services, they use different medical services (obstetrics, pediatric care, etc) which aren't necessarily cheap. An ob-gyn still has to charge a sufficiently high cost to patients to cover his/her sky-high malpractice premiums (relating largely to the ob part of ob-gyn, which isn't a part of an older woman's health care). As to why America does not do what other civilized countries do vis-a-vis health care, remember Hillary's statement, "We are not Denmark."
3
If everyone is Medicare, we end the multi-tiered health care system we currently have. No more "out of network" or doctors who won't accept Medicare. For current beneficiaries it will lead to better care
2
I have often thought that allowing younger families to buy into Medicaid and those who know longer need maternity and pediatric care to buy into Medicare would be a good way to divide it up. The benefit packages could be gradually tailored over time. Better postpartum home care could be added to Medicaid and more chronic disease and hospice options added to Medicare, for example.
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Thanks to Bernie Sanders and others for putting this out there. It is about time.
Now I'd like to see the press report on the truth about universal health care, instead of the sound bites. People in this country who are against universal health care spout all sorts of "facts" about wait times, rationed medicine, and second-class care, but when you talk with people from countries with it, you don't hear those kind of complaints. I'm sure there are problems, and some may end up on the wrong side of the system, but probably those situations are equal to what we have here. I know lots of people with medical horror stories from their care in the US. So let's see some real reporting on the issue, instead of story after story about infighting within Congress.
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As a user of the health system (twice in the last two years) I can assure every American that as a Canadian we got first class care and the medicine is not rationed. And if you have to wait at the emergency, in a way it is good news, if they rush you, it means that you are really in trouble. Of course, we have problems but I am rather to have to deal with our problems here than yours.
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Having dealt with "problems" in both countries, I rather have ours.
Lived in Canada for nearly ten years (Toronto). Canadians don't like to talk about the realities of their healthcare system (extra fees charged by doctors to make money because the government pays so little, doctor shortages, "concierge care") because they rather look down on Americans.
There is TONS that is good about Canadian healthcare, like the emphasis on preventive medicine, and the protection against financial ruin due to medical bills. But the "single payer" aspect of it is a mistake...which is why no other country of note (save for Indonesia) does it that way. Not the UK. Not Germany. Not AUS.
Then there are the sky high taxes...in Quebec nearly 50% after Federal, Provincial and local.
I have never come across anyone who was solidly middle class and who had lived with both systems that prefered Canada. Ever.
8
EB,
well I have lived with both systems, and I know which one I prefer. Canadian one. Though US Medicare which covers me now is pretty good too.
About 10 years ago, I required spinal surgery (a fusion). US hospital, where I had insurance wouldn't tell me what the procedure would cost, so no way to plan ahead with my limited insurance. My insurer hadn't "contracted" with local US hospitals, so that was another wild card. I could be charged full Rack Rates.
I got a second opinion in Montreal and they told me in advance what ALL costs to me would be. I would only be charged a flat daily fee to cover all radiology, operating room, post op recovery in a private room, etc. I chose to have the surgery done in Canada, by a top notch Neurosurgeon. Later my US insurer paid all my bills from Canada, well really just the one page document., less my deductible.
EOB endless paperwork (explanation of benefits) No. ? Later bills from various specialists, etc? No. Best part was no further bills arrived after the fact, no collection calls.
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Wrote this as a comment to Paul Krugman's column a few hours earlier; it's worth a reprise here.
The starting point for negotiations: Medicare/single-payer for all.
The fall back compromise when the inevitable greedy oligarchic forces are marshalled against the above: voluntary buy in to Medicare (in which there will still be room for private insurance supplementation, as there is now), and/or a public option based on the insurance options current Federal employees have.
I would like the first. But I'd settle for the second. Those who want to keep their employer provided plans could under the second, as was possible under the original Ted Kennedy proposals. But I suspect over time the portability of Medicare and/or a public option, as well as the savings due to reduced administrative burden/non-profit status, would encourage many to switch to those plans. It would happen over some years, giving the poor insurance companies and employers time to adapt.
And the second approach, given that it involves voluntary actions, has the added virtue of denying conservatives/Republicans a lot of arguments against. (Not to mention it would be easier to get moderates and some conservatives to accept.)
Let's not defeat ourselves by making the perfect the enemy of the good.
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Sometimes the good is problematic.
Because ACA was written to appease insurance corporations, it had second that we open to challenge. The Supreme Court ended up throwing out the Medicaid expansion, ripping a giant hole in the program.
If the Democrats had jammed through bill that said taxes will be raised to pay for everyone to be covered under Medicare, it would not have been open to legal challenge.
Simple is often better and the perfect is often simpler than the good. When you have the votes, pass the perfect!
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I'm a retired Fed and take part in the FEHBP, but remember that the cost to those in the program is greatly subsidized by the government. Here are the 2017 premiums for nationwide fee-for-service plans:
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/pre...
HMOs are subsidized similarly.
2
Yeah, leave it to we Democrats to boldly state, "This is what we want!"...then, settle for something much less because it's easier.
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