The problem with this column is that it gets the whole process backwards. As an Australian, living in a country which literally has "Medicare" (that's what we call it) for all and has done since 1974, let me explain what you are all getting so completely wrong in the health care debate.
Americans, like the authors of this column, get it wrong by starting with the political problems of introducing a new system. This is putting the cart before the horse. The only way to design any system to deliver an outcome is to define the outcome first, and then figure out how to achieve it.
In Australia, the desired outcome was that basic healthcare, especially any kind of emergency healthcare necessary to preserve life, would be provided to all Australians without any out-of-pocket expense. There are a plethora of details that have been attended to in creating the system that delivers that outcome, but they are just details.
Start with identifying the desired outcome as being that all Americans can obtain a minimum standard of healthcare, especially emergency care for sickness and injury, without having to pay costs billed by the provider directly to the patient. Then you design a system - or better yet, just adopt a system that is currently working, from Canada, Britain or Australia - that will deliver that outcome.
It's a new system. Start from scratch. Get the basics right from Day One and leave the details to sort themselves out over time. If we can do it, I bet you guys can too!
3
nowhere in the article do I see a mention regarding the huge savings that businesses would see by not paying healthcare for their employees (an odd system anyway, and leaving out millions that do not have it)...I would hope (maybe it should be mandated) that all of that savings would turn into increased salaries for workers, which, in turn, would help pay for an increase in taxes...
15
People need to accept , you pay premiums and/or taxes for expanded Medicare. Seniors pay premiums, co-pays and supplemental insurance costs. I think Medicare should provide a choice for the uninsured, however it will not be free.
5
It would have been nice if Ms. Luthra's (Kaiser Health News) full connection to Kaiser and Kaiser Permanente were mentioned.
As of October 2017, Kaiser Permanente had 11.7 million health plan members, 208,975 employees, 21,275 physicians, 54,072 nurses, 39 medical centers, and 720 medical facilities.[2] As of December 31, 2017, the non-profit Kaiser Foundation Health Plan and Kaiser Foundation Hospitals entities reported a combined $3.8 billion in net income on $72.7 billion in operating revenues.[1] Each Permanente Medical Group operates as a separate for-profit partnership or professional corporation in its individual territory, and while none publicly reports its financial results, each is primarily funded by reimbursements from its respective regional Kaiser Foundation Health Plan entity. KFHP is one of the largest not-for-profit organizations in the United States.**
**https://en.wikipedia.org/wiki/Kaiser_Permanente
5
Why not free-stuff for all..? Bernie says it’s our right as citizens of this great country to have free medical care. Free education. Free food too when in need, and free shelter with a living wage for all! Low taxes also. Tax the rich 1% and let them pay for the freight! Vote for free-stuff on 6 November, please..
2
The United States is the most backward industrialized nation on thew planet with respect to health care for all. Americans spend more on health care and get the least for it. A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses even with Medicare. Health care is a right not a privilege. US heath care policy is controlled by those who want to make profits from the illness of American citizens- insurance companies and drug companies.
Call it what ever name appeals- but we need national healthcare for all - anything less is a continued sham and disgrace.
5
“Medicare for all” is an oxymoron. Just ask anyone in the countries that profess to practice its equivalent. Better yet, demand that candidates making it their rallying cry provide simple details, like how it will be paid for, who will pay for it and what it will cover. Estimates of the cost to implement a program in the comprehensive manner its supporters imply are staggering. When pressed on that one aspect socialists like Bernie Sanders and Alexandria Octavio-Cortez engage in double speak or mimic a deer in the headlights facial expression.
“Medicare for all” makes a catchy campaign slogan. It’s another in a string of slogans employed by opportunistic politicians. To those fooled by similar promises like “my plan will save the average family $2500” and “you can keep your doctor” I would offer a salient response, “fool me once, shame on you, fool me twice, shame on me”.
4
If you are dissatisfied with your health care for any reason, there is a simple solution.
Vote Democratic in two weeks.
Democrats will cure all of what ails you. Quickly, cheaply and with a smile on their faces.
Trust Democrats. They are just what the doctor ordered.
1
President Trump is a jerk, a conman, he is in it for his money, a robber baron. Republicans obfuscate in order to deceive the voters.
Germany, the first country to have mandatory public health insurance started low-cost insurance for hourly wage earners way back in the last years of the 19th century when Bismarck was Chancellor. It grew to include salaried people and it had an income ceiling. People earning more were excluded and could use private insurance. Today everyone can choose a more expensive regulated private insurance. Most people don't do it. Medicare is part of the system and one premium includes dental care, eye care, and hearing aids and prescriptions, no other insurance needed.
The system never failed not even after two lost WW. It beats our system any time. It was a response to the socialists and it was good economics. Germany still is a productive industrial nation. Their system never caused harm to their economy. Trump would like to destroy the German competitive economy and the EU.
3
Fraud & Abuse - not mentioned in this article & most other discussions - is the Elephant in the single payer room. Per the GAO fraud currently comprises 10% of the Medicare budget.
It's an insidious problem often involving street level activities & dangerous behavior as well as systemic and financial crimes.
State & local agencies are necessary to effectively detect and address these activities as they have the "street smarts" to do so. Single payer means single control. That experiment for a large & populous nation was tried before in the Soviet Union (remember that) with spectacular failure.
3
While there is at least a national conversation on a better coverage, almost all who analyse these things will say it's going to take a long time to put something in place. And the need is in my opinion great.
In the meantime, there is as you may have heard a plan that would provide a single payer type coverage for all NY State residents.
It has been proposed for a few years now and has passed the state assembly for a number of years in a row. It narrowly failed in the Senate and hopes are strong, especially if a few more democrats get in, that it could pass this year.
Thought it doesn't get much press, there is plenty of info available online.
Google Campaign for New York Health for starters. We could have this in NY soon. It would be a great chance to help NY now, and to show the country it is actually feasible. So while we talk about the great difficulties in enacting national healthcare, lets not overlook we have a great chance to enact it in NY, hopefully leading the way for the rest of the country.
2
What a weird article, it reads like they locked the writer in a room and asked for 500 words on why Medicare for all was a bad idea and they couldn't come out until it was done.
Medicare is a system which exists, it works, it cuts out the for-profit, middle-man health insurance company, it negotiates with big Pharma for drug prices, it's cost effective.
Bernie's plan was simple, pick an age e.g. 55 and put a price on Medicare then allow people to buy into it. I would sign up immediately of this were offered and I'm 61 and in reasonably good health.
This simple action would plug the gap that exists where people who have some money but can't afford ACA policies (whose prices being driven up by deliberate republican malfeasance), would be able to buy good coverage at a fair price.
Then gradually crank the age down until everyone is able to buy Medicare, then cover everyone with Medicare and pay the bill out of taxes.
7
U.S. healthcare costs are roughly twice those of other "wealthy" countries, largely because of the administrative costs of managing the overly complex qualification provisions and payment terms in our multitudinous insurance plans. Our local doctors and hospitals tell me that administration and getting paid adds at leat 30% to their costs, not including insurance company administration and profit. Just having a single form policy and a single payment pool could substantially reduce the cost of medical care.
8
When Bernie Sanders proposed 'Medicare for All', he was called a Socialist, and the Republicans went to town on it. And, now to see the Republicans wanting to embrace the same idea, is not convincing. Is this another election time gimmick?
If 'Medicare for All' sounds Socialist or Communist, so what? Does it not benefit the people? On the other hand, having to leave everything relating to healthcare in the hands of the private sector, is also a reason for the high costs of healthcare in this country.
What has Mitch McConnell got to say about 'Medicare for All'? Thought, just a few days ago, with a straight face, he was proposing cuts to Medicare, Social Security and Medicaid.
No matter what you want to call it, these politicians, from both sides of the aisle, must cut to the chase, and come up with a solution to address the health care needs of the people. This is even more important than having to build the wall on the southern border.
4
What Americans don't know about so-called "single payer" systems is truly remarkable. It really is rather simple: around the world, in such systems, your taxes underwrite the cost, or nearly all of the costs, of your medical care. This is considered fair and prevents people from dying or experiencing shortened lives and undue pain because they may not have the means to pay for care as provided in private plans. It is also intended to prevent wealthy people from monopolizing the best care available. By and large, these systems are successful. The tangle of entitlements, wealth and priviledges that passes for health care in the United States is confusing, expensive and while it provides excellent care for those who can afford it, does close to nothing for everyone else. That might in good part be why life expectancy in the country is so low when compared with the rest of the developed world. You have first world care for those with means, and care more typical of a failed state for the poor. Promises to fix this have run up against all the well-funded lobbyists representing everyone who has something to gain from keeping the poor sick and everyone who actually can pay, paying more. Its complete neglect on one level and extortion on the other. And you call that medicine? Hypocrates is spinning in his grave.
9
Who has ever gone into a bookstore or even taken out a book at the library and noticed the cost label affixed to it. Ever wonder why that book lists two different costs- one for USA and a separate one for Canada which is usually barely 0.5% higher than the American one?
Such a small price to pay to enjoy and appreciate a medical system which keeps everyone with quality healthcare access and freedom from the anxiety of potentially going into personal medical bankruptcy.
Would you rather pay out of pocket 14K a year for 'insurance' premiums (only after a $2500 deductible is satisfied) or pay less than half that in a small tax on a few small items, knowing you no longer have to deal with shifty insurance adjusters.
8
There's a lot to consider, but right now I pay premiums of $11,500 per year PLUS a $2000 per person, $4000/family deductible. If all that can be replaced by a 7% or 8% tax, that would be a huge reduction.
The only thing I actually get out of my healthcare insurance is reduced prescription pricing, preventative care and coverage for serious illness/accidents, should that happen.
Standardized pricing might help too. If you go to the Dr for a cold, with insurance the negotiated price might be $80; without insurance, maybe $175.
There has GOT to be a better and more economical way to get better health outcomes FOR US ALL than the private - that is, for profit - system we've had for so long.
9
From the NYT August 2018:
A growing majority of Americans agree: Health care should not be a business. They’re finally coming around to the idea that it can and should be a public good instead — something we can all turn to when the need arises.
The favorite right-wing argument against Medicare for All — the most popular approach to universal, publicly financed heath care — is that it’s too expensive. However, our current health care system is actually the most expensive in the world by a long shot!
This is partly because a lot of that money doesn’t go directly toward keeping people healthy. Instead it goes to the overhead costs required to keep businesses running. These include exorbitant executive salaries, marketing to beat out the competition, the labor-intensive work of assessing and denying claims and so on. None of these would be a factor in a single-payer, Medicare for All system. Taiwan and Canada both have single-payer systems, and both spend less than 2 percent of total expenditures on administrative costs — and so does the United States’s current Medicare program. By contrast, private insurers in the United States spend as much as 25 percent on overheads.
But the most important way Medicare for All would save money is by using the power and size of the government, like other countries around the world currently do, to negotiate favorable terms with drug companies and service providers. There’s a reason a CT scan costs $896 in the US, but only $97 in Canada !
5
The first step should be to get everyone to agree that something has to be done. The cost of medical care takes a larger share of the nation GDP every year which means that it would eventually consume the entire Gross National Product.
2
Keep in mind that, according to Federal CMS statistics, physician incomes are roughly 10% of total health care costs (practice expenses are another 10%).
So if all physicians worked for 1 dollar a year, the total health
care cost would decline 10%.
But even that cost reduction would disappear over time as ever more talented students head to Wall Street and Silicon Valley, as quality of care declines, as accurate diagnoses (already declining) fade away, and as physician talent, motivation and work hours decline.
2
Sound bite talking points and misleading and incomplete questions in polls are an inappropriate and incorrect way to educate and address a complex issue such as this. It is a way to promote and propaganda-ize ones position, but pretty much only that. Questions about tax increases can't be asked in a vacuum - without overall comparison to what the offsetting difference to household costs for health care related expenses - including not paying premiums (or minimal costs for premiums vs current private market premiums), removal or reduction of co-pays, and no deductibles - plus the ability to have a uniform system (i.e. no pre-existing conditions, etc.) nation-wide - allowing for predictability and increased efficiency. Generally, one will pay less in increased taxes than they currently due in all of these other costs - but because it involves math, too many people revolt at even having to listen to talk involving numbers (and having to engage in serious, critical thought). These are simply a few topics and considerations - too complex for the current dumbing down of political disucssions and education in far right "rallys" and political push polls.
2
It occurs to me that Medicare was created as socialism for the health insurance industry. They don’t want to provide insurance to people they know are going to get sick and the older you get the more likely you are going to get sick. Instead they charge twice the cost of the rest of the world, only to insure people (the young) who generally don’t get sick. That’s a sick and evil system.
They didn’t want to carry older people because they get sick and eventually die, so the government does it for them. Socialism for them, hell for the rest of us.
5
If you think the federal gov't taking over all of healthcare will magically just bring these outrageous costs down for everyone, or even hold them steady, consider this chart - see link below - personal expenditures on healthcare in the US before and after the passage of Medicare in 1965. The issue shouldn't be about access, it should be about cost - and whatever our gov't decides to subsidize - whether healthcare or student loans, moral hazard and distorted market pricing lurk close behind. Prior to 1965 we had largely a cash healthcare system and folks purchased "catastrophic" private insurance. If you look at the unsubsidized, largely cash-side of healthcare today - plastic surgery, eye care, lasik surgery, dentistry, etc., the 20 year cost trend adjusted for inflation is virtually unchanged and for some services has actually decreased. The chance to let markets to work in healthcare died in 1965.
https://fred.stlouisfed.org/series/DHLCRG3Q086SBEA
1
Mitch McConnell just stated that the next step for republicans is to cut Medicare and Social Security to pay for their tax breaks for billionaires. Now they are talking about another tax cut because the last one didn't include enough breaks for their capital gains. They disguise these assaults on the majority of this country by claiming they are "saving" Medicare and Social Security and claiming the tax cuts are for the "little" people. Until republicans are removed from office, nothing will improve but it will get much, much worse for most of us under their watch. Vote!
3
@kay "Tax Cut" has become the magic talisman for the right, and "Taxes" the evil monster to be slain - with the persistent push and propaganda from the hard right, test marketed sound bite slogans and focus on support from the under-educated masses. These are the same people who don't understand that the fire department and police department aren't free, and have decided that homeschooling is a perfectly fine alternative to paying for all those darned teachers (who as everyone knows are socialist democrats). Reagan popularized the far right revulsion to medicare and social security - the Koch brothers and their John Birch Society mentality seeping through from the fringes to the mainstream of Republican thought (often wrapped in Koch brother greenbacks...) Sadly, there is a particular segment of this society that chooses to not be educated, or are simply uneducable, on this or many topics requiring critical thought and analysis. The Democrats may have to decide whether to bother trying to convince them, as compared to just show them once they are able to put in place the policies. (The ACA is a good example - many of those folks now like feature of the ACA - but hate Obamacare - demonstrating that showing them by giving them a good - or at least better - option was the right thing to do.) But the D's gotta win to be able to do this, and then not be their worst enemies by getting distracted by sideline issues.
1
Self-employed for twenty years, a decade of that in Germany, where I had excellent, highly affordable health care. For around $200 a month, everything was covered. We never worried about how much a procedure, test, or hospitalization would cost.
Back in the States: insurance more expensive, and so many restrictions, from co-pays to in-network doctors to what seem to be arbitrary rules for what would be paid for and what would not. Premiums went up every year, until we had to cancel our insurance altogether. We had no insurance until the ACA. Thank goodness we were healthy. Finally, subsidies (I'm a single parent) helped us to get re-insured.
Then cancer struck. Since then it's been nothing but a gradual piling up of enormous medical debt, with deductibles, co-pays, and again, care that the insurance company will sometimes pay for, and sometimes not. I will never get out from under this mountain of debt now, and it only gets bigger with every passing year. My medical expenses are driving me into bankruptcy. I used to be a fully participating member of society, have worked hard and paid plenty of taxes my entire life. Now medical expenses have turned me into a lifetime debtor. When I am older, I will have no savings and nothing to live on. Sometimes I wish that I had just died of the cancer, because the debt is hopeless. And I resent knowing that the money I need to live on is going to pay for the luxurious lifestyles of insurance execs and doctors. We are a sick nation.
20
I would like to see a modified single-payer system that requires companies with 50 or more employees to pay for the health-care insurance of their workers, with Medicare for everyone else. Large corporations got a big break from the new tax bill. Why should the taxpayers now pick up their health-care costs?
5
For starters politicians should pick a constituency, those aged 60 to 65 for example, and enable them to scale into Medicare over a period of years. The virtue there would be to remove an expensive health care cohort from the private insurance rolls. This would reduce personal and business health care expenses dramatically. These newly eligible medicare enrollees or their employers could stay on private health care plans or pay their premiums to Medicare. Every step of the way gains a new constituency and supporter of Medicare for all.
3
I wouldn't get too excited until we have another Democratic president. Republicans want to put us at the mercy of the cherry pickers and gatekeepers: the real Death Panels.
4
The problem with this pie-in-the-sky Utopian dream is that Medicare and Medicaid do not reimburse healthcare provides as well as private insurance, so the single payer option shortchanges physicians and would result in a poor healthcare system.
If such a Utopian model ever happened, the private insurance should continue to exist. Also, Americans should be given the option between the private or the public insurance models and this who chose the public model should be taxed appropriately and those who chose the private model should not be taxed to pay for the healthcare of others.
But as we witnessed with the rollout of Obamacare, the President's promise that if you liked your current insurance plan you will be able to keep it and if you liked your current physician you would be able to keep that person as well, an option between public or private insurance would be a lie. A lie, a ploy to get gullible Americans to go along with it.
Don't be fooled, America, lend a deaf ear to Utopian schemes, don't go the way of Great Britain or Canada, nation's whose health care systems pale in comparison to America's! Keep American healthcare profitable. That's the capitalist way. Capitalism is the way, the only way! Thank you.
2
@Southern Boy
Have you actually received care in Canada? Or is this your conclusion looking at Canadian care from somewhere within the Confederacy (likely through the lens of Fox News)?
Personally, I think the cancer care my wife received (and continues to receive though she's in remission) in Toronto is at least equal to a lot of what my relatives have received in the States. This is not to say that there isn't fine care in the states (I've received some exceptional care there before moving to Canada), but Canada does a good job too, with a much smaller base of wealth to support the system. The US should do better—it's ten times larger. But my experience with both systems suggests that dollar-for-dollar, the Canadian system delivers at least as well as the US system, and with far less financial disruption in the lives of those who need care.
4
Too many people are suffering economic devastation under our current system.
4
Democrats advocating Medicare for all are doomed to fail.
As economists in both political parties will attest, our nation’s entitlement programs, including Medicare, are quickly on their way to going broke. The idea that Medicare could be expanded into a single-payer system is attractive to the far left, but is a totally unrealistic budget-buster. Politically, the GOP will remain in power as long as Democrats try to cram down a single-payer system on all Americans.
Instead, Democrats should offer voters a clear, feasible choice by designing a Medicare option for all Americans at actuarial cost on a “non-profit and non-loss” basis.
Start by offering Medicare as an individual option for all Americans between the ages of 50 and 64, with the premium fixed at the average cost for that age cohort based on actual experience for this group alone This provides a safe harbor to older Americans outside the employer-based system of group medical insurance. There are at least 10 million citizens in this group alone. By focusing on them first, the bugs can be worked out of the billing and payments system, and the Medicare staff can be expanded rationally to make the service system work without flooding it with new enrollees all at once. Then the option for younger cohorts (35-49 next, and finally those under 35) can be added sequentially.
1
I was recently called a liar in this comment section when I said that NYC spends $30,000 per year per student on education. That number comes from a $33 billion budget divided between 1.1 million students. Even with this massive budget, the city barely manages to graduate half its students in four years of high school. The problem with Medicare for all is, what will actually be covered? Will we cover unlimited psychiatric care and counseling? Unlimited cancer treatments? Transplants? Potential spending on medical care is limitless and politicians have shown no ability to triage our resources to where they will do the best good. We squander billions on heroic efforts but deny average Americans access to basic dental care. Before the federal government takes on new obligations, they should balance the budget. After the US has put its fiscal house in order for 5 years, we can talk about taking on massive new obligations of Medicare for All.
1
"There’s also the thorny issue of how Medicare for all would affect the thousands of jobs at private insurers."
Huh? We must hesitate in our quest for fair and high quality health care for hundreds of millions of Americans because of
the "thorny issue of how Medicare for all would affect the thousands of jobs at private insurers."????
Is the New York Times company heavily invested in, or funded by
the health care industry? One might think so from the sad tone of this piece. This is one issue where Trump and the Republicans have nowhere to go - they have offered zero after trashing Obama care for years. The Republican thinking on health care should be called HUAD - "Hurry Up And Die".
For the dim bulbs who tell us that single payer, medicare for all is some type of communism, I say no, it is common sense. Unless you are in the 1% income bracket, catastrophic health problems are a real life horror movie that you can't escape from, and more importantly, can't afford. With all Americans paying into the system, there is adequate funding for everyone. This is what all industrial nations, except America, do right now. There will be glitches of course, there always are - but it is light years ahead of the disgusting, greed driven, system we now endure.
5
Remove the Social Security payroll tax cap and use the funds for Medicare For All. The SSA cap is regressive.
Problem solved.
4
Blah, blah, blah. Sounds like "Brexit talk" in England. Does nobody see how to do it: Enroll newborns at birth. Pay for it with a one-tenth of one percent tax on all financial transactions without exception, deduction, exclusion. Every time money changes hands, the bank send .1 of 1% to the federal government. Health care insurance is a scam, with insurance companies taking 20% to 30% for themselves.
4
Could this call for "Medicare for all" just be a hypocritical ploy to get elected, and then ignore it by finding other entertaining subjects 'a la Trump'? If Medicare for all is close to what a single payer universal healthcare system might be, awesome; but talk is cheap, and disengaging from the current one (initiated during WW II) based on employer's insurance, may be mighty difficult, and requiring a public demand to a divided congress, as the republicans would most definitely vote against it. So, let's not get too excited about it, as bad as it sounds.
People are so gullible; it is incredible. The cost of single payer is so prohibitively expensive both CA and NY nixed it. If you do not want any take home pay then vote for democrats and single payer. The rest of us do not intend on doing that; we are informed and tired of contributing to entitlement programs that will not be there for us in later years. Since the democrats want to flood the country with uneducated, non professionals who will flood the system for benefits they cannot contribute enough $ to keep sustainable with the minimum wage jobs. Nothing is FREE.
5
@Jan
I think you're right that a large group of Americans are gullible, but I'm afraid you've misidentified which group. Those of us who have lived, worked, paid taxes, and received healthcare in both the United States and other countries (in my case Canada) know that single payer systems cannot only be made affordable (to the extent any modern healthcare system is "affordable"), they can actually be cheaper than the US system. Yes, taxes go up. But insurance costs plummet or disappear altogether. Most people don't know it, but the employer-provided coverage that the majority of us well-off workers receive costs about $18,000 a year for a family of four. You and your employer share that cost, but that's the total cost. In a single payer system, taxes do go up, but insurance premiums drop. It's the same cost, just paid differently. The benefit is that in a single payer system your access to care is more reliable and not likely to bankrupt you when you become too sick to work.
And an aside on those immigrants—as fertility rates in the US decline, you are going to need more young immigrants to support the cost of your old-age entitlements. Your choice is having more babies, bringing in more immigrants, or just losing your entitlements and dying old, poor, and without care.
6
Btw your doctors hate that you have Medicare. Why? Because the reimbursements are laughable.
100 bucks for a spinal injection!??!
1500 for a Knee replacement?!!
The plumber charges 200 to fix a leaky toilet valve.
The only way doctors are able to practice is by limiting the number of Medicare patients in their practice so insured patients actually can pay the bills.
With Medicare for all - get ready for a true 2nd tier system for people who actually want to see well trained physicians. Because any doctor that can will immediately opt out of Medicare.
So you’ll be paying more in taxes for Medicare for all and still paying for a secondary insurance or cash.
Btw not all physicians are created equal. There are those that go medical schools on some tropical island and do a family Med residency at a fourth tier program and there are those who actually studied. You can guess who you’ll be seeing.
21
@Bob I love my Medicare. After a lifetime of experience with private insurance and the US-trained doctors providing the care, you don't scare me at all.
4
The title of this article is "way off." Defining the details of "Medicare for All" is one thing but claiming we should "not get excited" about it is another world.
Of course it needs to be defined. But we SHOULD get excited about it. Out current health system is a disaster. Each month we read new reports about it's weaknesses and low rankings on international measurements. Recently, a study showed we had on of the most inefficient systems; too much waste, cost and poor outcomes compared with other nations. Many have no access to our system because of cost. It is not socialism; a word with 10 different meanings and "meaning" of words is not important with health care. An unstandardized system like ours of course causes waste and inefficiency. Of the 33 wealthy nations, we are the only one with no national system. Free markets and glorious capitalism with its profit motive have no place in the health care of a nation. Let's get going with a national health care program.
6
A $200 bill I received, which would have been $350 without insurance, for a walk-in clinic visit on a sleepy Sunday that lasted all of two minutes, taught me all I need to know about single-payer health care. It taught me that when you suddenly get sick or injured, you should be able to go to the doctor and receive care without ever having to worry about a bill. If you want private insurance for elective procedures not covered by single-payer, you can buy it, but at the most basic level you need, your bills are already covered.
The politician who has courage enough to say this out loud will get my vote.
8
Very solid piece, balanced and honest. There will be winners and losers in a system where government is more involved in healthcare, and a follow-up should examine this specific issue more closely. One reason though why universal coverage gets more political traction now, then say 1980 when Ted Kennedy championed it, is that more stand to benefit from it now than before.
2
Medicare for all, single payer can happen here.
But not until we have an effective leader(s) who can team up and over shout the paranoia and the lies perpetrated by the GOP and finally get through to the voters that it IS possible to have a much less expensive health system and one that puts the physicians back in charge of our health, instead of the MBA's, politicians and CEO's who are milking us for every damn dime. Literally.
Rep. Sanders was the first brave soul to get the word out about single payer. Big Pharma and the insurance industry is ripping everyone of us off to the tune of billions of hard earned dollars with the help of too many greedy profiteering politicians doing their regulatory bidding for them. It is so so important to shout these pols out of town. As soon as possible.
5
I am a retired UAW member and I have health care through my union. I chose Aetna this time. It is a PPO with Medicare. Last time I chose BlueCross/Medicare. Both plans have a minimum cost and deduction. Since this type of insurance is done for retirees, and could be done by employers that offer health insurance. It would keep the private insurances, Blue Cross, and Aetna going without loss of jobs.
This cost me every month (Medicare, and a small monthly stipends) and I have to pay a portion of my drugs and hospitalization, but I could get another insurance (Aflec) to cover the parts I pay. The insurance companies will figure out how to charge for additional services, without a great loss of jobs. Competition helps keep the cost down for all.
2
First step: A constitutional amendment that identifies health care as an individual right, not a privilege. Our right to avoid bankruptcy or to simply go without health care due to blatant profit-mongering by Big Pharma and the insurance companies should be a basic premise, as it is in every other developed country on earth.
2
The real problem with American health care is that too few Americans have generic health care concerns until AFTER they have had personal health care crisis. Personal illness sharpens the senses and focuses the mind on generic health care. Nothing like a preexisting condition to cause one to focus on health care as a public health issue.
4
I think the heart of the matter and the reason why many Democrats don't want to elaborate on what they mean by "medicare for all" or "single payer" is that in all circumstances some sort of transition is required.
The reason the ACA was passed isn't because it represented the best alternative for improving the health insurance system, rather it was the best alternative that could be passed in our corrupt political climate. For Democrats to embrace single-payer or medicare for all, they'd have to be willing to confront the enormously powerful lobbying interests of the for profit healthcare industry. As long as their profit is in the equation, it will be virtually impossible to enact meaningful change. I believe you'll know Democrats are serious when you start hearing them talk about meaningful campaign finance reform as a prerequisite to any other change. It will likely take time before any comprehensive change can be enacted and it most certainly requires removing the Republican party from power. In the interim it might be necessary to accept stopgap fixes like a public option to address the immediate concerns of those who cannot afford health insurance.
3
France and Germany deliver healthcare with comparable or better results for half the per-capita cost, about $5,000 as opposed to $10,000 in the U.S. We'd have to be utterly incompetent not to get enormous savings from Medicare for All. It benefits individuals as well as businesses.
What it means is if we do healthcare reform correctly:
1. The cost to a typical family of four falls from $18,000 per year in premiums to around $12,000 per year in taxes.
2. Premiums, deductibles and co-pays go away; the taxes cover everything.
3. We go from 30 million without coverage to zero. Nobody has to worry about pre-existing conditions or fighting with insurance companies. You can choose your own doctor.
4. The government must have the power to force down prices to German and French levels. Doctors will get 30 million additional patients to make up for some of these price reductions with volume.
5. Corporations will still have to pay payroll taxes for their employees into the Medicare for All Fund. As the savings are achieved, these taxes can go down. This gets big business on the side of labor for a change.
6. Our long-term budget deficit becomes sustainable overnight, with healthcare cost inflation dramatically reduced.
7. There will be transition costs, with health insurance companies significantly downsized, but millions of jobs created also to cover the additional volume of patients.
3
Medicare for All? Be careful what you wish for. Those who think Medicare is a panacea, or that it's the finish line in the marathon foot race to affordable care, have a rude awakening coming.
My wife and I are both on Medicare, but because of rising insurance costs, coupled with the onerous prescription costs, our total premium and prescription costs are increasing 175% in 2019. That's because the drug my wife has been taking for 5 years, a drug advertised in this very article, has a co-pay for the year of $5,800. Her condition hasn't changed, the only difference is that she is now on Medicare, and the help for those under 65 disappears once they reach Medicare age.
Seeing my wife in a wheelchair because we can't afford the co-pay is not an option. Medicare.gov lists the drug price with no insurance at over $76,000 a year. It makes me wonder how long it took for the drug company to recoup its R+D expenses.
Our insurance and co-pays alone, with zero doctor's visits are over $11,000 in 2019, which doesn't include our individual and family deductibles. We aren't rich.
This drug has been on the market for 20 years and recently won an extension of its patent for another 16 years. Outrageous prescription drug prices, due to the greed of Big Pharma will continue as long as Congress members continue to accept lobbying moneys which far outpace that of any other industry.
5
@Yakker
I've got news for you. Your personal premium expenses would deflate greatly in a National health service/Medicare for all system simply because everyone would be contributing to the pool instead of only 65 and over seniors. That's a HUGE pool of additional funding support. It would also force supplemental insurers to become more competitive driving down costs. Notably drug costs. Big Pharma, right now, operate with total impunity to charge whatever they want because we have no national health service oversite. Hello?
2
My suggestion is to first beef up the ACA and make Medicaid mandatory for all states. As Medicaid and Medicare are already managed by the federal government, the next step might be to begin including more people in those programs. Federal tax liabilities should include a surtax that funds the growing healthcare system. Medical facilities and physicians could begin to be hired by these public systems. In short, it doesn't have to happen all at once. I can't wait for sore losers to start creating federal cases against various parts of the plan so the supreme court can reject it. By then more Americans will be enjoying healthcare without going bankrupt.
I got off the plane in Spain in 2016. Their GNP is like a third smaller than ours, they had 20% unemployment, in Granada it was worse than that. Everyone I saw there, other than the Americans walking around, was 100% covered by health insurance, from cradle to grave, and if they get cancer, they are still covered 100%. Throw in the climate, the culture, the food, the wine, the historical buildings, the architecture, the niceness of the people, and I saw it as an absolute paradise.
Americans living in the richest country in the world are living a miserable dog-eat-dog existence compared to most places for the sake of our rich people, courtesy of our politicians who seem to be waging war against ordinary people.
Gandhi said: Poverty is a kind of violence, the worst kind. Our system, created by our politicians are inflicting violence on us every day. The median wage hasn’t gone up since 1972 but GNP has gone up 150%. Where did alll that wealth go? To the 1%.
Medicare for all is just a start at a beginning to fix this country.
9
@Tim Kane
You quite accurate say: "Americans living in the richest country in the world are living a miserable dog-eat-dog existence compared to most places for the sake of our rich people, courtesy of our politicians who seem to be waging war against ordinary people."
Part of our problem, though, is that far too many of the ordinary people seem also "to be waging war against ordinary people." The politicians and their wealthy donors have pulled off the remarkable feat of enlisting the ordinary people to wage war enthusiastically against themselves.
5
Perhaps the first step is to make Medicare available to anyone who turns 50 years old since that appears to be the age when health care issues start to affect people. It would be a good start.
4
Let's start with all federal representatives and employees test "Medicare for All" first. If they like it, then I might consider allowing them to impose it on me.
I've seen too many UK Parliament PM Question times where at least one question was centered on the issue of NHS service or functionality. Really? I believe that's a sign of disfunction. Do we want weekly House/Senate discussions about whether Aunt Millie has to wait for (or can't get) treatment?
The closest thing we have to Medicare for All is the VA. It has a fair number of problems with graft, corruption, poor service, etc. It should get fix first before imposing a 'solution' on the entire population.
Will undocumented aliens be afforded all this 'free' healthcare? If you're going to be in a country that provides free healthcare for more than a casual visit they typically require things like a chest x-ray to prove you don't have some latent disease. Are we prepared for that?
In short, it's not an easy issue and no wonder why opinions are so divided.
3
"Surveys suggest growing enthusiasm among doctors, too, with more than half in favor."
I wonder if the good doctors realize that a single payer system/medicare for all would mean significantly less money for doctors, hospitals, (obviously) insurance companies, medical device companies and everybody else who makes a magnificent living out of the current for profit system.
Any talk of change is a pipe dream. Our current political system, with hundreds of lobbyists, will not stand for any change which reduces profit.
Medicare for all at current profit levels would mean huge deficits or extreme taxation.
All those talking about Health Care systems in other developed countries, and asking "why not us?", do not realize the huge differences between those countries and the US.
Just look at our current political system for the last several years: a system where even if you have a majority, nothing ever gets done.
A system where the majority party's most significant goal is to eliminate even the small achievements of ObamaCare.
Or, going back further, another majority party attempting Health Care reform (ObamaCare), only manages to patch the old Health Care system, so that they benefit some people, but hurt many others creating a system that many people can't afford. That happens because politicians are beholden to the special interests getting huge profits from out Health Care system.
2
We have to remember that all of the cost sharing features now in employer and ACA plans were not the idea of consumers. They were a reaction - going all the way back to the 1970's - for employers to reduce premiums by shifting costs to the employee and their families. This has not reduced the rise in health care costs at all. Now we have people paying 10-20% of their annual income to health care costs - sometimes before a claims is even paid on their behalf.
The commercial insurance industry has failed to control prices. This is why commercial health plans in the US pay between 175 and 300% (yes that is true in Indiana for example) of Medicare allowing hospitals to be grossly inefficient and profitable despite the fact they are supposed to be public benefit organizations.
1
The government already runs a major medical delivery system -- the Veterans Administration (VA). We've all read about the terrible scandals in poor treatment of our veterans. I wonder why the government's mishandling of veterans' care isn't part of the conversation?
Nor do we hear anything about the massive fraud that is perpetuated on Medicare (taxpayers) every year. According to the government's own Office of Management and Budget (OMB), as much as 10% of the money spent by Medicare is fraudulent, overpayments. etc. That's tens of billions of dollars a year.
3
Plus, Medicare would not involve government run hospitals or government employed doctors etc.
Medicare fraud is estimated to cost $40 billion per year. We spend only $100 million per year on 400 FBI agents who investigate Medicare fraud.
We should have at least twice as many agents investigating this fraud. Maybe we could get somewhere that way.
1
Health care costs too much because everyone at every step is making a profit off someone's illness.
This may be Donald Trump's transactional America, but we ordained our Constitution to promote the general welfare.
Too much money ruins health care and politics. We're on the wrong path.
1
It's not going to happen in this political climate. Trump and the Republicans are planning another vote to eliminate the ACA in the lame duck Congress. They will enact some form of cuts to Medicare and Social Security when possible to pay for the recent tax cuts.
People who vote for Republican party just don't get their fundamental bottom line. At rock bottom they don't believe government should be providing any benefit to citizens except for roads and infrastructure (sometimes) and the national defense. After that you're on your own unless you're a corporation or business. Make no mistake, a future with far fewer social services is what we are moving towards under Republican leadership no matter how they package it with Orwellian phrases that say the opposite.
Trump's bald lie saying that Democrats will effectively eliminate Medicare is beyond comprehension.
We have Medicare because of the Democrats (LBJ).
We have Social Security because of the Democrats (FDR).
But large segments of the population blithely believe the latest falsehood peddled by the Republican machine. Republicans have effectively branded Medicare and Social Security as "entitlements." Not a program that Americans collectively pay for. Social Security has a huge surplus which the government "borrowed" to fund past general government expenses. The term "entitlement" is in preparation for reducing said programs whenever they have the ability to do so.
I wish I could be more optimistic.
3
I have always been confused as to why the ACA met with such opposition other than Pres. Obama's skin color. I lived for decades in Germany where the universal health solution (other countries also use this model) was a universal mandate - with over 200 private insurers providing competing options. Some of those options were restricted to occupational groups, some open to anyone - AND there was one private insurer who picked up those who fell through the cracks and the govt. paid the premiums - providing that public option.
Medical care was always prompt, good, there was as much or more choice of physician as with our current system.
Premiums were paid 50% by employee and 50% by employer and capped at a percentage of gross wages up to a cutoff point at the high end.
If the ACA had been allowed to develop, it would have gone in this direction and I really thought that the US could accept it.
I would like to agree with you, but I think you are wrong. ACA is not a German system. German system is based on the Government regulations, that is absent in ACA. Such omission leads to uncontrolled growth of healthcare cost, and put the cost insurance. out of range of affordability.
1
Why do we think doctors have the answer? Arent' they part of the problem?
1
The United States is the only country in world history that has forced some of its citizens to emigrate in order to be eligible for health care. This has to change.
1
It’s real simple. It means Medicaid -not Medicare-for all including those of us who have been paying withholding taxes for decades. It means ruining the employer insurance system, rationed care and lousy doctors. It means an unworkable mess. Remember how Obama couldn’t even get the signup software to work despite spending many millions of dollars on it? That is what Medicaid for all would be. A disaster that will bankrupt the nation. This is just a cynical scam to buy the votes of every freeloader in the country.
2
Unworkable mess, it is what we have right now. The cost is higher than in any other country and quality is not better. Rations of healthcare is at every level, including what insurance to have because it defines not by need of people but by offering of employers. What doctor to use, what procedure to have, what drug to buy is defined by insurance that is not worry about your health but about their profit. It was even worst before ACA, because insurance could refuse you because of preexisted condition. So, why should we worry about losing the system what many could not afford anyway?
1
50% of people in USA are beneficiaries of single payer now (Medicare, Medicaid, Tri-Care, et al).
1
Wouldn't it be an interesting read for the NYT and/or other news outlets dedicating a Comments section from around the world to respond to the health care they receive, encouraging the best and the worst in their opinion about the care received. Opinions, not only the recipients of their health care systems, but from the doctors, nurses, administrators and all who contribute toward providing this service.
3
The world of health insurance is quite byzantine and complicated. The GOP takes advantage of this complexity to promulgate bald faced lies about Medicare and their own pathetic alternatives. The complexity is such and the amount of misinformation that has been peddled over many years means most Americans don't really have a clue.
Nothing short of TV specials done over several hours over several weeks would be necessary to educate the public. This is a crucial step that has never been done.
The first step would be to simply create the public option. Medicare plus a secondary medi-gap plan for co pays and deductibles would be only a few hundred dollars a month compared to individual plans through the commercial insurance markets which typically cost from one to three thousand dollars a month. There is simply no comparison.
The GOP has resisted making the public option simply one of a menu of alternatives you can buy in the open market? Since they advocate in their PR that they want people to have freedom of choice, why would you deny them on more choice that is the public option?
The answer is that these deeply dishonest GOP politicians know that simply by word of mouth of everyday people the public would quickly discover the superiority of public option medicare plus secondary over all other private commercial products out there. Soon a grass roots mass migration of Americans to the public option would swamp all the myriad commercial plans.
1
Our political minds operate inside a scam called "privately funded elections" which are of course "corporately funded elections." As long as this scam is over our heads, all good works are subject to the whims of the Wealthy Investor Class. Any single payer system engineered by the W.I.C. will surely do no harm to that class.
I do not denigrate that Wealthy Investor Class, they only do what most would, if in their place. I agitate the public to stand up against that class for our own interests. It's publically funded elections, or a rotten democracy. Take your choice.
1
If you've got half a brain, you'll actually use Google or Bing and go look at Bernie Sanders evangelizing single payer. What he says time after time is "Medicaid for All".
Until someone told him Medicare for All polled better, he knew what he was talking about. Single payer means destroying the United Health, Aetna, Humana's of the world.
As someone who lives in MN..that would mean the death and destruction of the largest employer in Minnesota.
If a single political candidate running in MN says they want Single Payer...they best have ready an answer for how they're going to replace 100,000 high paying white collar and grey collar jobs in the Southwest Suburbs (3rd Congressional District..for those of you who care).
Surprisingly, nobody thinks that Amazon and other Internet stores should be banned because they are killing the retail stores that employ millions of people. Why should customers support the jobs of the system that rips them off and makes the healthcare less affordable. Seems to me it defies the logic pay for making your health system more expensive. At least Amazon decreases cost of products.
1
Health care is another society's infrastructure like roads, bridges, mass transit, education, social security, high speed internet connectivity, law and order, ad nauseam of social program. These are good debts. GOP's and Donald's tax cuts to the elite and dole out to the military called national security are bad debts. It stinks to the heavens.
1
medicare for all is based on the assumption that medicare reimbursements support the current system...
mayo clinic, sloan, md anderson...high tech treatments...do not exist in there current form at medicare rates
it’s not emotional...it’s not good people and bad people... it is just simple math...
private insure heavily subsidizes the system
maybe a medicare only system won’t be bad...but it will be very different...there will have to be rationing...staffs and technology will be reduced...
those who advocate for it don’t know how the current works...
the fantasy of get rid of the beaurocracy and we will have plenty of money...old idea...does not work in a substantial way
1
How private insurance can subsidize the health care if they profit from the healthcare? You can not have both way, subsidize and profit from same system. And rations of healthcare is already exist on all levels. it is exactly what the insurance companies do to stay profitable.
2
A logical first step would be to make Medicaid a paid choice for companies and individuals. It should be true that it’s scale would be able to offer the most affordable options.
Drug pricing must be controlled.
Trump is far more likely to negotiate better prices for Americans and succeed than his feckless predecessors.
Trump should start with the simple premise that Americans should pay no more for drugs than other developed nations, and, given our buying power, we probably should even be paying the lowest prices.
Yes, ignorance is bliss. In the US, people complain when their MRI's are not done in a week, when the lab tests are not back in 2 days, and on and on....I have a home in Canada and Americans would not tolerate the Canadian model ...it is good and it is lacking but Americans want what they want....
Medicare for all...really? People cannot absorb a rise in gas prices in the summer without angst. Imagine underwriting the taxes on health care and for which you give the Government the entire decision making authority...Really?
Reducing salaries for specialists? And what do you think that will do when the days of the " idealized "doctor are over. ...People are already running from Academic Medicine to private practice for as long as it lasts...and in practice, MONEY is the driver....You think that docs will just become another branch of Civil Service...really?
And 16 Million people are employed in Health care and 20% of all new jobs....Good....let's let all that go as well...so you can line up at 4 am to hope you get in the Clinic or ER as people do in Canada every day ( and often sent home after 12 hours ) Really?
1
Strange that Canadians are not eager to adapt wonderful American healthcare system, that bankrupts people and out of reach of many and requires the Government subsidies. Yeah, sure that we should worry about of 10% decrease of 300K specialist's salary but should not worry about raising premiums that put healthcare out of range of affordability of many people with salaries 50k and less.
3
@yulia
You actually know little about the Canadian system. Many seek cross border care and many are just resigned to a system that they cannot change. It has good features but the US body politic will not like the bad ones.
As for physician salaries, it will be far more than a 10% decrease and that will have a profound impact on numbers of specialists available.
I hope you do not get what you wish for.
@Joel Levine
I do know a lot about both systems. There are problems with both, of course. Nothing is perfect. But you are completely wrong if you think Canadians are just resigned to their system. Yulia is right. Most of us would never trade it for the American system. We don't want our healthcare and our financial security to both be at that kind of risk.
1
the Australian single payer system is the most obvious fit for the USA.
1
Every talking point against national health care boils down -- in one way or another -- to putting profits over health.
2
Let me throw out the outlines of an actual solution:
1. The provision of care remains in private (profit or not-for-profit) hands
2. Services that will be covered by the government are identified and include all essential medical services and products
3. The government must do its best to ensure that these essential services are available with only a medically acceptable wait and within a reasonable distance from most patients
4. The cost of this program can be covered several ways. Most simply (and preferably in a perfect world), the government does what it does in Canada—pays the cost directly to the providers. However, given America's huge health insurance industry, a more practical solution may be something like:
A. Primary and preventive care is paid for 100% by the government—this ensures all Americans can get through the "gate" and enter into the health care system
B. Private insurance plans can be used to cover costs up to a certain limit. These insurance plans must cover all the essential services identified by the government (more if they want) with no preexisting condition limits. They can be purchased privately or provided by an employer. The cost is subsidized by the government for those who can't afford them.
C. Catastrophic costs are covered by the government, maybe in conjunction with private reinsurance purchased by the government.
5. All our various healthcare bureaucracies (Medicare, Medicaid, VA, etc.) are abolished and replaced by this one plan.
@617to416
One addition to this: if we are going to keep private insurance in the mix, we will have to do something to ensure that risk pools are balanced. The cost to the insurance company (which drives the cost to the consumer and the amount of government subsidies for policies) depends on two things: what's covered and who's covered. It's easy for the government to create a list of mandatory coverage. If this is what happens, for-profit insurers are going to then attempt to increase profits by getting the least risky customers into their risk pools and the most risky out. If they can vary the price of the policy by risk—and also offer inexpensive optional coverages that tend to attract less risky customers—they will attempt to price out risky customers and offer policies with optional coverages that are attractive to less risky customers. I'm not an actuary, nor an expert on insurance, but I do know that if we preserve private insurance, the government is going to have to address the issue of ensuring policies for riskier groups do not become unaffordable. The ACA has suffered from its inability to keep healthier young people in the plans and from the withdrawal of insurers from markets where the risk profile of the consumers is unattractive. This is always going to be a challenge with a private insurance system, and solving it will require fairly extensive and carefully considered regulation of health insurance on a national level.
Is not the idea of for profit medicine creepy? That people actually make money from other people's illnesses and accidents?
6
@Kuhlsue
They don't make money "from other people's illnesses" as you suggest. Health care workers earn a living by treating sick people. Like everything else in an economy they are providing a necessary service. Are you suggesting a doctor should spend hundreds of thousands of dollars and several years on education in order to take a vow of poverty?
2
I’d like to thank Bernie Sanders for bringing this all important conversation to the forefront of our national conversation !
3
Biggest obstacle to the Single Payer System; SPS. The willfully ignorant American population. Its far easier to stand behind the cliches of socialism, anti-capitalism the Right love to feed their base. Easier because it would mean taking a serious look at the issues/s, instead of simply adopting the more typical hater-side that shuts down reason and careful deliberation on the issue/s. Easier to plant a flag and stick it out with Repub incumbents and candidates who play to the fears of their base. Absurd fears about socialism, and death panels.
But the Dems are as equally to blame. In that they promote SPS, but never explain the what and hows. And then when they get in office, they suddenly become fiscal hawks, and behave the way Repubs are supposed to behave, and undermine their own policies by being too scared of how to pay for them, while not blowing up the deficit. And the Repubs feed on that fear, and hypocritically accuse them of profligate spending and adding more to the "welfare" rolls.
Watch, should the Dems win next month, and try to revive, bolster or fix parts of the ACA, or push any other spending for a safety net plan - the Repubs will be all over how the deficit is gonna explode. And the Dems will cower!
Just watch.
3
The Republican replacement for Obamacare is as follows:
1. You won't get sick. So why does anyone need adequate heath insurance?
2. You won't get old. Give the old folks "vouchers".
This is what they want the 18-40 year old voters thinking.
You may be lucky and win bet 1 but the only way to win bet 2 is to die young. What a solution.
1
T.R. Reid , "The healing of America" gave us the answer and about 8 more examples of how to do this. He spent a few years traveling the world to find out how other countries did have single payer, multiple payer, and other variations that far, far surpass our miserable, bankruptcy version of "health care". Reid spoke to hundred of political organizations, doctor's groups, citizen groups, and news outlets. See C-span for a number of them.
Listen to the GOP at your own peril, but just remember they lie about EVERYTHING !
1
Our medical insurance system may be dysfunctional but at least it doesn't go bankrupt frequently and repeatedly as does Medicare.
1
But why would you want to have dysfunctional system? isn't better to abolish the dysfunctional system and focus on fixing functional one?
I would like the CBO to estimate the savings and benefits of requiring every able-bodied American to walk 30 minutes and perform Tai-chi for 20 minutes every day. I think that would go a long way to solving the problem.
1
Really? The walk is guaranteed prevention of cancer, viruses, bacteria, genetic diseases and old age? Would snake oil do?
1
All the plans and all the consensus in the world mean nothing when a Republican minority controls every branch of government and is warping the rules so they keep it permanently, no matter what the majority wants.
The first order of business has to be structural reform to give the vote to individual humans - not donors, not states, not corporations, not PACs, not think-tanks.
Once that's done, single-payer is a given. If we magically turned into a genuine, representative democracy today, we would have Medicare for all by the end of next week.
4
This article, supposedly informative, is actually the opposite. There is a great deal known about how to make single payer systems work—virtually all developed countries have one, although the details vary quite a bit (I’ll put in a plug in for T R Reid’s book). At this stage what Medicare For All means is the intention to work out such a system for us based on what we have. That is a good, rational thing to do. That’s what everyone else has done.
The article tries to turn that story into fear, uncertainty, and doubt. Not surprising from publicists for the status quo.
7
Seems to me we can’t even agree that the current system needs improvement, let alone be fixed. Unless your team is the one suggesting the betterment.
1
A single payer system based on an improved and expanded Medicare system has two big advantages. First, it will allow providers being relieved of the burdens of running a business, and, two, severely limit opportunities for fraudsters to bleed funds from taxpayers through scams and thefts. In particular, Medicare Advantage systems provide far less portals for scammers to drain the system! Also, a well designed and administered central records system will greatly limit wasteful duplication of tests and procedures.
3
Higher personal taxes, loss of the family doctor... Where have we heard this rhetoric before? Now I remember. It was in 2009 during the debate over the ACA. More scare tactics by the GOP and the health insurance companies.
Reality is this. Too many people are uninsured. Medical insurance it too expensive. For those on government health care, there are too many agencies administering the plans. We have medicare, medicaid, the VA, the military, and numerous state administered plans. All of these plans could be incorporated into a single payer plan and expanded to include everyone.
What is the cost? Lots of estimates from 30 odd trillion to over 40 trillion. What is the amount of money already in the system? It is estimated to be between 40 and 50 trillion dollars.
We need to have the discussion, based upon facts, not rhetoric.
5
“Medicare for all”, while lacks in detail, is known to everyone what it means - that people of all ages will be granted the same benefits that Medicare provides to older people.
“Repeal and replace” not only lacked details it lacked a vision. Replace with what? There was no goal other than repeal.
7
I wish Americans could overcome their fear on this. No system is ever perfect, but the basic fact is that no one in Canada lives in fear of going bankrupt because they fall ill. I am 76 and luckily in good health. I pay a couple of hundred dollars a year to be part of a health clinic that provides excellent care and if necessary can negotiate informed access to the superb, world class specialist services available in Toronto's great teaching hospitals. The insurance industry in America likes to put out anecdotal scare stories about the Canadian system, complete with nonsense about death panels. Well, here's another story. A Canadian friend in Paris had a baby born with serious birth defects. She came to Toronto and the baby had two 6-hour operations at the brilliant Sick Kids hospital. I saw her last night at an art gallery opening, with her baby happy and sleeping in her baby carriage. "This is the best place in the world for this kind of problem," she said. And she didn't have to go through the nightmare of "pre-existing conditions" or having to empty out her life savings. Come on in, Americans. The water's fine.
12
This just reminded me to look at our enrollment website to see what is being offered next year. The most comprehensive family plan, which I cannot afford, is employee paid $23,400 and employer paid $4700 for a total of $28,100. Maximum out of pocket costs per family, for in network, on that plan are $4500, bringing the employee cost to $27,000, or the total cost to over $32,000. This doesn’t even address what the costs for out of network can be.
Rates this year went up 6%. This is actually an automatic enrollment year which shouldn’t have seen any increase. Next year we will be hit with our typical 10 to 20 percent increase.
Just some perspective...our average employee gross income is in the mid 60k range.
Our cheapest plan at $3,200 per year has an $11,000 deductible and out of pocket cap of $22k. Total cost should you get ill of over 25k.
So a person making 60k, carrying family benefits, nets about 48k of that, then either pays half of it as premium or gambles that they don’t use it.
And did I mention our plan is excellent to work with, and I’m stuck with my employer because we max benefits every year and don’t want to lose our doctors.
Can someone please fix this.
7
This essay is about unanswered questions and doubt, but let's begin with the signal incontestable fact presented by our authors: "...this month President Trump wrote a scathing op-ed essay..."
From there we're supposed to buy a single thing they have to say?
Then there's the fact this essay is written from the perspective of people who never had to wonder whether to eat or get their kids healthy, to pay their mortgage or die in some shelter, leave a little something for the kids or die a week, a month, a year early.
This is an essay about economics and the ease with which politicians and policy wonks scramble meaning, play on insecurity, make stuff up. Because we succeed brilliantly at under-educating our people.
Instead of focusing on buzzwords anyone attempting to sway the public uses, the authors could bring to bear some reality, some real reality that escapes the bounds of politics and economics to speak about the benefits and the real costs to people hoping to be served by such a system.
Your "Whoa, taxes are gonna go way up! But you'll save some in medical costs." being a sterling example.
What you'll also save is crushing anxiety about paying insurance scams for some fictional sense of security, aware any serious need will be denied or subject to endless Kafkaesque analysis and recrimination.
There's more to this than the cash; it deserves to be discussed in plain language and awareness that what look like limitations to the authors may be a godsend to most.
5
Every single person I have spoken to who advocates Medicare-for-all does not actually understand Medicare. This article, too, appears not to. Medicare has premiums for physician services (ranging from $134-$430/month, per person, depending on income which for many people is similar to their employer-provided plans), and Medicare generally only covers 80%, so for expensive events, patients are often on the hook for thousands of dollars. Even for hospital services, where there is no premium, patient burden is significant: patient pays the first $1340 out of pocket each year, then for hospital days more than 60 days in any year, $335/day and for more than 90 days in a year, Medicare doesn't pay anything -- the patient has to pay it all (there are a total of 60 days over your whole life you can use after the 90 in any year). If this were a private plan, the same people clamoring for Medicare for all would be shouting about how awful it is that even insured people end up abandoned after 90 days, and that big things (cancer, transplant, etc.) bankrupt people. Medicare for all is no solution. If we want to go universal healthcare, we should seriously discuss and consider that. But Medicare for all actually *IS* an empty slogan used by people (and major newspapers) who don't understand Medicare.
4
I am fortunate to be covered by a plan where I go to the Mayo Clinic with $3,200 yearly out of pocket, no deductible, and premiums that cost less than $10,000 per year. That’s a bargain in the US.
What I don’t get is the negotiated rates insurers have with medical providers.
I was at Mayo for a procedure and the bill was over $15,000 but the negotiated rate the insurance company paid was less thank $1,000. If the Mayo Clinic can survive with $1,000 why do uninsured need to pay sticker price?
1
The Australian single payer universal health care system is excellent. Medicare pays 100% of most private dr visits (some have low co-pay), (Drs are paid a scheduled fee and can charge a co-pay if patient agrees.)100% public emergency health care, 100% public hospital elective medical and surgical (necessary but non-emergent) although there are waiting lists for most non-urgent procedures, 100% of public in-hospital day patient chemotherapy and subsidies for many many drugs for all patients with special benefits for pensioners. Public care is very high quality. System still has some gaps, notably lack of universal public dental treatment & not enough cover & services for mental health and waiting lists too long in some areas so still needs improvements. Private insurance system in tandem for patients who want private services for immediate access and choice of dr. Private insurance is about $3,000 pa per person for high level cover with tax rebate. Would be better if could bank premiums against old age and if there was less out of pockets gap if use private system (can still use 100% Medicare if want to when faced with medical event). Americans have nothing to fear from such a system: it offers high quality cover for all and greater choice & convenience for those who can afford and want it.
7
Dems have to accentuate the way single-payer medical coverage works vis-a-vis benefits in the vast majority of economically world leading countries, where we were in the world community on this score before squeezing through Obamacare's partial reforms.
Additionally, though both parties are married to big money interests, it's critical that Donald's tax cuts be clearly pointed out for the debt skyrocketing elite benefitting fraud they are.
Accordingly, the message has to go out that hitting the privileged with restoration of significant graduated taxes can stabilize medical benefits as well as social security and infrastructure projects creating jobs. We don't have to label it class warfare, but in effect that's what's needed to right the horrendous economic imbalances and injustice too long contaminating our politics.
When Republicans descry Socialism, we need to expose their systemic disenfranchisement of the American worker and family.
5
Every American is a major illness or accident away from bankruptcy.
If republicans were thinking beings , they would understand that a healthy populace is better for the economy. But they choose not to comprehend that. In the meantime trump promised " better affordable healthcare for all"
I haven't seen it yet. My retired sister in her 60s pays 12,000 a year for insurance that covers nothing and has huge deductibles. She is waiting for Medicare.
5
The Republican Senators and Members of Congress don't care, as long as they get to keep their free taxpayer funded healthcare.
There are many points to the argument of Medicare for All. We need information from the CBA as to why Congress has been allowed to dip into Social Security and the Medicare fund that was supposed to be free of being dipped into for anything other
than its intended use, and what those dollars were used for.
Most states have sales taxes on goods, including over-the-counter medication. This is like the VAT only it is called sales tax.
The Social Security Administration could absorb the jobs that would be lost, as it will need many more employees to administer the benefits and to negotiate lower prices.
Employers and Employees now share equally in the FICA tax. If companies did not have to offer Health benefits, it would be a huge savings for them.
We could fund Medicare for All by raising the fica tax another !% on each side.
Medicare is a first class program. You do not have to switch doctors. It is portable. It covers pre-existing conditions. Most Medical practices accept it.
I would suggest that a small Committee be appointed after the Mid-Term election to study this. If I were to pick that Committee it would consist of Senator Warren, as she was the architect of one of the best agencies in Government, the Consumer Protection Agency (Trump wants it to go), Richard Cordray who ran it, two Moderate Republicans and Democrats, a member of the Medical Profession, the Insurance Industry, a Financial expert (Warren Buffet comes to mind and one everyday voter.
2
The by far biggest issue and the one overlooked in all arguments is that buying health insurance is, arguably, a tax, and a retrograde one at that. No matter if you're the lowliest on the pay scale or a corporate executive of a company we all pay the same for employer provided health insurance. Most pay hundreds of dollars a month as their share of their employer provided benefits. Some workers still get 100% employer covered benefits but I believe that is pretty rare. Many workers pay 50% of the cost. If Vermont's state income tax rate rose from 4% to 9% that still equates to a lower cost than most are paying now on the lower end to middle class wages. My husband pays $120 a week for a family plan that covers him and me. My husband pays over 5% of his income for health insurance now in addition to state income tax so essentially it's a wash. But we also have a $7500 deductible in addition to our yearly health insurance expenses. For practical purposes he is paying over 10% of his income now for health care. Why would we balk at paying less? If a worker is making $60K a year and paying $120 a week towards insurance with $7500 deductible his health insurance costs in reality is 22% of his income excluding his 4/5% state income tax. Unless you get deductible free fully covered health insurance through your employer most would easily benefit from single payer. Simple math. The Democrats miss the boat by not calling health insurance what it is, just another tax on the workers.
2
I am not sure why this is important. All policy positions begin from a broad concept such as "let's cover everyone with the system that works so well for older Americans." It is not reasonable to begin from a perfectly written legislative proposal. That isn't how legislating works. One possible step is a system that allows people to buy in to Medicare which is what Bill Clinton proposed many years ago. Let's not let the perfect be the enemy of the good.
4
It does not have to be assumed Medicare for all would remain exactly as is. To do the program justice there should be careful analysis of the best parts of Medicare along with tweaks that may be needed to be an effective national program. If it were to become the national program, we need to take the time to set it up an do it well.
6
And in Australia, where the NYT has an office, there is medicare for all in a system called 'medicare'. As a number of comments on this article note, the United States does not lack for choice in international examples of how to provide 'medicare for all'. It only lacks the political will to establish healthcare as a basic right of its citizens. Perhaps this is because it does not esteem all of its citizens equally.
'Medicare for all' operates in Australia alongside a private health insurance market. If your employer pays for private cover (as a number of U.S. companies do for their Australian employees) you enjoy the choice of both systems.
Reading these articles, I wonder when America will come in from the cold on healthcare. Maybe when it esteems all of its citizens equally?
9
Why not free prescription medication for all? It would be a good start to make sure that 95% of health issues are serviced. Nurse practitioners could provide inexpensive renewal and adjustments to medication.
Care provided by specialists and hospitals is the real reason health insurance is necessary. It is very expensive at the top of the medical pyramid.
With the government paying for medication, the taxpayers could reap the savings of medicinal advances and cures. Big Pharma needs to put people before profits.
3
A healthcare system that guarantees every American is covered goes well beyond monetary issues.
It means that fathers and mothers need not worry about healthcare coverage if for whatever reason they lose their jobs or their businesses fail. They are and always will be fully covered. So this important element of stress disappears.
It means that if you fall ill, your healthcare is paid for by the government. You don't have to go bankrupt or even fear bankruptcy. This means that your children will still be able to pursue their dreams, get a good education and become responsible - as opposed to dependent - members of society.
Universal healthcare gives you the freedom to move where you wish knowing that your family's healthcare will always be covered.
It means that if you become critically ill the hospital will do the best for you, no matter the cost.
Sure it means you pay more in taxes. But when you add the additional cost to Americans of private health insurance, those taxes are actually lower than Americans pay when all costs of living are included.
The U.S. is a wealthy country. It can well afford topnotch universal healthcare.
9
On thing that doesn't worry me in all of this is that the salaries of specialist physicians might drop by about 12%. People are literally dying in this country--sometimes going through the humiliation of bankruptcy first--through lack of access to healthcare. A 12% drop in the salaries of medical specialists *cannot* be part of this conversation.
7
Public option should be the next step, the option to buy into Medicare.
The Medicare provider network is vast, larger than the network for any private insurance carrier. There is a very high probability that if you like your doctor, you can keep your doctor, since there are few doctors that aren't Medicare enrolled providers.
Medicare is large enough that they're able to negotiate lower prices with providers then can be achieved by private insurance companies.
The Medicare bureaucracy is already in place and doesn't have to be created from scratch, just moderately repurposed.
Medicare coverage has very few if any rural geographic gaps. Unlike private carriers, Medicare is not a regional program often with few or no providers available in rural areas.
Medicare is not a for profit insurance carrier, so you save this overhead cost.
Private insurance carriers would still exist, but, they'd have to compete with Medicare. More likely they'd do what they do now with over 65 customers, supplement Medicare, covering costs Medicare won't cover, such as abortion services for younger customers.
If successful, the public option, could evolve to be the de facto single payer system, since so many would likely be participating in the system.
The public option should be tested in three states that have high, medium and low populations. If it works well, then expand it to the remaining 47. If not, then scrap the idea.
2
Businesses and industries die over time when their product is less attractive or less valued than a new alternative. Disruption is a key feature in today's economic environment. While I feel for employees of insurance companies if Americans' healthcare system is replaced by a single payer plan, no government effort fought to protect jobs at Eastman Kodak when digital photography replaced film. The lives and health of millions versus profits and jobs of a few this ands? No contest.
5
One thing that is implied in this interesting article is that nobody's talking about Medicaid for all. As a lawyer who challenged Medicaid expansion in the 26-states' constitutional challenge to a couple of features of the Affordable Care Act, I have thought a lot not just about how the proposed expansion of Medicaid was coercive (7-2 agreeing), but how it makes no sense to expand a broken system like Medicaid. Before we go about providing expanded government-funded healthcare, doesn't it make sense to stick to the knitting and fix what's wrong with our system across the board -- first and foremost being lack of transparency about cost and benefit?
3
I have been on both sides of the health care industry living in Canada for 18 years (dual citizen)--There is no difference in care and the average life expectancy in Canada is almost 4 years longer than in the US. The fallacies that the US system is better and less costly to the insured is one of those free-market myths that Republicans like to throw around. Peel back the curtain and take all the costs and citizens into consideration and the myth falls apart. The benefits go to the insurance companies and the pain to the consumer. Medicare is fine but when I retire I'm heading back to a more normal country.
8
Within the past few years, my husband and I have become Medicare eligible. The transition from private insurance to Medicare has been seamless. And it is as if we have been given a pay raise. It cost us $900/month for me me to be included on my's husband's work policy. We have a supplemental plan and a drug plan. My husband is scheduled for knee surgery in the spring, but the delay is due to the doctor, not the government. But make no mistake. I would far rather our payments to insurance companies for supplemental plans be paid straight into a comprehensive Medicare plan that covers everything and most importantly EVERYONE.
6
Affordable health care should ned no justification in a wealthy society such as the US. It is above all the extremely wealthy who beat the drum for their freedom to amass even more cash at the expense of the less fortunate. However, as cynics in extremis, they should realise that if they succeed in eliminating all of those they probably regard as mugs, they themselves will have to start paying taxes (which at the moment many of them do not). Keeping people healthy enough to hold down a job (especially jobs which people like, say, Jared Kushner would never want to do) is in the interests of society as a whole. And despite the claims of the infamous British Prime Minister, Margaret Thatcher, society not only exists but is the basis on which the extremely wealthy depend
4
When Medicare and Medicaid was enacted the question about everyone in between came up. It was decided then that the in between could be taken care of in another session of the U.S. Congress. Half a century is a long time.
5
I am a doctor and a patient. I’m now on Medicare, and have a free choice to go to any doctor or hospital in the country.I wish all Americans would have the opportunity to buy into such a program. It could be phased in gradually, but if we just start by lowering the age of availability, we won’t ever get around to insuring children, who should be our first priority.
6
What seems to be missed by many,is that health insurance for all will give us a healthier nation. Treating disease and illness in the young will allow them to grow into healthy more productive citizens. How many adults are there in our country that are physically challenged due to some childhood illness that could have been corrected had insurance been available?
6
The US healthcare system has two problems: uneven access and excessive expense (along with rather poor outcomes).
The excessive expense reflects the fact that you are paying people in the healthcare industry too much relative to other countries. In fact you are overpaying by about $1 trillion per year or possibly even more. This article makes the point that you cannot cure this expense problem without paying people in the healthcare industry less.
This will not be an easy transition. $1 trillion represents 10 million jobs each paying $100,000 per year. The holders of these jobs will not go quietly and if you can squeeze them out it will have a large effect on your economy.
On the positive side it will get rid of your federal deficit.
6
For all other business decisions, consolidation of administrative overhead across organizations is lauded as CEO brilliance. For some reason (and we know why), consolidating the Nation's crazy-quilt of of health insurance enterprises is excluded from that judgement. Why? Because the profit-taking layer of the crazy-quilt would be diminished if efficiencies were realized for the delivery of services. If a single-payer delivered an effective baseline insurance for all, or most of the Citizens, there would still be room for a supplemental industry... but it wouldn't be as lucrative as what the private sector has now.
3
so after Nancy repeals my tax break and I start paying 40% federal, almost 9% state, 7% social security, plus current medicare tax, my absurd property tax, student loans, my dem politicians are suggesting i can afford another 5 to10 percent to pay for medicare for all - that my two income family making $300k combined, I should be happy with less than $120k to live on. When are the elections!
4
I have to say, even this supposed expert op-ed fails to define what single payer or medicare for all mean. And I'm certain candidates who use those terms don't share a common understanding or agreement on what they would look like. I'll also wager that nearly 100% of the people who are calling for them are basically thinking health care for all and "free". But like everything the devil is in the details. There are high level issues to start with like do we really want to dismantle the employer sponsored health care environment that covers 170 million people and works? And of course those who advocate for "it" also want it "free". And for the coup de gras they want everything covered with no out of pocket cost. Oh, and did I mention free? The ACA had the potential to be a long term solution. It should have been worked on to improve on it's weaknesses and not repealed. But nothing is getting done in this country with bi-partisan cooperation and health care is one of the biggest examples of that failure. I'm confident nothing constructive and bi-partisan will get done now, in 2020, or maybe ever.
5
My household of two salaried workers pay $6000/year to Medicare and then $10,000 per year for our own care.
If medicare for all was on par with this then I am in. I don’t expect it to be free and no one else should either
7
@Deirdre how could it be if Medicare is going broke, your net tax bill will have to go up!
I have a close friend the couple years ago was diagnosed with cancer in her sinuses and in the back of her mouth. She struggled with finding of physician to treat her and then was a preferred to a physician about 1 1/2 hours away.
She was finally given radiation. About a year later the cancer returned. After months of waiting she was given a second surgery. She was caught from ear to ear, had parts of her throat removed. Immediately after the second surgery the surgeon strongly recommended specialized radiation treatment about five hours away. She would have to stay someplace near the hospital for daily proton radiation treatments.
She is a single parent and is now out of work. That was two months ago. She remains waiting for this life-saving treatment. The problem is the various providers and hospitals will not give her an answer as to whether or not the treatment will be paid for. Part of the problem is these facilities are out-of-state.
The lesson is that we are letting people die, who are in need of life-saving medical treatment and it is truly sad that this does not enter the political discussion. Medical services for all require first that we have, actually, a progressive tax system; instead of the wealthy paying a small percentage compared to most taxpayers. Let's put this into perspective. The wealthy get what they need including lifesaving healthcare. Those that cannot afford it can simply die.
6
The fact is Medicare is garbage insurance compared with private sector and employer sponsored insurance. As for paying for it, well, we all know who that will be. The people who will lose their good employer or government benefits provided as compensation for going to WORK. People who have sacrificed time and money to acquire an education and advanced training to earn a simple middle class income.
It's not the rich who will pay its nurses, truck drivers, police officers, firemen, teachers, civil servants, administrative white collar workers, pink collar workers, or just about anyone with an income, or combined incomes of over $150,000 and BELOW! It's what is left of the middle class that works 50-60 hours a week enduring long tedious commutes and qualify for ZERO government assistance especially to send their kids to college.
Medicare for all sound like a snappy political banner but when you dig into the weeds every person that goes to work and has to pay their own way through the world knows its just another tax increase and benefit reduction for them.
4
We need universal coverage. But I don’t agree with Single Payer. And if “Medicare for all” means designating the insurance system we have now and putting everyone on Medicare, then you can count me out on that too.
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No. What I would like is Limited Medicare for all. Basically, I envision a system where the government provides every American with very basic health insurance: along the lines of the policies Ted Cruz wants us to be able to buy. This insurance cover catastrophic illnesses and injuries, annual physicals, and vaccines but that’s it. People who want better coverage can buy it: or work at jobs that provide it. The individual mandate for buying expensive policies is gone in this scenario.
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This would do a lot of things. Medical bankruptcies would be a thing of the past. There would be a backstop to what private insurers have to pay out and so their premiums would come down. Overall costs would come down as money would be no excuse not to see the doctor regularly. And we would be able to say “yes, we have universal coverage.”
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And let me tell you: when I was in a forum full of right wingers and I told them “this is my vision for Medicare for All” they stopped flaming me as a socialist and quickly said they could agree with this kind of approach.
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Sadly this sort of realistic approach seems to be foreign to the men and women in Washington DC. And no, I’m not a medical expert but I have done research and I’ve lived places where similar systems work.
3
I pay $900 a month for health insurance to a private company, who then pays their own company expenses as well as part of any medical issues I have.
I'd much rather pay $900 (or whatever is decided as my part) into a government Medicare for All fund.
That's how we need to look at it, not as freebie.
6
It's simple. The Republicans don't want change to solve the crisis in health care the the Democrats want to find a solution to the crisis.
4
We are already paying for Medicare for All, we just aren't getting it.
The premiums we pay to private insurance would instead be paid into Medicare when we are under 65.
That includes what our employers pay.
On the other hand, we spend almost twice as much per capita on healthcare than the other first world industrial countries.
We spend on the order of $10,000 per person. The other countries spend on the order of $4,500 to $5,500 per person.
And we have places in the US with infant mortality rates the same as a third world country.
And we are the richest industrial country on the planet GDP / capita.
9
The article makes a point. But it still treats full, free, universal healthcare as "radical", when in fact it's the most ordinary, and do-able, thing, something that's already happening in many countries.
The article veers off into 'where we might save' here and there, falling right in line with the politicians' strategy of lowering expectations. The piece does expose political manipulation. But it does so in a way that DISempowers people, not that empowers them.
We don't need "years to decide" how much healthcare we should expect. Go for it all. This is not radical. This is not pie-in-the-sky. We don't have to reinvent the wheel here.
It's real, it's been happening for decades all over the world. And it needs to happen here, now.
11
While I do think being critical of these proposals is fair, I feel we should be more critical of the Republican Party which pretends either that there is no problem, or that nothing can be done, and works hard to make the problem worse.
The truth is that in countries like Japan or France health outcomes are noticeably better at half the cost. Some how the Republican Party thinks we can't do it.
This problem affects all American families. My elderly father recently died. My prevailing thought is that I'm thankful that he was able to die without bankrupting his family. No one in France or Japan is made to feel that way.
8
I guess we could start by listing what Medicare for old people is.
Just make list. Old people get this procedure for this price, etc.
Then, put the list out there.
Is that really hard to do? I don't know.
But, it should be possible. After all.
Medicare does already exist. Old people are already using it.
5
Cutting the average doctors pay from $250,000 to a measly $225,000 is outrageous. There is no way they can get by on that. I predict that if this happens we'll see almost no one go into medical school. Seriously, why go through all the bother of college and medical school when they can just work at Wal-mart and collect welfare. No, now more than ever we need to raise physician pay or at least lower federal taxes for those making more than $200,000 such as physicians and real estate developers. Freedom!!!
7
The more successful Medicare has proven to be, the more desperately Republicans have scampered to dismantle it. Same with Obamacare. The last thing they want is public exposure to a health care system that provides dependable high quality health care with no attendant anxiety about costs and denials.
This is a fight to the death. Literally.
9
Medicare for all if and when it comes will be very similar to the present Medicare program. Those of us lucky enough to have it now will just keep paying exorbitant prices and exorbitant taxes for our care, most likely much higher than before.
3
We should do a few things:
1. Expand current Medicare to all over 60 and then all over 55.
2..Medicare should offer insurance policies to the rest of the non Medicaid population and absorb Obamacare with means tested support for premiums.
3. The tax subsidy for employer paid premiums should be phased out and individuals should no longer be required (or bribed) into such systems.
4. Providers should be required to publish their prices.
5. Some where in all this must be real incentives for individuals to practice "good living".
Medical personnel are over paid because of various monopoly practices and their compensation will have to be reduced if we are ever going to have an affordable healthcare system.
These would be difficult enough to enact and perhaps we should throw all healthcare back to the States, other than the required changes in the tax code, so that the electorates can decide and provide popular support.
5
@wjth
I would like to see the nurses union approached with a large reduction in pay and pension. That will be fun to watch. You think MD's are overpaid---check out PA's, CRNA's, lab techs, etc.
How are you going to cut everyone who works in the medical field salary? It can't just cut MD's.
1
So... what you're saying is that, sometimes politicians will promise things in order to get elected, but in reality they have no clue as to whether those things are even feasible to pull off? I'm very surprised to hear that.
6
"More and more politicians are calling for single-payer health care. Is it just talk?"
"Is it just talk?" During Obama's first presidential candidacy, progressive U.S. historian Howard Zinn proposed that "Obama will not fullfill [the] potential for change unless he is enveloped by a social movement which is angry enough, powerful enough, insistent enough that he fill his abstract phrases about change with some real solid content."
https://www.dailykos.com/stories/2011/6/16/985932/-
The same can be said about the broad but malleable support for medicare for all: without a strong movement, it will remain a finger-to-the-wind, un-seriously-endorsed, un-realized, aspirational-but-un-followed-through-on nod to the potential for deep political change.
Stan Brock - the recently deceased, great humanitarian originator of Remote Area Medical (RAM) brought basic free healthcare to the working and nonworking low-cincome in the U.S. at heathcare events that attracted thousands at a time. Attendees wait for days for basic care.
A politicized, pro-medicare-for-all version of RAM could generate Zinn's movement.
3
One issue not addressed here is whether people who are over 65 and receive Medicare because they paid for it over decades will be required to pay additional taxes so that there will be Medicare for all.
I am 6 years away from eligibility for this benefit and, because I'm self-employed, my monthly premium is $600 for what amounts to a catastrophic plan. Still, even if I get a break for the next few years, I don't support a Medicare for All program that will require me to pay higher taxes in perpetuity. I don't think people like me who are truly 'entitled' to Medicare because we already paid for it understand that they will be substantially harmed financially.
5
@Robin Actually your Medicare taxes are paying for current beneficiaries and are not being stashed away in an account with your name on it. The real problem is that there are not enough young people paying into the Medicare trust fund for the baby boomer retirees. So what is really unfair is raising the taxes on young people to fund old people's Medicare benefits and the young get nothing from it. That is why after the midterm elections, expect pretty drastic cuts to Medicare benefits as hinted by Senator Mitch McConnell.
Medicare for All is inherently fairer because everyone contributes and everyone gets the benefits. And it is paid for by taking tackling greed and simplify the current bureaucratic administration that our multi-payer system creates. That is hundreds of Billions with a capital B in wasted dollars. It is the only rational solution.
5
Let's think about that 12% reduction for physicians. Doesn't seem like much does it? All of our physicians are greedy and overpaid, right? Doctors run businesses. Overhead is 50%, at least. That means the remaining 50% is their pay. You are cutting 12% out of that. That's a 25% pay cut. If you want payments to truly go down for everyone, privatize Medicare and have every citizen on free market healthcare. If you know what you are talking about on this, you know Medicare is a cruel monopoly that pays pennies, and doctors are subsidized/recover this loss through private insurance adequate pay. If ALL are on free market, cost lands somewhere in between for all, everyone is happy. Quality and innovation remain. Access improves. But when you run on everybody gets stuff for free, how can you lose?
5
You obviously didn’t read the article. It CLEARLY talks about how costs for Dr.’s office would go down. So, no, the Dr.’s 50% share wouldn’t be cut by 12%. Please read the article.
I support the discussions that the Act sparks: they provide a catalytic starting point. As a Republican, I believe that we’re headed eventually for a healthcare system that has at least a component of single-payer, and that we cannot afford to get it wrong. Regardless of the path we choose the likelihood is high that despite all the waste and monumental bureaucracy in Medicare, Medicaid, the healthcare components of Social Security, the Veteran’s system, the state accretions and the ACA, as well as the costs to our employers … we’re going to pay more in the end. If we get the eventual solution mix wrong and cost, taxes and the degree of government control skyrocket beyond the people’s perception of the value it all buys, then the political backlash will retard ALL efforts to arrive at a wearable, humane and responsible solution for our people. That’s just bad governance. The crapshoot-nature of ACA imposition, regardless of the potential costs and implications, was well-intentioned bad governance. We elected the 111th Democratic Congress and Barack Obama in part to do better, and they failed to do better.
I also believe that “Medicare for all” is simplistic and poorly-understood. But its value lies in defining a desired end-state. If its exponents can sell that end-state, then all that remains is figuring out the transition and how to pay for it. But I have a different end-state in mind.
Single-payer (federal government) for BASIC healthcare for ALL Americans, not …
1
… insurance but direct payment for services typically received in hospital emergency rooms and outpatient clinics, plus generic drugs associated with such services, regular checkups and life-saving procedures. ALL else is provided by subsidized insurance from nationally-chartered insurers. In return we decommission current government programs. Employers would benefit by eliminating the Basic component of their benefit offerings, but could still compete by subsidizing the additive insurance packages. We still would need to solve long-term and end-of-life care problems, overwhelmingly for our elderly, which are currently bankrupting Medicaid – but, over time, those subsidized insurance packages could provide the solution to this chalenge, as well.
A million details would need to be negotiated.
However, Britain’s NHS creaks awfully, perpetually short of funding and the source of immense political faction; and every year its cost forces Britain to forego the funding of other priorities. France’s system operates by diktats at all levels, which never would sell here. Canada’s may get there, as well, because it’s heading down the same road that Britain embarked on in 1948 with its NHS. We should look at everyone’s system for ideas, but in order to find a workable compromise here it needs to work for all Americans, its costs must be strategically wearable, and the extent of government power over its operation must be tolerable to most. “Medicare for all” doesn’t get us there.
3
"all the waste and monumental bureaucracy in Medicare, Medicaid, the healthcare components of Social Security, the Veteran’s system..."
Please, Richard, explain.
Something a little richer than conservative bromides and fraidy-pants projections.
Because massive experience says we'll get better health outcomes for significantly less money and avoid ancillary inconvenience like people dying in bus stations, spreading their personal plagues in grocery stores, looking nasty on fashionable streets.
As for your puffed up worry about government intervention, take a look at most run of the mill insurance policies. Not excellent ones like yours, of course, but what all-too-common-men or women may expect in the free market. I never elected the part-time nurse looking to pay off his new Honda by telling me my child can't have that $8,000 test.
I assume you're much happier with that, though, because Business.
Speaking of Businesses, imagine the competitive edge once they're freed of responsibility for health benefits. That alone makes it worth doing.
In a rational world, they'd kick some of that blessing back to the public that bestowed it. But they won't because, again, Business.
In spite of your lumping Britain's NHS and Canada's single payer plan together, they're worlds apart. Canada sends you to your doctor (yes, mostly, YOUR doctor, and pays the bill; NHS runs the hospital).
End-of-life care? Isn't that one of the crosses you prepared for Obama? What's up with that?
2
@Richard Luettgen
Are you looking for perfection or are you looking for an efficient healthcare system that gives excellent care to all citizens.
In Canada we believe healthcare is a human right.
Americans must first decide on that issue.
If you have Original Medicare (not Medicare Advantage) make sure that you and your doctor know the difference between a "Yearly Wellness Visit" and a physical. Annual physicals are NOT COVERED. The Wellness Visit doesn't cover any tests unless the doctor considers them "medically necessary" and uses the right codes when submitting the bill to Medicare. So if you want blood tests that you are used to having for a "physical" for cholesterol, kidney function, etc make sure the doctor's office knows how to bill Medicare so you don't end up paying out of pocket.
2
The country already has a true single payer model -- The VA hospital system. This is what will result in our country. Also, we already have a single payer system, in that all fee schedules from all insurers are based on Medicare reimbursements at some level. So right off the bat, we know that single payer won't get us very far. Unless drug pricing for us is matched to the global market, our health care will always be too expensive no matter what we call it, and we will all pay for it. I support a Medicare for all option, premium based, so that everyone can be assured of at least being able to purchase a low annual deductible plan. And all Medicare providers would be a part of the Medicare for all option too, so that narrow network problems are eliminated. If we take care of our drug pricing problem, everyone's insurance premiums will decrease as well. As far as outcomes, our health outcomes include the uninsured and Medicaid populations, so a real analysis of the quality of our system for the insured population with access to health care is an unknown. With the monetary savings from drug reimbursement correction, Medicaid funding should be fully supported and not be a problem given the many billions of extra dollars available. I wish us luck.
1
I go to any doctor I want, specialists included, and pay nothing. I go in the hospital, and come out without owing anyone anything (unless I want a semi-private or private room).
My employer provides supplemental health care coverage - even when I retire - to cover the semi-private room and drugs that aren't covered by my provincial (state) health care plan. I do not pay a premium for that coverage.
Yes, my income taxes are higher in Canada than if I was living in certain states, but my property taxes are much, much lower. A million dollar home (which is average in Toronto now) generates a $10,000 annual property tax bill where in most states that would be $25,000 to $30,000. I recognize that property taxes have little to do with healthcare expenditures, at least in Canada, but it is still a tax and so it shouldn't be ignored in the discussion of the cost of universal healthcare coverage vis a vis taxation.
Unfortunately, I don't think the U.S. will see Medicare for All in my lifetime. Too much big money involved in your health care industry and we all know money is all that matters to your politicians.
11
As an American who has lived in Canada for almost a decade now, I have good experience in both systems. I had a very significant illness myself about 15 years ago that was treated successfully in the US. My wife went through cancer a few years ago, also treated successfully, but here in Canada. From my experience, both systems can provide excellent care, though in both systems, a lot depends on how active you are in pushing for what you need. You can't be a passive consumer. That said, the key advantage of the Canadian system is that there is no worry or stress dealing with bills and insurance claims. When I was sick in the US, though I could barely walk or breathe, I was constantly having to deal with finances and paperwork. There is absolutely none of that in Canada. The bills in the US were large. Fortunately I had good insurance and could afford the thousands in out of pocket costs, but for people with lower incomes it would have been devastating. Further, the complexity of the system would overwhelm most average people (I've worked in the employee benefits industry for years, so I'm very knowledgeable). And I have a wife who is a suburb advocate and knows how to balance niceness with aggressiveness to get things to happen.
If it were me, I'd leave provision of care in private hands. But the government should pay for care, funded by us taxpayers. I think direct payment is best, but I'm also fine with the government subsidizing private insurance. That's just a detail.
3
There is in fact a very simple reason why the Republicans and other individuals and groups are so fanatically opposed to any kind of ^universalhealthcare^
Once such a system was implemented and successful the eyes of the public would start turning to the whole corporate racket world with its clever ways of avoiding paying taxes etc...
Suddenly the whole corrupt money making structure of America would be up for examination and change..........
Now that really does keep corporate America awake at night...
8
Maybe start by not calling it "single payer" and rightly calling it "single insurer" or "Insurance for all" as that is what it will be. we will all just make our payments to the single insurer, the US government or Ourselves which is what government by the people is instead of the profiteering scum whom have created this evil mess we falsely call "the best healthcare in the world".
Every time republicans tell you government is the problem they are telling you that you are the problem.
7
I hope everyone understands that Medicare only pays 80% of your bill and you need supplemental coverage (from the private sector) to get the other 20% covered. That being said, I receive Medicare and it has been excellent. It makes sense that we move toward Medicare since the system is already in place and we can slowly lower the age of eligibility so as not to overwhelm the agency responsible for enrolling people and eventually everyone is covered. We needs this. People have wrangled with the costly private insurance system for too long.
3
Medicare IS NOT synonymous with single payer. Medicare A & B cover only 80% and don't cover everything. To have complete coverage, you would need a Plan F Supplement, offered by an insurance company and costing $3,000-5000/yr. You would need a Part D plan, costing about $300/yr. And you would need additional insurance to cover optical and dental. To replace a typical employer health plan with Medicare, an individual would need up to four additional private insurance policies, and the cost would be only somewhat less than private health insurance. I'm all for single payer, but Medicare for all is a half way measure.
4
I noticed, with chagrin, that the cost to average taxpayers, and those with employer plans, is rarely noted to balance out positively when the savings from insurance and medicine costs are factored in, even after (unspecified) tax increases.
Does the Times have a bias against positive presentation of what is clearly a good thing? Perhaps for fear of Republican and industry attacks, withdrawal of ads, and so on?
2
When Jared Kushner starts paying taxes we can think about Medicare for All.
6
Consider “Medicare for More.”
Persons with chronic and/or catastrophic diseases — cancer, lupus, diabetes, seizure disorders, et.c — could be able to buy a Medicare policy at a price corresponding to their income.
1
the health care reform debate is consistently been derailed by a failure of both parties to understand the true nature of the health care market. the debate is based on the premise that the markets for health care are characterized by free market capitalist principles. this is absolutely not the case. instead the markets are based on 4 interlocking govt sanctioned monopolies. Doctors enjoy a govt protected monopoly to practice medicine, and a govt protected monopoly to decide who can obtain a medical license.Doctors also enjoy a govt protected monopoly on access to prescription medicine, and pharmacists a govt protected monopoly to dispense it. Insurance companies enjoy a government protected monopoly to sell insurance. US Pharmaceutical companies enjoy a govt protected monopoly to sell drugs in the US. to say that these govt granted monopolies exist is not advocating that they be removed. however it is essential to recognize them for what they are if the two main purposes of health care reform, cost containment and guaranteed access, are to be achieved. usually when govt provides an industry a protected monopoly as in the case of utilities it creates a commission to control prices and ensure quality of service.going to a single payer system would not solve these problems. the entire range of costs; doctor salaries, medical school fees, pharmaceutical costs, shared pharmaceutical development costs, supplemental insurance costs will all have to be taken into consideration
2
It means having the same kind of care for the same cost as the lifetime government employment and benefits including health care welfare kings Senate Majority Leader Mitch McConnell and Speaker Paul Ryan. McConnellcare plus or in addition to Ryancare.
4
Ehh, it means no insurance & other middleman creeps allowed.
2
OMG a 12% cut to doctor's pay to achieve universal Medicare for all ? Doctors would make ONLY 293% of the avg. US salary instead of 334 % ! pass the Kleenex
7
Blah, blah. No one knew how Social Security would turn out either. There comes a time for bold moves because the Human Beings in this nation are at the end of their rope. We move forward and then work on the needed improvements. This article reads like the author wants to prove her smarts and apparently has no concerns about own medical coverage.
4
Even a well designed plan can be badly managed. The easiest way to cripple a good plan is to underfund it, so, for example, wait times become very long.
And we are seeing in real time the fact that many American voters will trade off good health care for official racism and other hatreds. The famous remark by Lyndon Johnson to a young Bill Moyers, is still very true.
To me medicare for all is a catch all phrase to indicate any number of national, affordable, quality health plans that nearly all of our peer countries have instead of the pre ACA de facto criminal republican plan of be rich, don't get sick and/or don't have a serious life event while billionaire big pharmaceutical/hmo execs make money off of sick Americans.
3
Um, are these the same Republicans who want to kill Medicare? They say “Medicare for all,” but they mean “no health care for the poor.” LBJs war on poverty has morphed into a Republican war against the poor,
Bloomberg 2020!
1
Americans never let the discussion go beyond the taxes and “socialism” angle. Until we get beyond those we will continue to fail as a Christian society.
3
No one is. But at least we will elect people who won’t just let us die off because we can’t afford healthcare!
1
Medilcare for all simply means everyone pays a "healthcare tax", not based upon income but upon, may be age, like all seniors pay medicare tax each month (it is not called tax, it is taken out of Social Security). We still have secondary insurance companies for the 20% cost not covered by medicare. Companies may offer secondary insurance to their employees. Doctors and hospitals willl be required to treat any and every patient and not reject a patient for "no insurance". The success of this system depends upon honesty of the citizens (and immigrants). That includes patients, doctors and health industry businesses. To do so, it needs to offer discounts to people who lave a healthy and non-risky life style. If you ant to smoke or drink, there should be surcharge. If you want to participate in injury-prone sports such as car racing or boxing or football, there should be additional fee. And is someone has not paid for it and gets injured, there should be a charge for that, like I have been paying 15% per month for being three years let to enroll into medicare. It must be fare to those who follow all rules of healthy, no-risky n=lifestyle.
1
These 2 authors attack the most promising idea in a sneaky and untenable way. Obamacare WAS what the sausage co. we call Congress produced!
It's crystal clear that GOP Senators (minus the 2 with a spine) WERE WILLING to see citizens die ... if the choice was some combo of "a win for the Democrats" and higher tax bills for the folks on whose payroll they effectively are!
CRITICALLY, Obama (and anybody with JHS-level savvy about how politics works) could not be sure whether a "public option" could get 50 or 60 votes, given how even Dem. Senators have taken millions from interested parties like drugmakers & insurance companies.
But NOW, it's as simple as -
a) people differ on these complex questions. You'd have to be naive or duplicitous (or are the authors BOTH?) to expect Elizabeth Warren to be on the same page with Sen. Jones from Alabama.
b) you can't ask, "Hey, Google, what would Bernie's plan cost?" And you certainly can't predict what big and small changes to the tax code will fly in DC.
But this much is simple, and it would be great if the Times got behind it! We pay more as a country and get less in connection with health care than any developed country. THEY allow Govt a bigger role, insurance companies a smaller one. "Marching to a different drummer" shouldn't be "over millions of dead citizens," loved ones whose deaths enriched insurance company execs.
"Pre-existing conditions" are a proxy for What Matters More - someone's profit ... or someone's LIFE?!
5
New York can lead the way toward national, single-payer healthcare with the New York Health Act! All we need is one more Democratic State Senator. Vote!
Learn about this fantastic bill that is on the cusp of passing!
https://www.nyhcampaign.org
Learn the details and spread the word!
https://www.nyhcampaign.org/faq
2
To me, too often forgotten in this discussion is that:
1) Single payer insurance is a great idea that cuts administrative costs as long as you like the insurance and the payer. If you don't, you have no where to go, and a single payer has no particular incentive to be user friendly. Single manufacturer automobiles would also be cheaper -- no duplication of development costs and marketing, as long as you like the only car they produce. A single payer may offer different plans (e.g. low cost, high deductible vs high cost, low deductible), but it is still one organization.
2) An insurance market place does have an incentive to lower costs since insurers win business by trying to keep insurance premiums lower than the competition, which means trying to control costs. In the for profit sector, which I am not a fan of, insurance companies make money on the spread between what they charge for premiums and what they actually spend on medical care. In other words, the less costly the care, the more the investors make.
The single payer debate unfortunately evades the ugliest reality of the health care system -- the amount of health care spending that ultimately goes to investors (e.g of drug companies, but others as well). It assumes that administrative efficiencies will solve the problem when so much of it is price gouging. Sadly, it also evades the issue of "pseudo-insurance" that fails to protect from financial ruin when ill, which is the point of having insurance.
2
I know what Medicare is. I chose it because I'm eligible due to my age. I think Medicare for all means changing the eligibility age so that anyone can choose it -- although they wouldn't have to.
Not hard.
5
Andrew Gillis says, in one of the favored comments, "It hardly seems fair to pillory Democratic politicians about a lack of specifics on Medicare for all when Republican politicians were allowed to run on "repeal and replace Obamacare" without being held to specifics as to what the "replace" part would actually be. As we have seen, the replacement doesn't really exist."
The media turned the Affordable Health Care Act into Obamacare. Racists immediately hated it. Those same old angry men and who think "white" skin makes them something special.
When they learned that it was actually America's Affordable Health Care Act and that their "heroes" were taking away THEIR health care - the first many of them ever could afford to have - they rebelled.
Much of the chaos in OUR world right now is due to media trying to get "ratings" and dollars. Chaos and confusion supposedly keeps us "engaged". That's why so many people ignore it and turn to places like hate radio and fox so-called news where others think for them.
Sad.
2
This would be disasterous for the elderly the population Medicare was originally intended for. The elderly carry an enormous disease burden and with Medicare for All they would be competing for increasingly scarce resources. Physicians are aging and reducing their income particularly specialists it will make finding a physician that accepts Medicare or Medicaid for matter nearly impossible.
1
Medicare for All is the way to go to ensure universal health care we deserve. The existing mostly for-profit health care fails to cover millions, cost too much, is about 16% of the GDP, more than other countries and provides poor results. Time for a change. Most people like their Medicare. It operates at a lower overhead cost than for profit insurances. It is high time to stop providing cover to for-profit insurance companies with deceptive articles such as this one.
2
Are Americans, living with significant pain, willing to wait for six months for hip or knee replacements as many in Canada do ? I see no where in this discussion where wait times to see Doctors, have various tests, scans & procedures are discussed.
@Nancy
How many in Canada wait?
Nancy,
I have good healthcare through my wife's Union. It took 10yrs. and 3 different insur. providers to finally replace my knees. Had a preventative partial replacement been done earlier I wouldn't have need TKR. As it was I was sent thru every injection, therapy and simply told, no, too young, loose weight, (I was 180, @5'10" age 50) etc. The final yrs. I was braced on each knee, walking poorly with a cane and popping pills to get through the day and to sleep the night. I stopped construction being unable to perform. Weight did gain from lack of mobility.
All this with a very good insurance by American standers.
Would M4A be better?
Don't know.
But the current system left be unemployed, in pain, addicted and debilitated for 10yrs.
1
@Nancy. What are these wait times. For what procedures. How many people. What parts of the country. Can you augment with personal insurance.
Dig deeper. Don’t just parrot talking points.
As long as there are red states and blue states, no meaningful national health care reform is possible.
The blue states should band together and create a public option. That could be a first step toward sanity. A next step could be education reform. Let the red states pursue their vision and the blue states pursue theirs.
3
@Alexander K. On so many issues I long for the blue states to ban together and lead the way. If only it was possible. I would have to move but so be it.
I got on Medicare 1.5 years ago. I'm still working. I make decent money. I pay more for Medicare than I did for private insurance. When I suggested that I stay on my own insurance I was told " there will be a penalty FOREVER, unless you're on a group plan." I pay the highest tax bracket, which incidentally is higher than either HRC, BHO and most corporations (based on public info)and I'm guessing far more than DJT, who may have paid less than nothing like some very profitable companies like GE, who instead of taxes get credits- so if they ever have a tax bill, they really don't. Interestingly I make far less than all of them. I was hoping the "socialist" BHO would have addressed the tax system before health care because they're both a mess. Instead most of the gains of his recovery went to the top, just like they always have. Trumps tax cuts have made it worse. I don't want anyone to make America great again, I'd like someone to make it fair, for the first time.
3
I really liked my doctor. I was covered by insurance through my employer. In 2013 my group insurance did not negotiate a contract with my doctors group so if I wanted coverage I couldn't keep my doctor. Not President Obama's fault.
Now I have Medicare which I love. Let's make sure Mitch McConnell keeps his hands off my medicare!
3
Medical care in this country is horrible. Sure we have some great hospitals with great equipment but the average person will never get to see it because of the unending levels in the system. Is your DR in the network, is the hospital in the network, do you need a prior authorization, what's the co pay, what tier is your drug, is it in the formulary, are you between jobs with no insurance and on and on. I would take a system anytime where you walk in, get care and know exactly before hand if and how much it will cost. Like everything in this country our health care system is designed for the wealthy.
4
Yes, complexity upon complexity. Every one who works and gets a salary is on Medicare NOW. One pays into the program for 50 or so years first and gets the benefit after that...if they live long enough.
For all without that kind of support means $$$$$ NOW NEEDED for SERVICES for ALL NOW. Some know this, others will learn. There is no free ride. If each of us does all that can be done to stay healthy, then there will be sufficient funds to help those whose systems still fail. But it can't be done just with insurance and services.
Personal responsibiity must be factored into workable solutions. All else is folly.
3
The Canadian health care is great you are covered don't go bankrupt or loose your home like in America. The medicines are cheap and they are happy. Sign me up now. The GOP plan pay insures 5 times more for plan is a insult to the working poor and the poor and the rich will only have health care.
1
This is why Democrats lose: while we're debating nuanced issues like health care that bore regular voters to tears, the Republicans are out there gathering and agitating angry mobs and inciting violence against American Citizens. Unfortunately as Democrats our respect for law, order and decency prevent us from responding in kind to the violence and criminal behavior of all of these raging mobs of hateful Republicans. But we can hold rallies. We can keep the message simple. We can try pleasing crowds again like we did in Obama's day. Instead it's just endless yammering about the subtle differences between "single-payer" and "medicare for all", things that the average American knows nothing of and couldn't care less about.
3
Medicare for all? What a terrible idea. No, no, no America, just keep doing what you're doing. Above, all don't look at what happens in every other industrialized country. You won't like it. Trust me.
3
Honestly, it's kind of silly that people are debating health care at a time when Republicans are engaged in a foreign-backed coup to replace our entire system of government with a dictatorship. Trump is about to make the Republican hoax of "death panels" into a reality, and health insurance is going to be a lot less affordable when thousands of Americans end up in hospitals from the oncoming waves of Republican mob violence.
1
I strongly suggest that the NYT, look into the German health care plan, what it costs the State and how it benefits all. I am American, widow, my husband German. I am 85 yrs. old - with chronic health problems. The Health Insurance Companies, (more than a few) are 'controlled' by the Government, thereby making premiums affordable to all at all ages with full benefits. There are also 'private insurers' of which I am not at all familiar with as my provider is employer/employee based, don't know the proper name for that. I have experienced in the 30 yrs. here 2 knee operations (personally refused a replacement), gall bladder and uterus removal (2 procedures), cost completely covered by insurance. C0pays for meds are limited to 10 Euro of which I am partially reimbursed at year's end. Please, please for the benefit of all investigate this system. I am certain you'll receive full cooperation from whomever you contact.
5
here's a thought for you .. I don't play the lottery .. but the current powerball last night was 900 million ... that basically 3 million dollars for every person in the U.S. I think that would pay for each person's care for a long time.
2
Not really. That darn decimal point. <3$/person...about 2 hrs of coverage for my insurance.
2
Finally! Some perspective on the reality rather than the political sloganeering regarding health care. The central issue is COST not coverage. The second is the reality of how those costs support a massive element of our economy which could face significant disruption and substantial economic pain for many -- including lower paid administrative personnel. Third, there no perfect system where one can expect outstanding, leading edge care for all maladies throughout all of life (especially at the end) at little or no cost. Fourth, we are living with a system founded primarily on treatment because the "good life" in America is based on unhealthy diets, lack of exercise, and the expectation that we can have this and experience no negative consequences. Lastly, there is supreme ignorance about how insurance really works. Regardless of the plan everyone in a pool is paying for everyone else's costs. We may well choose the path toward single payer, but the population needs an eyes wide open perspective on what it will really mean.
2
Fear is the currency used by those who prosper under our current bloated Byzantine monstrosity that puts profits first and healthcare second.
Our system serves the interests of but a privileged sliver of the populace yet they’re able to use their considerable resources and self serving motives to confuse and frighten Americans from demanding a far more humane and fiscally responsible approach to healthcare .
We Americans talk a big game about how brave and bold we are but when it comes to corporate control over our healthcare , essentially life and death , we’re silent as church mice .
Corporate interests and their bought and paid for legislators should be the last people we listen to when it comes to wielding our massive healthcare spending influence . Their concern is the bottom line and shareholder returns . Of course they’ll obfuscate and prey on out fears . They’re well compensated to do just that .
The fact is we have an inherently flawed system that will only continue to cost more and serve fewer all while primarily being tied to increasingly tenuous employment.
It’s time to free ourselves from the yoke of corporate servitude and demand a MedicareForAll system that serves us and provides healthcare to every single American .
1
I live in an EU country where purchase of healthcare is mandatory and the government regulates the pricing overall. The only overpriced pharmaceuticals are those coming from the US. What I pay per month is not burdensome, considering I have full coverage with no deductibles. People in the US are being conned really bad with this. If you can rein in the greed of the insurance industries and Big Pharma, it can be done. The cost of services, tests and drugs are not widely overinflated here, that's how it works.
4
Yes, every future presidential candidate who plans to express support for Universal Health Care in the United States should begin now to become educated about UHC (I use as blanket term) as practiced in at least two countries.
I have now benefited from Swedish Universal Health Care for 22 consecutive years, during which I occasionally benefited from Medicare when visiting in New England. I have been increasingly satisfied with SE UHC but know the wrenching changes that must be implemented were the US to try to develop UHC.
I use an n = 1 anecdote that illustrates this: 10 years ago a Swedish interventionist who had also practiced in CA put a 3d stent in my circumflex. As he did this he told me why he had returned to Sweden, where he would work on salary rather than becoming rich as US interventionists can become.
He wanted his children to benefit from UHC, his wife to benefit from pre, peri, and post natal care given to all and from parental leave and other such benefits ending with tuition-free college and medical school.
I do not know how much Bernie Sanders actually knew but Warren, Gillebrand, and Harris had better learn.
Only-NeverInSweden.blogspot.com
3
Why do people equate single payer health care to "Medicare for All", when it really is closer to "Medicaid for All"? And why would they (Bernie Sanders etc.) want to mix this into what is really a non-discretionary spending trust fund that includes Social Security? Medicaid is discretionary spending -- why aren't people advocating for non-discretionary "Medicaid for All" -- particularly since this is more likely to be funded by everyone who pays federal income tax? So what is it meant to be -- single payer health care as in Medicaid for All, or something that changes fundamentally what not everybody is paying into? Does anybody know what the deal with not calling this Medicaid for All is all about?
2
There is no perfect national healthcare system. Demand for healthcare will always outstrip the means to provide it. But what many countries achieve where the US fails is that the basic provisions that all citizens can access is higher. The key difference between New Zealand and the US is that we choose to pay collectively through taxation for a system that provides a broad social safety net to all citizens. It is not perfect. But NZers don't live with the constant fear that they are one accident or illness away from total ruin or a shortened lifespan due to woefully inadequate access to healthcare.
NZ could have a better system if it were funded at a higher level. This would be achieved through taxation. We know this and guide government decisions on this with our votes. When health spend goes up it benefits everyone. Watching the current US debate, it seems that there is little clarity for voters about what they are opting for and little consensus about what is being offered. It is also clear that it is an issue that US citizens care deeply about. The political party who can articulate a clear path forward would be rewarded at the ballot box. Good luck with that.
1
They got it wrong on France. I know because I lived there for 15 years. It is a single payer system (like Medicare for All), with health insurance as one of the benefits covered by their Social Security Administration (along with old-age pensions, disability insurance, and welfare).
More info on it is here:
https://www.cleiss.fr/docs/regimes/regime_france/an_0.html
They do allow private insurance as a supplemental insurance to cover things not covered in the national policy.
Also, Medicare is a single payer system for people 65 and over. Medicare for All would be a single payer system for everyone.
Final point: The pollsters are asking the wrong question about taxes, and it skews the result. The question should be:
"Would you pay a slight amount more in taxes INSTEAD of the hugely expensive insurance premium you are paying now, to get much better coverage?" I bet everyone would say "yes"!
9
Medicare for all: change the age at which you qualify for Medicare from 65 to 0.
Collect 2/3 of the premiums currently being paid to private insurers.
Done.
4
Medicare For All health insurance would replace the highly inefficient Blue Cross Blue Shield system. We should look at exempting small business from Medicare & SSI payroll match. Bring back the alternative minimum tax for the wealthly real estate deprecation millionaires like Kushner and Trump. Eliminate carried interest and other wealthy welfare. Institute a national sales tax and an import tax on goods and services on countries whose workers do not enjoy American pay and benefits....comparative advantage should not be based pay inequality but producticity per person. We need to rethink how we strengthen any pay for healthcare and social security and eliminate or reduce the exisitng regressive aspect and also exempt small business. Universal insurance under Medicare For All is a pragramatic and progressive response to the current inefficient and inequitable system.
3
I recently lived in Australia for 9 years, and got to experience the Australian version of Medicare for all. It was a great experience! Appointments with GP's and specialists were readily available with small copays ($10-15) and drugs were mostly free, or if not covered, then a fraction of the cost here in the US. At one point my partner cut his hand badly, and within a few hours was undergoing emergency microsurgery with a top surgeon. He then had physical therapy for several weeks. He was not billed a single dollar for all of this. It removed a huge stress knowing that, no matter what, all my health care needs would be covered without question and mostly with no more than negligible cost. I cannot recommend it highly enough.
5
Why not improve the original ACA/Obamacare, now that the Republicans might be persuaded to consider it seriously instead of plotting to undermine it? The Republicans have demonstrated that they have no idea--and no enthusiasm--for a developing a single-payer healthcare plan (although Trump apparently assumed they had it all worked out, since he certainly had no clue about how to fulfill his promise when he was spinning the "repeal and replace" mantra). There are plenty of possible solutions out there, many based on the most successful systems in other countries. And it puzzles me that people balk when told they may pay higher taxes when they would no longer have to pay all those itemized bills for everything from an ambulance ride to cancer specialists. This is a smart country, we could do it--if so many of our wealthiest citizens weren't greedy for tax cuts. (And yes, I'm looking at you, bogus POTUS.)
As both a physician who accepts Medicare and a Medicare recipient, I think it is lost on many people that "Medicare" is not the same thing as "single payer." It is very difficult to find out details, as the Medicare regulations are longer than the IRS's, but when I take care of Medicare patients, the payments to me do not come directly from the government but from Medicare contractors, which are private insurance companies. My understanding is that Medicare is a grant program: Medicare Administrative Carriers (MACs) get a fixed amount of money from the government and then distribute it for care. So, like so many of our American institutions, there are middlemen involved, and they do not provide this function out of the goodness of their hearts (though their admin. costs are MUCH lower than commercial insurers.) Contrast this with a system such as France's, where doctors are paid directly from the government. It's a detail, but an important one, because keeping adminstrative costs down is one of the best ways to save money on health care.
7
The best part of this article is that you interviewed
Dr. Carol Paris, president of Physicians for a National Health Program (20,000 MD members) has for many years researched and reported on what is a publicly financed National Health Program that would fully cover health insurance for all Americans.
They know better than everyone you mentioned or interviewed how universal coverage works in other countries and which are hybrid national/private and which are similar to "Medicare for All".
http://www.pnhp.org/
Go to their website. Read what they know.
Interview Dr. Paris, Dr. Woolhandler and Dr. Himmelstein who can explain all the options and solutions.
I believe the chatter is that people want Universal Health Care Coverage. How this is obtained and covered is to be determined. PNHP knows how to best do this.
I recall that when the ACA was being built in 2009 that representatives of PNHP were barred from discussions because the insurance industry had great control over the proceeding. That was a huge mistake.
But the time is now to open up this discussion. NOW !
And for those who worry about jobs in the insurance industry. Claims still have to be processed and paid. A claims person who works for an big insurance company does the same work as a claims person who works for Medicare.
Their jobs should be protected.
Insurance co. CEOs and administrators who make outrageous money while they deny payments for people - they got to go.
Read www.pnhp.com
VOTE Blue !
7
The effort to avoid a social solution to health care costs by using markets has not succeeded well for our country. It has produced system that costs twice as much as single payer systems with poorer overall outcomes and cannot serve the needs of all. The problem is simply that buyers cannot know how much their health care will cost and care givers cannot tell them until the care is given. Nobody can afford to buy insurance covering the worst case scenarios and insurers cannot control their costs selling insurance to individuals whose risks of incurring care are unknown. To make a profit with those whose needs for health care are known becomes a cost plus profit situation which just makes the cost of care that much more expensive for all. The shared risk side of insurance requires a pool of insured individuals whose risks can be estimated with sound sampling and statistical analyses, and the costs of paying out and the profits shared across the pool. This is where the single payer universal system becomes the most rational. Since the population covered is in the millions and all are subject to similar risks as a class, the costs become predictable and more easily managed.
2
I support Medicare for all, like the Canada model. But a good compromise could be medicare for birth to age 16 or 18. Get children off to a healthy start. Include annual dental visits as well.
3
I am now on Medicare; it isn't free: I pay $134/month for basic medicare and about $140 per month for a private medicare advantage plan. I had to juggle to a different plan in year 2 to get my healthcare providers all in-network but otherwise I am pretty happy with the program. Repeal the recent tax cut, restore progressive tax rates, eliminate the cap on SS contributions and cut defense spending to pay for medicare for all. It all comes down to priorities: make the rich richer, bomb more people or keep your citizens healthy. Not that difficult.
9
We’d welcome being reimbursed at “mere” Medicare rates. Since 2010 my wife - a pediatrician - has seen her Medicaid population increase from 18% to 45%. Being a good hearted person, she can’t turn these kids away in spite of the income hit we’ve taken from Obamacare.
Medicare reimburses at significantly higher rates than Medicaid. Combined with less bureaucracy from private payers, she (and other primary care physicians) would likely earn a more reasonable income while helping more children. Meanwhile, overpaid sub specialists might take a small pay cut.
Sounds good to us! (And I’m a Republican.)
4
@David..."Sounds good to us! (And I’m a Republican.)"...Why?
1
I'm not looking or "free" healthcare. But paying over $1000 a month for a family in premiums, plus high deductibles, copays, coinsurance, and prescription costs is not sustainable. Many middle class families who get health insurance through their employers and do not qualify for subsidies, are seeing premiums rise every year while their coverage shrinks. I know there is a better solution, since almost every other country on earth has better and more affordable healthcare.
I think that the trillion dollar elephant in the room is the private insurance industry. There is not a politician out there who seems to be willing to take them on, and we're all paying the price.
12
Medicare as it exists now is not free. The premiums are kept out of my monthly social security payment and these premiums are based on my income. I am still working and paying into medicare through payroll tax and my employer is matching this amount. All I am saying is that it is not free. I have been very happy with Medicare.
6
Taxes are the price of entry to a civil and just society.
1
This is really pretty simple. Do exactly what France does. Cover more people, enjoy better outcomes, save $1 trillion annually.
No wheel needs to be re-invented. Just do that.
5
Medicare for all is only vague for two crowds, those who truly are new to the concept, and those who are purposely trying to obfuscate it and derail progress . For many of us who have been working on the issue it is clear as a bell.
Opposition comes from insurance, certain medical groups, medical device companies, pharmaceutical companies, centrist Democrats, and most Republicans (and their various think tanks). No one said this would be easy.
We are trying to do something as profound as establishing Social Security, or Medicare, or Medicaid. But it's actually more than that, because this would be the first real government benefit that everyone gets, from birth, regardless of age or income. For the United States, it's a small revolution. And we need to fight for it.
We may very well have to rethink the framework of the current bills. An over-arching plan, call it the Health Security Act, that includes a single payer system, but also addresses the other healthcare needs and abuses we have, might work. Like Social Security, Health Security is something we all need. It's time we get it.
5
When politicians call for Medicare for "all", how do they define "all"? All citizens only? All citizens and legal residents? Or do they include all illegal aliens? We now have a caravan of 3,000 to 4,000 Central Americans breaking down barriers to cross into Mexico, most it seems planning to break into the U.S. Are we supposed to give them all free health care too? Of course it will not be really free for legal workers, who will pay for it through our taxes; and I know that will cost many citizens less than they now pay in premiums and deductibles. But how many benefits should we have to pay out to people who come here illegally? I have yet to hear of any politicians discussing this issue.
6
The democrats will want an amnesty for these border crashes and then they'll be "citizens" and hopefully vote democratic and you can pay for them then. Feel better now?
Pols have been confusing this issue for decades. Assume that in a civil society health care is a human right. Now remember the words of Jesus of Nazareth that we should care for the “least among us”. Then, try to differentiate between the generic “illegal alien” and those fleeing terror (much of it USA created; i.e El Salvador) who are seeking asylum (a legal process under immigration law), and perhaps you will begin to understand. “Who knew immigration could be so complicated”? Certainly not Fox and Friends.
Bloomberg recently ranked us 54th out of 56 countries for healthcare efficiency, with mediocre results. Why don't we take the best ideas from the top 5 or 10 countries and adopt those? Apart from hurting so many people, we will bankrupt the country if we don't do something soon. If our Lobbyocracy can't fix something this simple, what hope do we have of solving difficult problems?
6
If USA had a parliamentary national executive, any opposition party "might" be required to compose and defend explicit, realistic and acceptable alternatives to status quo or administration proposals, instead of sloganeering all around the house ("Repeal SatanCare Death Panels" vs "Anything for All and Death to Profits" vs "Down with Sickness") with no way to pin down what any of it would mean.
"Medicare" is an existing federal program, so why not use this term ONLY to represent shared facts about how the thing works now and where we go from here.
Single Payer and Single Provider are not equivalent labels.
Are there any hospitals on earth that currently operate for a profit in a "free market"? Local governments, hospital districts, foundations or religious charities operate most of them.
Existing employee/retiree healthcare coverages already have baseline sets of facts which are subject to arithmetic.
Can there be a democratic consensus to give up existing coverage systems, before developing a common understanding of what would be different? Not these days.
1
I moved to Australia, which has a mixed system of public single payer plus private insurance required in addition above certain income levels, three years ago. It is a huge contribution to my quality of life that I don’t have to try and remember what that bill for something apparently done three years ago was for, don’t have to be careful to stay in some ever-changing network, don’t have to worry that I’ll be treated by an out of network doctor without my knowledge and owe tens of thousands if there should be a medical emergency. And I’m a youngish and healthy person who had good insurance through a major employer in the US! Forget money for a second - the US system is an enormous, dysfunctional engine of stress for sick people and people who might fall sick (that would be everyone).
14
@Christian Haesemeyer. Isn't it true that Australia tightly controls immigration, as do the Scandinavian countries, Finland, and Canada? These countries do not have a huge group of illegal aliens, many of whom are poorly educated, unable to speak the country's language, and thus unable to work, therefore not contributing the taxes required to keep the single payer system solvent.
2
"Medicare For All" may be a hollow phrase in politics, but there is actually a real, working model of "Medicare for All." It's in Taiwan.
Taiwan's National Health Insurance was actually modeled on US's Medicare after a study of different public healthcare models around the world in the 90's. (There are, of course, changes. But the basic model was based on Medicare.)
It's ironic and classically American naval-gazing that there has been a working example of "Medicare For All" for about 20 years, but Americans debate each other as though in a bubble. This is, of course, on top of the many other examples of single payer healthcare around the world. But we carry on like the rest of the planet doesn't exist. The idea of debating whether single payer is possible is really nonsense. Of course it's possible. A better debate (backed by actual study carried out by healthcare professionals) is which model would work best for the US.
7
The most effective means to get Medicare for All is to gradually lower the age for eligibility for Medicare from the present 65 say about 3 years per year..
Also starting at age 55 allow people to buy into Medicare. This means paying an insurance premium for Part A and Part B.
Gradually lower the eligibility age for the buy in to Medicare.
We must also allow Medicare to negotiate drug prices.
5
One thing no one comments on is the US consumer mentality to healthcare. This will require a core adjustment on the part of US citizens who accept government funded care. No longer will all surgeries be covered (e.g. no hip replacement for your 80 year old dad) and access to specialty care will remain but with long lines. I work as a physician and have had Canadians come to see me because they have a 9 month wait to see a specialist. This is not pro or con a single payer system but is necessary to discuss these aspects of what single payer means. Politicians certainly don't have the courage to say it and advocates ignore it. Compromise must be made in the healthcare arena for this country to move forward and the consumer mentality of getting whatever one wants must adapt as well.
9
@Tom
In our medicare, since we pay some premium and deductibles,physicians will accept it if there is no alternative. There does not seem to be a long lines to see a specialist now, and they will also accept if there is no alternative. We will be able to see more patients if there is no paper work.
If there is a hip fracture in a 80 year old, it will be covered. For hip arthritis, surgery may not be necessary and they can wait unlike we have it now. Moreover, specialists make lot more money nowadays with procedures and primary care practitioners who toil will also have some increased remuneration. System needs to be similar to our medicare, not just Canadian. I agree consumer mentality needs to be changed, and we have to convince them that this is not a government take over and it is not.
Please note my response below yours.
I am a retired physician and it is not so complicated. It is our Medicare system which is similar to Canadian system. The government pays to hospitals and doctors for all patients, but restricts the amount they charge for treatment and procedures. They can control drug prices. There needs to be a low premium and deductible except for the very poor,so that there is no overuse of the system. The total cost will be lower since there is no involvement of insurance companies and doctors are relieved of paperwork. We need to control some of the obvious wastes that are happening in Medicare. We may have to pay some more in taxes, but it will be less than the premiums we pay and hassle we go through with a hodgepodge system, where millions of people are not covered and go ER for sickness. Industries will be agreeable to more taxes,since they do not have to pay employee premiums.
Many people think it is a government take over and use anecdotes to prove their point. Medicare works here, but not enough money was deducted from payroll years back. I have been to Canada and talked physicians and general public. Both groups are very satisfied with the system in very a democratic country. However, I would not advocate British system which is a total control by the government. People who want special care, can pay more premium. I really believe we will have a better system with less total cost than we have now. Hope the politicians listen.
6
@KRS:"We may have to pay some more in taxes, but it will be less than the premiums we pay and hassle we go through with a hodgepodge system,"
I have some land in Detroit I would like to sell you.
Are you aware of some of the employee paid insurance plans that are out there?
@Jp Premiums for employee paid insurance plans are going up every year. One year, my premiums went up by 200%. Most of this money goes to private insurance companies that do nothing to improve healthcare and make the entire system less efficient and more expensive. Private insurance companies need to be phased out.
Does anyone really know what "Make America Great Again" means?
1
Here's what we can agree on:
1. Medicare plans should *at least* be available for purchase on the exchange.
2. We should Repeal the corporate tax cut and Replace it with healthcare subsidies.
4
medicare does not have family plans as its all single plans - no pregnancy as all women are too old for that. men who are married to younger women - need a private plan to fully cover costs - with the spouse. when Obama care was written - options were written for seniors ( grandparents - who were taking care of grand-kids.) why not just call - this system a single payer. and model part of it on states paying half - with the 1st increment of care being 250k to 300k as in medicaid - with optional steps being available . Pres Obama saw 20k bankruptcy's a year and created no top amount versus requiring a overage option. presently we have million dollar policies - under Obamacare which are better than the Dont get sick policies of Trump - but what would a 1/4 or 1/2 million dollar policy cost versus to multi-million dollar top of Obama - and instead of the bronze, silver, gold & platinum step - a pricing tool like Flo offers on auto insurance ? do i 60 year old need pregnancy coverage or childrens' medical - no for that i choose the max deductable 10000 -
1
I emigrated from England years ago. I have given birth to children in 3 different countries. I did not see a difference in the quality of care, but there was a huge difference in the cost. Guess which one was more expensive? My sister developed a cardiac problem in the UK + was admitted into a cardiac unit and treated within a week. The same thing happened to me, it was treated on an OP basis. I found out how much American insurance companies control health care. I was denied tests. I needed to go to the ER twice. Waiting for referrals, to scheduled appointments and tests, it took over 6 weeks of misery until I got the treatment I needed. I have worked as an RN in 4 US states. I have seen a deterioration in the quality of care in the US in the last few years, regulations + micro management are suffocating. Outcomes for some chronic diseases are sometimes better with VA care vs private healthcare. Since being on Medicare I have found my stress level has gone down. CMS does have problems and CMS loves statistics. The opioid crisis can be traced back to the CMS demand that pain be a 5th vital sign and financially punishes hospitals when patient report pain 7 or >. Fractured healthcare, eg. private insurance companies, Medicare, Medicaid, VA is not working. We need a single system. Medicare for basic healthcare and catastrophic events. If people want more than this basic plan then supplemental insurance can be bought. It's easier to improve a single system
4
Remind us again, what is the Republican health care plan?
6
@PaulB67....They are going to deliver for profit healthcare that does not penalize preexisting conditions..... without imposing a mandate. And the sun will rise in the west tomorrow.
1
Sorry if I am a bit skeptical about an op-ed casting sideways doubts on UHC and single payer written by a Kaiser employee. At least try to pretend that you're objective.
4
To earn perhaps two decades of Medicare services in our later years, we pay into it for as many as 45 years or more. What will it cost to make such a system pay as you go.
1
You are aware that people are already paying for healthcare as they go, right? Maybe you prefer if your money pays for insurance company profits and unnecessary paperwork, but you can’t claim that healthcare for those not eligible for Medicare is currently free.
5
As an independent contractor who pays the full cost of my health insurance, I can barely afford the limited coverage plan that I have and would be bankrupt if I ever had to cover a quarter of my $10k deductible so who is going to pay for me to have anything approaching full full coverage? You may want to be a welfare charity case but I’ll take my chances before I ever accept a penny of someone else’s forced charity.
1
What thoughtful, compassionate, reasonable and insightful comments by all here. Thank you.
So ... why are these comments not making it into the public debate? And, with the volume up?
Democrats (I are one) LISTEN UP: Your national audience and various constituencies for improved and affordable health CARE are consumed by these issues right now.
Agree on your PLAN.
Be clear, factual, creative and persuasive. Hammer home the message over and over and over ... as our president seems to do daily with his simplistic ones that really help no one.
We are counting on you for 2020!
3
HCA has hospitals in England. The hospitals are staffed by docs who work about 1/3 of time in “private” sector. In US this model will clearly result in two tiered
Doctors who wish to make more money and care for more affluent people will work in the private sector. There is the holiday inn and the ritz Carlton . A bed and night sleep in both places.
Not sure the same people who are upset about fairness will tolerate a no wait , easy access to doctors and technology system for the wealthy while the rest of folks wait in line. Can say you have that now except the Ritz Carlton hospitals with all of the protocols, great staff and equipment take all comers thru the ER- and vast majority of all docs treat patients with no funds or insurance. This will truly segregate the care
The most difficult aspect of this issue is the fact that there are many entrenched positions, many going back to just after WW-II, so the political will and economic effort to make substantive changes is formidable. Add Paul Krugman's article today ( https://www.nytimes.com/2018/10/18/opinion/taxes-medicare-social-securit... ) on the Republicans wanting to gut Medicare further to balance the additional deficit they created and one has to believe that such expansive ideas for Medicare are primarily in the province of the Democrats. This despite that the ordinary citizens who vote Republican generally want to see something more comprehensive, especially if they don't have to pay for it.
One would think that an overall a healthy population is better for the Country than a sick one. Which is something, in theory, more comprehensive coverage should provide. But there's probably too much money being made in the status quo that is itself a drag on any substantial change. And that pesky detail of defining what it is we actually want in the first place, before we can change anything.
2
If we develop a national health care system, I hope it's better than Medicare. Medicare is more complicated than it should be or needs to be. It includes Part A which is very basic coverage, Part B to cover part of what Part A doesn't cover and requires a premium. Then, a supplementary insurance policy is required to cover what Part A and Part B doesn't require. This has led to private services that navigate the system for participants. We can do better than that. How about in return for paying our taxes, we get a card that states we are American citizens that have paid for our health care through our payroll and income tax. We present it when we need care and the doctor bills a single-payer like he bills insurance companies now. Medicare for all, may just be an easily understood campaign slogan that means health care for all citizens. I hope so, because we can do better than Medicare.
3
@P. J. Brown I believe that you have just described the French system. All western democracies have a "two tiered system. They seem to work well. What we have is a system in which administrators take 20-30% of each healthcare dollar to DENY care.
3
There are two types of voters in America: those who vote with their Hearts, and those that vote with their Heads. Single-Payer appeals to the former because it addresses a deep-seated belief that no one should make money off of someone else's health. And that is the REAL driver behind Single-Payer.
Myself: I am in not in any way comforted by the assurance that the money I pay for my health would go to an overstaffed government agency instead of to a greedy insurance company.
2
@Connecticut Yankee:"Single-Payer appeals to the former because it addresses a deep-seated belief that no one should make money off of someone else's health. And that is the REAL driver behind Single-Payer."
If the taxes one pays for Single-Payer are based on income then someone does "make money off of someone else's health"
Otherwise we should all pay the same tax/premium whatever you want to call it.
1
I have just finished reading the Physicians for a National Health Program proposal that was referenced in this article. I encourage all to read it. It is helpful and I liked the concluding remarks, "...myriad healthcare reforms-most well-intentioned-have been proposed and attempted. Yet continued reliance on private insurers and profit driven providers has doomed them to fail. It's time to chart a new course..." . That is the crux of the matter; the hodgepodge system has failed under its own weight and complexity.
5
Medicare For All is a national security advancement, as important as a hypersonic gun.
When a solider is shot with a bullet, he or she need not find a doc, get a health plan, and list a pre-existing condition. The soldier gets treated.
If the US get into a conflict, say with China, every citizen is a US asset. A kind of soldier. That was true in 1941, and just as true now. To keep assets strong, treat them with top medicine, fast, at no cost to your soldier.
2
What Bernie proposes is Medicare for all "but better." Presumably this would mean getting private insurers out of Part D, and he has talked about abolishing deductibles and copays. Presumably, it would be paid for by a progressive tax.
1
@dr. c.c.
" Presumably, it would be paid for by a progressive tax."
Oh yeah, "Progressive-to-the-Max !"
1
@Connecticut Yankee.....A government run single payer system in Canada pays 40% less for healthcare than we do. What is it you don't understand about "it costs 40% less"?
1
@W.A. Spitzer
They also restrict access to a wide spectrum of testing, interventions and treatments, along with limiting lawsuits that are often unfounded but result in settlements to avoid massive trial awards. This is not an argument for or against single payer healthcare but cost savings come with compromise for everyone, including patients. Thus far, the American patient still says "I don't care what it takes, but do anything and everything", an attitude which drives excessive testing, interventions and treatments. Everyone involved in this mess must give a little to benefit the whole.
1
People are beginning to see that health care is expensive and that everyone needs it to live out their lives in optimal health. How to pay for it and to deliver it at the least cost is the social challenge. The market does not work because nobody can know how much their care will cost. They have limited funds and they have to prioritize how they are spent. For a whole population the average costs and variations can be accurately forecast which enables an accurate knowledge of how much funds are needed, but everyone must be included.
The existing Medicare system offers that kind of circumstances for people over 65 yers of age. It’s got a good reputation and expanding it to all would seem to be simple and cheap. But people’s health care needs from in the womb to end of life is an unknown proposition in this country. A single payer system works across the world. Perhaps that should be the objective.
I live in Australia, a dual citizen. I know EXACTLY what it means: every child can see a doctor when it needs to. Emergency rooms aren’t overflowing with patients who can’t get care anywhere else. People can change jobs, cities, states without worrying about their children, or pre-existing conditions. Employers can hire with the same freedom.
I was interstate once and forgot the antibiotics I was taking at the time. I went a block down the street to the nearest clinic, explained my situation to the doctor, got a new prescription in minutes, and paid....nothing. No hunting for someone in my insurer’s system, no muss, no fuss, no expense.
That’s what it means.
10
Medicare for seniors currently only covers 80% of costs. In order to cover the other 20% seniors must either have insurance as part of their retirement package through a job they had or pay for an additional policy. Police, firemen and other government workers as well as some other union members have been covered by these government or union provided policies for many years. Will they still be able to have coverage under the plans set up for them by their unions or will the "new Medicare for all" cover 100% of their medical bills or will there be "something else to be determined" to cover everyone?? Will prescription drugs be negotiated? Why didn't the Democrats pass a law in 2010 to allow Medicare to negotiate drug prices when President Obama was in power and he had the House and the Senate? What is going to change in the future that allows this "Medicare for all" to pass the House and the Senate?
6
These are all attempts to address insurance costs. No proposals address the skyrocketing costs of delivering health care. Why are these costs rising so much? Why isn't technology rushing to fill the needs associated with rising costs? Could it have anything to do with massive costs associated with federal regulation of health care? Every device, every practice, every solution that touches patient care has to be approved by the FDA. The approval process is hugely time-consuming and costly, and stifles innovation. As long as the federal government heavily regulates the industry, cost-saving innovation will be suffocated, and costs will continue to rise.
1
@Janet....So you don't care if the drugs you take don't work?
2
The so called Obama care was a great attempt in compromise in all accounts. It expanded the pool of insured, it allowed for sick people to enter the system, yet it didn't cut out the large pharma, ridiculous priced hospital services and the corrupt health insurance companies who through this all are still the only ones winning! America cannot continue calling itself a leader awhen the basic human right to proper health services is continually threatened by Republicans. I was insured via Obama care when I was full time self employed, and I am currently offered a "blessed" option for health care via my employer the difference is stark and not in a positive way. I currently pay near 1.1K before taxes a month for coverage for 2 very healthy under 40 years of age individuals and I am always guaranteed to have extra bills come in directly to me after a doctor /hospital visit due to the lack luster coverage. To contrast that my personal responsibility while on Obama care was 480/mo but I had more flexibility than currently. As someone with preexisting conditions, I would always be willing to pay more in taxes, contribute to a larger pool to insure others, and overall be motivated to take care of myself better if I know that 80% of my "investment" wasn't going towards lining the pockets of greedy insurance companies and pharma. This country is sick, and behind on adapting, all because the interests of large conglomerates overshadow the interests of the people.
6
"Heavily regulated health care" in France? Whatever does that mean? I'll tell you what it means. I, as a cancer patient, am 100% reimbursed for indispensable treatments like PET scans, chemotherapy, regular consultation with an oncologist. But, I have contributed for many years to the French health care system. Thank God I'm here. In the US, I'd be in a cemetery.
Kaiser, I believe, is a private health insurance company. Just sayin'...
4
At the risk of sounding negative, the idea that everyone should pay somewhat higher taxes for the good of all is a concept that seems to be losing traction in the US. This fragmentation has been developing for quite some years now, on a variety of issues, and we can see things are getting even more hostile now.
Making practical decisions for everyone's benefit always gets mired in politics and big money. On healthcare, I remember what happened to Hillary Clinton when she pushed for better healthcare in the 90s. And with the ACA, I also kind of remember it being promoted as healthcare-for-all, until the "death panel" rhetoric started and the original plan was ultimately diluted to serve the interests of the powerful healthcare/insurance lobbies.
2
Looking at the tax increase that single-payer would entail in Vermont, I would sign up in a heartbeat. Our family spends about 30% of our income on health insurance when you factor in the astronomical payments and the $13K annual out-of-pocket max, which we almost always reach.
Paying 10% or even 15% more in taxes would be a total win for us!
If this took the place of employer-based health insurance, companies could just up employees' salaries to make up for the extra taxes they'd pay. Kind of how many companies will give you a pay bump for declining their health insurance if you are already on a spouse's plan.
4
The problem with Medicare for All was Bernie Sanders purposely informing his young acolytes about Medicare. Medicare is NOT "no premium and no copay" which what Sanders and his Nurses PAC have been spreading nationwide. People currently receiving Medicare pay monthly premiums AND copays. If Sanders hadn't lied about the funding for the current program, perhaps he wouldn't have had to lie about the funding of his 2016 proposal.
2
Many good comments as I scrolled thru. What's needed is people joining efforts that are working on this, we the people will lead the politicians and they need us to activate. A number of states have grassroots efforts as in Maine with MaineAllCare.org and many members of the medical community support universal health care as a basic need. We can do this!
2
Medicare for everyone over 50 makes sense insofar as many people who make it to the age of 50 have taken care of their health and seem to be a good bet to continue on that track.
1
Medicare For All?
One thing that puzzles me. I and millions of workers and their employers (sometimes the same person) have paid in to the Medicare system all of our work lives. I think of it as prepaying the premiums.
Will the new people coming in to the system pay higher premiums that we do? After all, many of us have been paying in since 1966. I was working then at 15 and paid the tax for 50 years ( as did my employers). And today I am still paying premiums as well as for a policy to cover what Medicare doesn't pay as well Part D which newer.
6
Classic political move: talk about something important for convenient political gain, blur the meaning of it so nobody knows what to expect, and then trivialize it into irrelevance for being nebulous and confusing. A crass and callous move.
2
The evidence that universal health care systems provide better outcomes for citizens is published constantly in studies carried out internationally. Countries with universal health care for all citizens always score better on many health-related measurable parameters.
The real problem in America about health care is that American citizens and politicians are ignorant about what is going on in the rest of the world in health care for all. The two major factors which condemn American citizens to world rankings somewhere below 20th place in all studies are health care and education.
It does not take a genius to look at comparative rankings among countries of the world and conclude that American citizens are not being well-served by their own ignorance about what measures would improve the health of all American citizens.
4
"Who knew healthcare could be so complicated?"
A bunch of other countries have figured it out, decades ago, and keep doing so. Maybe we're just stupid? Our system, pre and post Obamacare, is not sustainable on a cost basis - change is required and here are some templates.
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
It's the details that matter, A LOT, more than whether single payer or not, full nationalization or not. Yes, it will be messy, the transition from our current and past unsustainable messes to a less costly (financial and mental) future, but there are blueprints from others who have gone this way (some stayed private others went partly or wholly public).
The question is whether we have the will to do this right, to get the details right, rather than angling for political advantage or mouthing meaningless slogans as if it is a sporting even with 'sides'? There is ultimately only one side here - us.
5
The GOP/Fox News and big election donors have long influenced how health care for all is labeled---as too left wing for America. This creates norms that drives how our media presents the issue to voters. Health care as a profit center has long set the limits of the debate. Confusion reigns. TV cable news ignores analyzing the issue.
The big story of our time is the US as an international outlier in citizen health care.
The Times, an international paper of prestige and influence, must explain this table and what it means.
From the True Cost Blog—dates when countries started h/c for all:
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
2
In Denmark, if one earns the equivalent of $68,000 US, they pay about 50% in federal and local taxes. In addition, certain medical services are not covered, including physical therapy. In Canada, pharmaceuticals aren't covered, which is why so many Canadians have additional private insurance. In fact MOST countries are a blend of private and public medical plans. Please do the research to ensure you're propagating truth.
2
@GariRae Drugs are much. much cheaper in Canada due to the restrictions of marketing practices, so the impact of out of pocket is not the same as the US.
@stewart....good point.
Bernie Sanders told how he had escorted a bus trip of cancer patients to from Vermont Canada to get needed drugs they could afford. For some reason he didn't use this in his campaign as far as I know.
In news reports about the Medicare for all debate, we should be reminded that 1) beneficiaries over age 65 paid a lifetime of payroll tax to earn entitlement to Part A (hospitalization) and 2) the Part A trust fund is projected to be insolvent within 10 years. Some combination of tax increases, benefit cuts and rate cuts will be needed to stabilize the program's finances. Expanding Medicare to all citizens (and non-citizens?) will require huge tax increases that for many in the middle class will be far higher than the amount saved by no longer paying health insurance premiums. It's hard to see how the single payer program won't resemble Medicaid more than it does Medicare.
2
A side benefit should be the increase in full-time jobs offered by employers who currently favor part-time positions due to the cost of providing health insurance for their full-time employees. I ran a small public entity and would have preferred being able to offer full-time employment, but it made to sense to do so considering the added cost of health insurance I would have to have provided. How many young people currently cobbling together two part-time jobs to survive would suddenly find full-time positions available?
7
We have several problems to solve to get to the crux of our health care debacle. Cost, convenience, the private market, and efficiency, as well as incomes for medical professionals etc.
To try to upend the bureaucracy of both the private and public insurers in a short amount of time would have rather catastrophic results I'm afraid and leave people even more miserable. I think that a gradual sunset by age group, lowering the age to become Medicare eligible and have co-insurance through your employer until retirement would be a start. Gradually draw down the size of the private industry while increasing the size of the public infrastructure. Rather than raising taxes on individuals alone, have employers gradually change from paying into private insurance plans to paying into the public plans which should be much cheaper, and at a flatter cost. Companies can also offer a "perk" of co-insurance for any gaps in coverage. Over the course of several decades, we could get to a "Medicare for all" kind of system with a smaller private insurance market that people or companies can also buy into. But a sudden shift would not work anytime soon. However, requiring all individuals to be insured again and lowering premiums, co-pays and deductibles should be the first hurdle to overcome.
7
Legislation is simply the wrong answer to the problem of rising health care costs. It can't and won't work because the basis of rising health care costs is intrinsic to the health care system. The system is flawed and can't be repaired by political solutions. It needs to be overhauled from top to bottom from within. The problem is we have a Sick Care System not a Health Care System. We need to invest more money in promoting health, preventing disease and reducing dependence on pharmaceuticals. We need to create a healthier population that consumes less medical care. The tools are all there to make this happen, but the willpower and understanding to fuel this change is not -- at least not yet. You can be sure that the powers that be will do everything they can to assure that the Sick Care System survives and that Americans do not achieve better health. Better health for Americans means less money for the pharmaceutical industry, the hospital industry and for the health care system, and the economic health of this system is far more important to politicians and to the system itself than the health of Americans.
2
We need to save cost on healthcare. I have Medicare Parts A & B. I get a number of ads for "Medicare Advantage"; apparently this is quite lucrative for the for-profit companies offering this! So we should be wary of what is offered as "medicare for all" because they can influence the politicians (we do not have publicly financed political campaigns!)and the beneficiaries of the current system (insurance companies, doctors, hospitals, pharmaceutical companies etc)will fight hard to to prevent a financial loss for themselves. Cost savings could come from administrative cost savings of single payer vs multiple payer and deciding the "best practices" for a treatment based on scientific outcomes (e.g. physical therapy vs surgery as the first option to try first). Hospitals are going to make some of their own generic formulations to counter cost and inadequate availability; pharmaceutical prices are totally not controlled so government production of essential pharmaceuticals (e.g. insulin) could be done. Again medicare's cost control for doctors, hospitals, procedures helps cost control. People who want something more could pay for a medicare supplement. I am not sure exactly how this could be done but I feel that the USA is headed for an economic downturn so changes may be considered.
1
Nice article. Its pretty clear to everyone who was involved in developing the ACA that these are very tough questions, requiring a thoughtful and highly informed person to sort out. It is interesting that Trump weighed in on this question, blissfully unaware that he is the least qualified to lecture us on this convoluted matter. Fortunately, many commentators, e.g. Sanders, are interested in an effective program, not political posturing.
1
Those of us who've been organizing for Medicare for All for years know exactly what it means. It means extending improved Medicare - including vision and dental care and replacing privatized supplemental coverage with fully public benefits - to the entire population. Democratic politicians trying to co-opt our movement by means of empty rhetorical flourishes don't care what it means as long as being "for it" in some vague way helps get them elected. Please don't mistake their agenda for ours. Most importantly, don't mistake having "access" to health care for having guaranteed health care as a right. I already have "access" to health care in the same way as I already have "access" to affordable housing - through the marketplace. I can have all the health care and housing I can afford. Do yourselves a favor: please study H.R 676, the Conyers bill in the House, to inform yourselves of what Medicare for All really means.
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The point about medical professionals’ salaries is the key. That bloc will absolutely not accept something that would work, and by that I mean the Australian system. Can’t explain it easily, but as an American in Oz, I can assure you of this...if the US population could wake up tomorrow morning with the Australian system in place, and with the knowledge of how it works implanted in their brains (and this is vitally important), they would be happy with it. The red pill..
1
The short answer is that MANY who 'want' it and EVEN MORE who rant against it have no idea what they are talking about.
Single payer only addresses the insurance side and is only as good or bad as how it is set up and those running it. It fails to address the cost and quality issues coming from the private provider side - private provision distinguishes single payer from a nationalized healthcare setup. Fear of "SOCIALISM!" regarding only single payer appears 'premature' given that England and Canada have nationalized systems yet are market oriented democracies, not dictators, lots of freedom.
That said, here are 5 developed countries with varying systems, all of whom get similar or better health outcomes than here for a fraction of the price and without bankrupting anyone or causing the worry that we have here. Some have single payer, some do not, some have public providers, others do not. What they have in common is universal (or near) insurance, sufficient regulations, and the will to address any shortcomings. Note that even those with nationalized systems, the UK, allow private healthcare for those willing to pay, and many allow private insurance on top of the single payer (like medicare supplemented by private insurance of a former employer).
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
2
Republicans have taught us that we are a nation of "No, we can't." In the realm of other nations, most have managed health care for all. Why can't we, and why can't we do it better? This used to be the "can do" country...
3
The main problem that I see in setting up a single-payer program that would provide quality, accessible, affordable healthcare for everyone is this:
The gigantic and very profitable health insurance industry and the conglomerates of the healthcare industry will never let this happen.
We should repair and improve the ACA instead.
3
My normally polite father, an FDR Democrat, would spout the most hair raising language at the TV when a “repeal Obamacare” Republican was on. I pointed out what Kathleen Sebelius has stated, that Obamacare established the concept that in a first world country health care for all is an affordable right. The concept is now firmly planted and isn’t going away. We will have to tolerate the usual political circus acts on the way, but a universal system will come. The US will most likely be the last first world country to establish such a system, but that’s because we are exceptional!
“Americans can always be trusted to do the right thing, once all other possibilities have been exhausted.”
6
Our health care is hard to understand because the industry has grown wildly out of control in pursuit of profits. As a physician, I have seen this beast devour family budgets. No developed country on the planet lets this happen. Are we Americans so stupid that we can't protect our own ? I am tired of arguments that a single payer might lead to higher taxes or lost insurance jobs. Good grief...that's the whole point! We need to replace an arcane system loaded with profits and waste. Yes, the insurance industry will shrink,, and yes, we will pay higher taxes. BUT the offsets are that we will not have to pay health insurance premiums ...and everyone gets coverage for life.
Finally, a word of caution to those who like the current status quo. A growing majority of U.S. doctors favor a government controlled national insurance plan. The reason is that private insurance has become too complex and contributes to burnout. If patients want their doctors to stay in clinical practice, maybe they should begin listening to them.
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@MAK
What contributes to burn out is government regulations. Absolutely horrible!!
We need to ask why the US pays more per person for healthcare but does not lead the world in life expectancy...there's a disconnect somewhere.
2
@Steve
Obesity.
1
@Tcarl Maybe an obesity tax is in order. At the very least, an AMA penalty should be considered.
What seems to be missing in these discussions is the fact that people on Medicare who are above the poverty level pay a premium for Medicare (about $134 a month in most cases). These premiums help to pay for Medicare (about $1,608 a year) but they do not cover it all, mainly because Medicare recipients are elderly and elderly people go to the doctor more frequently than young people.
If "Medicare for all" means young people paying the same premium as retirees but using the services far less frequently, then they help amortize the Medicare cost among a larger number of people. That's the way private insurance companies make money. A sliding scale for premiums for lower-income families would ensure universal coverage and most families would be willing to pay as little as $134 for basic Medicare and would probably purchase supplemental plans, from the government or private insurers, who seem to do well selling extra coverage to seniors. They too would benefit as partners in the single-payer system' the same way they prosper selling supplemental coverage for seniors: Even better for them because younger, healthier people will use it less.
It's the old "Keep it simple, stupid" principle.
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@Joe Kernan
My wife and I pay $900 a month for our Medicare.
2
@Joe Kernan
The Medicare premium was originally set at 25% of the estimated cost of (Part B) benefits. The rest of the cost is made up through general tax revenues. Congress dropped the 25% standard years ago when health care inflation started to cause premium increases that it felt were unsustainable so now less than 25% of program cost is funded through premiums.
1
@Tcarl You must be much better off than I am. But all premiums should come down when more people feed the kitty. Pardon the gambling reference but all insurance is a calculated gamble. I'm betting that a universal single-payer system would benefit from premiums from young people who are healthy. Sliding scale would be essential but phasing private insurers out of health care. Imagine if all the money spent on TV ads for television was pooled with taxes to support universal health care. There is something unholy about profiting from someone's illness. It is somewhat barbaric and unseemly.
It means Obamacare is a complete failure.
1
@Happy Selznick, it was a patchwork.
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We need to hear from citizens abroad who pay taxes for their guaranteed health care and can give concrete stories of their experiences, going back generations. Tell about their taxes and health care costs. Would they ever want to change to US style h/c? Why not?
The Times as an international paper must start interviewing citizens abroad on this. Don't keep it dark and undiscussed here.
H/c for all is centrist policy for generations in other democracies that are also capitalist systems. Their rw parties accept it and don't try to dismantle it, unlike our extreme rw GOP.
Whats related is this: Abroad, they don't turn their election campaigns over to the corporate mega donors for funding, US style.
Abroad, they don't have a huge Fox type media monopoly across the land that puts out fake news against guaranteed health care for citizens.
Abroad, their medical care system is not based on private profit as highest priority. It is centrist that citizens health care is higher priority---that's democracy. Thus it's accepted that their govts can regulate insurance and drug prices. That's called representing citizen interests. Here that's off the table.
America has the world's most high cost and most profitable systems for both health care and for elections. And this is even with ACA---using our taxes to subsidize insurance profits.
Yet this is a big improvement over the previous US h/c situation---a violation of human rights by 20th C international standards.
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@Meredith
I live in Switzerland, previously England, France and Australia. England is the worst, France good in theory but the French bureaucracy is a shambles. Australia is the best, but as an anglophone I’m probably biased.
Here in Switzerland insurance is compulsory, you pay the first 300 francs of medical costs in a year and after that 10% up to 700 francs. No restriction on provider or treatment, see who you like, get as many second opinions as you like, facilities first class, easy to get appointments, never had to wait more than a few minutes after scheduled time.
2
@Glen...thanks for your info. Now give us some idea what 300 francs and 700 francs means to Americans. And how that compares to what many average earners pay in the US.
I've seen on cspan the UK parliament Question Time on Sundays. and the labor leader Corbyn sharply criticizes the cost cutting of the conservative May.
France has it's problems--as do most other nations, but they still have h/c for all----UK since 1948, and France since 1974.
France's rw Marine Le Pen favored keeping their h/c for all.
Canada has h/c for all since the 1960s.
Sometimes their conservatives cut but don't dismantle their systems.
@Meredith
Here in New Brunswick, Canada we have Medicare NB which owns and operates the hospitals, including all lab testing facilities, imaging, X-rays, CT scans, surgical services, etc. The doctors, who provide services at the hospitals, and also run their own offices are paid by the province. When you have a problem you go to your family doctor, who is the gatekeeper to the system and who will order necessary testing or hospital procedures, and prescribe drugs, etc...The nurses and other health care professionals are public servants. The dentists and optometrists are not covered by the public system, unless the case involves a medical emergency. Prescription drugs are not covered by the public system, except for seniors and social assistance recipients, etc. Most people purchase dental and eye and prescription drug plans or are covered by their employees/ group plans. It is important to note that every province has its own separate plan and no two are alike. We do pay higher taxes such as the GST and higher prices for liquor, gasoline, etc... However, we never see hospital or doctor bills as they are paid out of the general tax revenue of the province. If you don't have dental or eye care insurance or a drug plan it can be very costly, however nowhere near what it costs in the USA. I am retired on my union drug plan and my wife and I pay only 10% co-pay for any prescription.
No one would like to go back to 50 or 60 years ago, which is where you apparently are.
2
Why does no politician address the many economic benefits of universal single payer healthcare? Entrepreneurialism would explode if people did not need to count on their employers for healthcare for themselves and their families. Health insurance coverage controls the economy right now, people live in fear on a daily basis of losing their coverage. Coverage is renegotiated every 12 months! Your firm may cover you today but not next year. This is ridiculous. People would be able to save more for retirement and spend more of their daily funds. People would be able to move to any part of the country they wanted to without being chained down by employer based insurance coverage. No one in the US is free with this burden weighing on us at every moment.
Things are okay right now, I am responsible in my savings and spending, have a successful career on paper, but am just an accident or benefit change away from the complete financial annihilation of my family.
With the current state of our healthcare system, Americans do not fit any of the definitions for freedom:
free·dom /ˈfrēdəm/
the power or right to act, speak, or think as one wants without hindrance or restraint.
absence of subjection to foreign domination or despotic government.
the state of not being imprisoned or enslaved.
the state of being physically unrestricted and able to move easily.
the state of not being subject to or affected by (a particular undesirable thing).
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@CEl With all due respect, why would entrepreneurialism explode if people did not need to count on their employers for healthcare for themselves and their families. Is there any real basis for making a claim like that? I don't want to debate this, but that's sort of conjecture, like saying single payer healthcare would spark a massive growth in technological advancements. What I think you're really talking about is relieving stress and improving health in many peoples lives -- why not just stick with the direct benefits and quit turning this into a panacea for every ill in U.S. socioeconomics?
@CEl..... Terrific comment, going beyond the usual to the heart of the matter in a democracy.
Reminds me of this NYT op ed:
The Fake Freedom of American Health Care
By Anu Partanen, March 18, 2017
This Finnish journalist moved here after marrying an American.
Quote:
“The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care. The point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom.
As a United States citizen now, I wish Americans could experience the freedom of knowing that the health care system will always be there for us regardless of our employment status. I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures. I want the freedom to know that the system will automatically take me and my family in, without my having to battle for care in my moment of weakness and need. That is real freedom.
So is the freedom of knowing that none of it will bankrupt us. That is the freedom I had back in Finland.”
@CEl
Yes, yes yes!! Freedom and liberty are now directly tied to health insurance. And right now, the American population, most of us, don't have freedom because of this debacle of health care.
Perhaps the largest lie of American politics is that price driven, for-profit healthcare is acceptable. Voters can change this and should vote republicans and their "freedom to suffer and die" crowd out.
3
As long as most Americans are adverse to higher taxes , it will never happen . The Republicans make it a point to constantly remind voters , while giving huge tax cuts to those that don't need them and can afford their cadillac care . The usual carrot and stick routine ; all the sad stories of Americans bankrupt by serious medical issues are met with sympathy and then forgotten with " thank God it's not me" . You always get what you pay for .
1
As long as our (Democratic) leaders insist that we must "pay any price, and bear any burden" to save every last junkie who has been brought down by his/her own hand there will never be the resources to save those poor souls who have been brought down by the hand of God.
The GOP, of course, would just as soon throw us all under the bus.
1
i have been treated for major ailments in france, germany, and italy. Before MM's Sicko came out. i can tell you it is soooo true. Better care, and lower costs. Emergency throat specialist in paris on a Sunday (hospital des enfants malades) the bill was about 12 dollars US. I offered to pay full freight and was told that was it. If i had been french it would be free. Same in italy where the doctors laughed and said you must be american!! In germany it was more expensive.....about the same as co-pays with medicare.!!! I would also add: question anyone who writes about med care and works for kaiser. Maybe it's getting better now, but ask around. thanks.
4
How funny to be reading this from the author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." The answer is really simple, other countries do it and spend far less per capita on health care, with better results.
Health care is now something crazy like one sixth of the American economy. Not the same in other countries. Btw, poor people in France and Germany aren't turned away because they didn't pay taxes into the system.
So lots of people will be hurt if we ever model our system on those that successfully work in other Western countries. That's what happens when you get rid of all the parasites.
That includes hordes of people working for insurance companies, who mostly try to find reasons why they won't cover a necessary test or procedure even though you've paid your premiums. "That doctor or MRI facility isn't in our network."
That includes shareholders of Big Pharma, and plenty of drug representatives shuffling from hospitals to doctors offices trying to convince everyone that their newest medication is definitely superior, while neglecting to tell anyone that it costs triple the current alternative.
As a physician, yes that includes many of my colleagues whose salaries will decline in line with what they're paid in other countries. Perhaps that would need to be offset with free medical school tuition so more of the best and brightest are drawn to the field.
And we have a critical shortage of RNs and PCPs looming . . .
5
The authors of this piece would have us nail down every minute detail before pushing for this idea's enactment. That's not how politics works, and they know it. I can only conclude that the authors have a vested interest in the existing system and, rather than revealing their true motivations, they are attempting to get the public to shrug its shoulders and accept defeat because "it's too complicated and expensive." Meanwhile, while the left dithers, rightwingers are pumping out their truly half-baked ideas 24/7, with great success.
2
Ask any senior if they want to give up their Medicare and go back to private insurance. I think you'll have your answer as to which is preferable.
6
Of coarse they don't want to go back to private insurance. Medicare doesn't cover the cost of their care, so the doctor takes the hit. That's why many don't take it and hospitals charge everybody else an arm and a leg. There is no free lunch.
@Al
No, there is no free lunch but there could be a shared one. First of all medical school could be virtually free as it is in most advanced countries and doctors would not start out hundreds of thousands of dollars in debt. Maybe more would go into family practices which might not be as lucrative as plastic surgery but more beneficial. Cut out the administrative costs of private insurers and hospitals would save a bundle. My internist loves Medicare because it's so simple, but then she's a "real" doctor. My friend who has lived in France for many years was diagnosed with cancer, had multiple surgeries and chemotherapy (which was administered to her in her own home), and her ultimate bill came to the equivalent of $1000. Every other advanced country can do this and we could too if we get our priorities straight.
October 19, 2018
The New York Times
To the Editor,
Re “Does anyone really know what ‘Medicare for All’ means” (Opinion, Oct. 19):
What’s the problem?—‘Medicare for all’ is a ‘single payer’. It’s easy and meaningful for people to understand the terms interchangeably.
Differentiating the two confuses the main issue—that health care is too costly for most.
Making ‘single payer’ synonymous with ‘Medicare for all’ does more good than harm.
Edward Volpintesta MD
155 Greenwood Avenue, Bethel, CT 06801
1
'Canada and Britain come particularly close to true single-payer. Their governments pay medical bills with money raised through taxes and have monopolistic negotiating power over prices. But after that, the systems differ.
...
Britain goes a step farther. Its government owns hospitals and employs many specialists via the National Health Service. A small private system exists, catering mainly to wealthier people seeking faster access to elective procedures.'
Misleading and incorrect.The United Kingdom of Great Britain and Northern Ireland does not have and has never had a single NHS. Rather, since 1948, each of England, Wales, Scotland and Northern Ireland has had its own distinct, separate and autonomous NHS. It's a sad state of affairs when Wikipedia is a more reliable authority than the NYT on the four National Health Services in the UK.
https://en.m.wikipedia.org/wiki/National_Health_Service_(England)
2
I'm embarrassed by the false arguments and the "me first, to heck with everyone else" ethos so active in the US, perpetuating a ridiculous hangup over something as important as access to health care. The naysayers indicate incredible selfishness or little understanding of how such a system could work. Dismantling and reorganizing a system built around insurance companies, though, is going to be tricky. Best of luck.
This is an excellent article that separates single-payer from universal plans, explains a range of options, and looks fairly at problems of cost and politics.
Nice. And even better, for once most of the comments are rational.
Let me point out a couple of things, all the same. As mentioned, Medicare comes with a premium, has deductibles and co-pays, and is an 80/20 plan...which means you pay 20% of a lot of the costs, unless you buy supplemental insurance. It’s also easy to forget that its affordability rests in guys like me paying in for over fifty years of taxes before I use the benefits. One nice thing, though—for all the yelling, Obamacare did away with the Part D “donut hole.” If you know somebody in Medicare and you don’t know what that means, you need to find out.
Another thing that us lefties need to get through our heads. If we want everybody covered fairly, everybody has to kick in something. Malcolm Gladwell put it nicely: you can give a relative few every benny there is, or you can give everybody the basics. Canada went with the latter approach; we went the other way.
But you cannot...possibly...afford...everything for everybody. There’ll have to be rationings, whatever they’re called. And by the way...you want health care cheaper, well, about half of our costs come from what are euphemistically called, “behavioral choices.”
That means we’re fat, eat badly, stress out, smoke too much, likely drink too much, and don’t exercise.
Want lower costs?
5
@Robert
Just curious. Don't Canada and the U.K. have their own stressed out couch potato smokers?
1
They do and they die. It's about rationed care. Something Americans better get used to if the want Medicare for all.no system gives everybody everything all the time.
@Al
Including private insurance.
Americans know that "Medicare for All" simply means expanding an improved version of Medicare to cover everyone, and a clear majority support it.
Politicians on the left recognize the popularity of the Medicare for All label and have used it to support their feeble public option and Medicare buy-in proposals that would leave the dysfunctional, post-Obamacare status quo in place.
Politicians on the right also recognize the popularity of the term and thus, led by President Trump, condemn it in whatever pejorative terms suit their campaigns.
After the election we should demand that those on the left professing to support Medicare for All keep their campaign promise. Those on the right attacking the Medicare for All label are now supporting a guarantee of health care for those with pre-existing disorders. We need to show them how they can keep their promise by enacting an efficient and equitable single payer national health program (Medicare for All, but avoiding that label). We shouldn't care if they want to call it Trumpcare as long as it gets the job done.
I am a Doctor. We need this desperately. No pun intended, but it is a reflection of the health of our Democracy in every respect.
So many billions are paid into private insurance with very high overhead unrelated to the delivery of healthcare. Insunrance companies, not Doctors, are determining YOUR healthcare. People are suffering and dying needlessly yet we, as a nation, pay the highest amount in the world per capital for our care.
The “establishment” - those who profit from healthcare delivery (most often NOT Doctors) likes this. It owns hospitals, clinics, drugs distribution networks, big pharma, etc - all for profit. Millions must choose between food and medical care and many millions more go without either, one especially the elderly and very young.
Our Medicare model is superb. It is comprehensive, able to monitor and coordinate results and is very efficient. Yes, we CAN include everyone in this, and fund it with the money now wasted by “the establishment”. Republicans don’t want you to know this. It’s not Communism or socialism; it’s workable common sense and great for everyone. Doctors would even get fairly paid and everything one would get quality care - but YOU must VOTE for this or it will not happen. Trump and his minions oppose it. That tells you how much they care - they’re rich and/or stupid.
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@RealTRUTH
As a physician I agree with you whole-heartedly.
2
@RealTRUTH
" .. So many billions are paid into private insurance with very high overhead unrelated to the delivery of healthcare ..
Hey, REAL .. why are so many complaining that today's Medicare is over budget?
Y'all really have to get your stories straight .. this isn't Comedy Central, this is real life. Thanks.
@RealTRUTH
Can doctors get together and lobby for this? This would be a priceless lobbying for the right thing. I don't know what the AMA feels about Single Payer. Worth investigating.
Many people write to complain about the ongoing costs/taxes of single payer or Medicare. What they fail to take into account is the unexpected cost of a sudden major illness or accident or surgery which can dramatically increase medical expense to the individual or family. Not only is a sudden trip to the hospital unknowable for otherwise healthy people, so too the costs of hospitalization or surgery, etc., etc. One suspects that the very expensive and profitable medical industry wants to keep people in the dark about these matters.
2
It is largely because Britain has lots of poorly educated immigrants who are heavily dependent on government services that many Britains voted for Brexit. The government does not have enough money to take adequate care of everyone. The National Health Service has been cutting back. See the NYT 1/3/18 article "N.H.S. Overwhelmed in Britain, Leaving Patients to Wait”.
Canadians have been able to fund their health care system by carefully controlling who can move there. It gives preference to those who could contribute a needed ability to the Canadian economy, who are fluent in English and/or French, and who would assimilate easily. These immigrants are able to pay taxes that help support the Canadian health care system.
Canada has relatively few illegal immigrants.
Contrast the Canadian immigration system with our own. Most of our green cards are awarded to family members, regardless of the person’s education, skills, fluency in English, or overall ability to assimilate. And we already have between what PEW Research estimates at 11.2 million and what professors at Yale’s School of Management estimates at 22.8 million illegal immigrants, with more coming all of the time.
There is currently a Caravan up to 4 thousand Hondurans on its way here. Would Medicare for All cover everyone who manages to enter our country?
6
Ann - perhaps your harangue against immigration would have been more appropriately placed in a column about that. It is minimally mundane to a National Health implementation and casts a prejudicial view upon those seeking asylum in what was formerly a bastion of Freedom. I,migrants are not to blame for our lack of excellent health care for all - narrow-minded, greedy entitled people are. Until that changes, our country is a disgrace on the world stage. VOTE THOUGHTFULLY, not myopically.
3
@RealTRUTH. Too bad, but Ann is speaking the REAL Truth. No only Canada, but also Finland, Australia, and the Scandinavian counties have very low levels of illegal immigrants and very high satisfaction with the national health system. It won't work if millions who don't pay into it are allowed to take out of it. It will be interesting to see if other countries suddenly flooded with poor, uneducated immigrants - such as Germany - see the same decline in health services Britain is experiencing.
In reading this article on single-payer/Medicare healthcare alternatives, it seems to me that to change the system all at once could be difficult and confusing for both the government (especially the government) and the beneficiaries. The proposal to lower the age eligibility for Medicare caused me to think that perhaps the best way to implement such a drastic change in the healthcare system would be to incrementally lower the age eligibility levels over a defined period of time. If the Congress would ever get it's act together and pass such legislation, the new health care bill would have to define the time frames within which each succeeding age lowering eligibility would be implemented. For example, initially lower the Medicare for all age level to 60, and then give it a specifically set period of time for the new system to put into practice, say, for example, 2 years. Once that time period has passed, and people are integrated into the system, then the next lower age eligibility to 55, and then so on and so forth, until such time as all Americans for successfully integrated into the Medicare system. This might be a painless way for such a "Medicare for all" system could be successfully accomplished for all Americans.
2
Michael - I respectfully disagree. The Trumplicans just passed a major tax revision which affects ALL American immediately. Even these slugs knew that this could not, would not, happen in stages. “Phasing in” a National Healthcare policy would not work with multiple competing systems at bay - insurers at odds with Medicare. We have seen this before when Hillary tried valiantly to get one passed but got blind-sided by insurers who changed the rules strategically and ruined all hope.
We need a definitive long-term plan, one that actually would work out of the gate (one that is not corrupted by Trumplican IEDs), and a firm deadline for implementation with adequate public information. We do this now quite successfully as older people become Medicare eligible. We will survive this new tax abomination until it is repealed by a rational administration. It is amazing what America can accomplish with great leadership and the will to do good. Insurers will just have to bite the bullet - this change is inevitable and they are already anticipating it by buying other healthcare-related industries like pharma and distribution. THEY see the handwriting on the wall, why don’t we (the answer is greed and propaganda)?
2
Medicare for all means that seniors, who paid for Medicare for decades, will be moved to the back of the line for accessing health care. That's inevitable in an ageist society, but so be it, I guess.
2
I recently watched a BBC documentary series on one very large hospital (Queen Elizabeth in Birmingham) that is owned by the NHS (National Health Service) with 43 constantly busy operating suites. The impression given was that medical professionals were well trained and dedicated and the patient's ability to pay was not an issue. The contrast with our slapdash money mad system could hardly have been greater.
I watched several major, life transforming operations fully paid for by the government and thought, how wonderful if we could have such a system, but then I despaired, because it can't happen here. One of our two political parties is geared up to sabotage it by any means. Even this supposedly even-handed article brings up more reasons why we can't than we can.
Perhaps some day we will catch up with the rest of the world, but boy it will be a long hard fight to get there.
1
I'm divorced and seif-insured under Obamacare. This summer, I went to the ER; so far, my share of a $3100 bill is $1500 and counting. This doesn't count follow-up visits to specialists I needed prior approval to see, as well as gas and ferry expenses to get to these specialists.
My son, still covered under his father, went to the same ER. His bill was less than $150.00. Dad is under NY State employee health insurance.
Why is my private insurance so expensive in comparison? Healthcare will never be "free," but I have to believe the insurance and big pharma are doing quite well at our expense.
11
Medicare for all, as proposed by Bernie et al, is NOT Medicare as we know it that serves those of us over 65, the disabled and other eligible groups. Original Medicare includes sensible copays and deductibles. The insurance industry provides Medigap and other programs to share risk for these copays and deductibles. I choose to avoid these insurance products as Original Medicare is a wonderful insurance product on its own. Medicare is ranked highest in satisfaction among most health insurance programs.
The United States desperately needs a National Health Program of some kind. The point is that any National Health Program that provides first dollar coverage, without copays and or deductibles will fail.
The best option would be to extend the already existing Medicare Program to a lower age group, say 60 year olds, and continue on lowering the age group for eligibility if it is successful. Why reinvent the wheel.
4
One thing I never see is a simple analysis comparing total current expenditures by individuals, insurance companies, and government payers including current Medicare and Medicaid with what the total cost would be under Medicare for all. Many of the comments point out that simply saying Medicare for all would cost north of $32 trillion over the next 10 years. Is this supposed to be in addition to current expenditures or is a significant portion going to be offset against current costs?
Senator Sanders introduced legislation for Medicare For All in the current session. Devoid of details on revenue and assumes all providers would accept Medicare Reimbursement Rates for all patients. You can enter into a private contract with a provider to receive covered treatments outside the system. That is likely what the relatively wealthy will do. Two class healthcare system the likely result.
https://www.congress.gov/bill/115th-congress/senate-bill/1804/text#toc-i...
This article says Obama promised "that people wouldn’t lose their doctors under the Affordable Care Act", but what he actually said was "If you like your health care plan, you can keep it". According to the PolitiFact article cited, less than 2% of insured population had their policies cancelled. Those cancelled were low-cost, low benefit policies that did not meet the higher ObamaCare standards.
Like most other articles on the subject, this one raises the specter of higher taxes to pay for Medicare for All. It barely mentions in passing "premiums, deductibles, co-payments and out-of-network charges" that Americans currently pay. According to EHealth Insurance (cited by CNN) the current average family insurance annual premium is about $10,000 and deductible expenses about $8,000. If Medicare for All were paid for by a progressive tax, most people would see their overall payments for health care go down.
1
We could have a health insurance system that would be much better than either government single-payer insurance or policies currently offered by corporate insurance companies. Which type of company would be most trustworthy and offer you the best health care insurance policy? The answer is a company that you own.
We have mutual savings banks owned by their depositors and the depositors also elect the board of directors. We have mutual life insurance companies owned by their policyholders and the policyholders also elect the board of directors. A mutual health insurance company, owned by its policyholders, would provide the best health care insurance.
It always galled me that Mitt Romney and I paid the same amount of taxes for SS/Medicare (in those few years I was lucky enough to make more than $120K).
Eliminate the Medicare tax cap - currently $128,000.
Obviously, repeal the recent tax cuts for the wealthy.
Private insurance industry shrinks - fine with me.
Medical specialists take a pay cut - fine with me.
G.P.'s get a pay hike - fine with me.
ER visits only for emergencies - fine with me.
No one, no family faces bankruptcy because of illness - very fine with me!
6
@TMM
If you want to pay what Mitt pays, then get a different job. It bothers me not in the least that he pays the same. I chose a different career and accept that some will do better. So what.
2
@TMM You are wrong there is no medicare tax cap. you pay 2.9% (with your employee) on every dollar you make.
In fact you pay an additional 1.8% a year (4.7% total) on any salary above $200,000.
You and Romney pay the same amount on Social Security, but that is weighed in favor or lower wage earners who get back much more in proportion then they put in versus those who contributed more.
https://www.nasi.org/learn/socialsecurity/benefits-compare-earnings
3
@Rob
I stand corrected - re: the HI portion of FICA - thank you.
Therefore, I will amend my comment:
I am still galled that Mitt and I paid the same in taxes toward Social Security. Eliminating the cap on earnings above $128K would go a long way, and be a step in the right direction, to ensuring SS solvency in the future.
Lower wage earners getting more than they paid in is fine with me - that is what insurance is all about - if Mitt were to suddenly become destitute, he too could rely on SS benefits.
Financing a single-payer health insurance plan would indeed require a tax overhaul, including the HI portion.
The rest of my comment remains unchanged.
1
"But what exactly these proposals mean to many of the people who say they support them remains unclear."
I really, *really* don't want to waste my time with op-eds that worry about what something "means" to some group of people.
1
@polymath
The point is, when it comes to financing health care services, almost everyone has an ardently held opinion but almost no one knows what he or she is talking about.
Medicare-for-all is a common goal. The ability to have government negotiate the price of medical care on one's behalf. Medicare can "sell" different plans. How much should those plans be subsidized? That question applies to private insurance as well.
1
This is an excellent example of where we Democrats get too wonky, too quickly, to our own detriment. The American people don't care about the details. They care about the core value that everyone deserves medical care. The particulars of how this can be worked out later. Please, let's not subvert ourselves and our values by focusing on the details when we don't yet have the policy or the people in power who could
bring it forward.
4
@Cy
You sound like the Republicans who wanted to repeal the ACA and would worry about what to do instead later. Except this is much, much bigger and easier to mess up. If we adopt a single payer program and try to wing it, we will fail.
Americans need to understand that healthcare is a finite resource and it has to be rationed (as it is in every country in the world in one way or another). Right now in the US it is rationed by price. In the UK, it is rationed by access (long wait times for many procedures). Go online and read a UK newspaper about the issues associated with their healthcare delivery system. It's not a pretty picture. We also have to pay for it. Our taxes will need to increase significantly to pay for this (it is not free, never will be free and the "rich" can't pay for it - we are talking trillions of dollars). We need to change what we have but there is not secret answer. And remember that CO and VT both voted down single payer in their states due to the cost to the taxpayer.
4
@Anita - The average cost of a family insurance plan in the US is $28,000 for premiums and deductibles. For a smaller sum in taxes, that same family would no longer pay premiums or deductibles or co-pays, wouldn't have to worry about pre-existing conditions, wouldn't have to cling to a hated job just for the insurance, and wouldn't have to worry about bankrupting their family if they had a serious illness.
As for "rationing," the US is the country with the rationing. Not enough money for health care? Then you don't get it. But if people believed the lies about rationing in those other countries, we should expect to see them dying like flies over there. Instead, they live on average 2 to 6 years longer than Americans. And as for wait times here, my husband had to wait longer for hip replacement in the US than he'd have had to wait in Canada.
4
The NHS’ problems are largely—not entirely, but largely—due to twenty years of Thatcherite hacking at its funding, and the system STILL generally offers better or as good outcomes as ours.
This excellent article, if read, actually talks in detail about costs.
4
@Anita all Americans are granted life and liberty. Life necessitates adequate healthcare. Our for-profit, price driven system is unAmerican and must be replaced.
1
Medicare as it exists today provides a good level of care for senior Americans. If the system could be expanded in it current form to the entire population it would be a reasonable solution to the problem. However, what many fear is that what would ultimately be deliver is MEDICAID for all. If that proves to be the case expect many current providers to retire or go into another line of business. Expect long waits for low quality care in sub standard facilities. Be very careful what you wish for - you may get it.
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@TW Smith
It also raises the spectre of a governmental hospital system like the ones that are run by the VA.
Like any significant public policy issue there are winners and losers with the adoption of any Medicare for all or single payer system. The winners would be the overwhelming majority of Americans who now pay (or cannot afford to pay) large sums for premiums, co-payments, deductibles etc. Most, but not all, of these people would be under the $100,000.00 annual income threshold. The most obvious losers would be far less numerous but probably much wealthier and more powerful on a per capital basis. Medicare for all or single payer could result in the loss of the entire medical insurance industry, which vigorously fought the Clinton's single payer proposal in the 1990's. Additionally, drug companies and many physicians and hospitals could see their incomes drop, perhaps precipitously. Finally, many upper income Americans ($250,000 and up) are more likely to have their insurance paid for by their employers as part of their compensation package. So not only would they lose their cheap and good insurance, they would also necessarily bear the brunt of the increase in income and/or payroll taxes to pay for some version of Medicare for all or single payer.
In the end, Medicare for all or single payer is a moral imperative but the politics of it - that is, picking the winners and placating the losers - is tricky.
3
What's the problem? Currently there are over 44 million ocitizens covered by Medicare today. That's about 15% of the population. The important thing is that it works.
At age 82, I have been covered by Medicare for the past 17 years.
There are some additions, such as Medicare Advantage, that have been added along the way which in fact have benefitted many retirees.
We have had public schools forever as well as private schools. There is no reason why we cannot have pubic insurance and even private insurance like New Zealand. I totally recommend "Medicare for All." It works!
3
New taxes? Horrors! Don't tell me that the Jared Kushners of this world might have to fork over the price of a couple of new cars a year (out of their multi-million dollar incomes) so that their fellow Americans can live decently! Horrors and more Horrors!!
(Seriously, though. Expanding the Medicare system should start at the bottom and the top — that is, include the youngest eligible portion of the population and lower the top age requirement, working gradually toward the middle, over a period of a few years. That way, the young people, who statistically don't have as many health issues, would be part of the pool — and invested in keeping it going for the long haul.
Finally, the reason "Medicare for all" is a successful slogan, and will eventually be a successful program, is because Medicare works. As a senior, I can tell you from experience that it works very well.
5
It kills me that the media fails to explain the immediate savings a "Medicare for All" type plan would provide to anyone who currently has insurance. Few, if any, have a plan completely paid for by their employer.
Medicare is currently paid for (Not entirely, but very close) via a 1.45% tax on employees and 1.45% tax on employers. It covers 15% of the population. Multiplying the tax to cover all people makes it 8.5% But we could likely cover everyone by raising the tax on each to roughly 5%. Why? Because the current 15% that are covered are those who use healthcare the most, the elderly. Adding in everyone includes a vast amount of people who would not need care beyond an annual checkup. But they'd be covered, just in case.
Now I sure companies would balk at paying 3-4% more per employee, but for those who now provide coverage to employees it would pretty much be a wash.
In addition, all the companies that do not currently provide coverage would be paying into the system as well, equalizing the burden. And all employees currently not covered would be paying into the system, too.
For those desiring additional care, they could opt in for private supplemental coverage as is now the case with Medicare.
Personally, I think it would need to have co-pays in order to keep people from abusing the system by showing up for needless issues, and to also even out the burden. (If you use it, you pay a tad more.)
It's doable people. We just need to remove the political rhetoric.
5
Here’s something non-political: math.
Medicare is actually paid for by having your 85% of the pop paying in for fifty years before they use the benefits, your continuing to pay premiums and co-pays and co-insurances, and the fact that a lot of geezers die every year.
And here’s a bit of physical reality to boot: every time coverage is expanded to a population that never had coverage, costs go way up for at least five years. There seem to be two basic reasons: folks rushing for services, and very sick folks who were in desperate need.
Stop with the hey presto.
2
@Robert Math is indeed a wonderful thing.
The 85% of the population does NOT pay it for 50 years and then reaps the return as one does with SS. The 85% pays in EACH year to cover the 15% that need coverage EACH year. So expand the payments and expand the amount of people covered.
The ACA added an additional 20 million to the coverage rolls. And 14.5m of those were under Medicaid, so they weren't paying in. According to your logic, my insurance premiums should have soared, yet they went down instead. AND two years I got rebates because the insurer did not pay out more than 80% of premium charges in benefits.
Lastly, it's amazing how every other civilized country in the world can do this but US. Yet, we're supposed to be the leaders in ingenuity.
There are several reasons why the US health care 'system' needs 'drastic reform'.
The US is renowned for not learning anything from other countries. The isolationist mindset says that things in other countries can't possibly be better than in the US.
The US has evolved very differently & behind the the more developed world in several areas - health care, education, social security, etc. Health care systems in other countries didn't happen overnight. Britain in 1948 & Canada in 1953, & it took 70 years of evolution & experience to arrive at the systems they have today. Throughout those years the US has built its system of 'for profit' private industry. The US has to catch up on 70 years of evolution.
The US was built on white immigration from Europe & Scandinavia. These days, there is none (nor from Canada either). The people in those countries are happy staying in the societies they have built over the years. That's a good indicator, I think, of how far behind the US has become.
But wait! US GDP, low unemployment, stock market numbers, are all so great! But plenty of US economists have done their analyses to show that these numbers are misleading.
Those who want universal health care face a tough challenge.
BTW - B. Sanders knows Canadian health care. He has studied it. Listen to him.
Why should I care? I'm an 80 year old Canadian, & I love my health care. Doesn't cost me one cent.
6
Thank you for this.
And yes it is a crowd pleaser but the crowd is seldom told what they are buying.
People cheered on cue when Obamacare came on the stage, then elected Trump when they got billed for not having insurance they could not afford in the first place.
And yes I am tired of social programs that have raised my taxes to the point I now pay 35% of my pay check in taxes, insurance and social security. Despite all that, I can’t afford to go to the doctor as my copay is high and medical is expensive. I need dental implants but who has 10k for that? So I pay in to all this social wonderfulness that I cannot afford to use. Some solution, Obamacare.
Yet the socialists come on stage and say ‘medicare for all’ and people cheer and shed tears of joy. Wonder if they understand they will get billed for all that.
The only thing that I disagree, is that you mention that Ocasio-Cortez has a plan, yet she has never said how she plans to pay for what she’s selling. Granted, people have not asked her either. Candidates like that are dangerous to tax payers like me.
3
@AutumLeaff we really don't know how and who pays for our current healthcare mess. Taxes pay for much of the employer covered healthcare we've benefitted from (if you're employed by a large wealthy company). We need to turn off the tv fox/sinclair news propaganda and study how Japan, Germany, Netherlands, etc. have succeeded in meeting this first need of their citizens.
I’d point out to you that Obamacare got you checkups, tests and vaccines and other stuff at zero cost, and point you towards Kaiser Family’s studies of how our health costs got this way, but your yelling about socialism suggests that you’d have trouble with the big words.
FYI, I also pay at least a third out of my paycheck—in taxes, Medicare, retirement, insurances, and so on. Boohoo, boohoo. It’s cheap at the price, and while I’m not rich, I am doing quite well as I near near end of my career. When I quit, I’ll have money in the bank, a solid oension (even if I have to give up a third of the Social Security I paid into for decades, because of the nature of my pension, and to support people like YOU), and a few other goodies. Boo hoo for me. Alas, alack, stuff costs money.
But I don’t live in Manhattan. How do you?
@AutumLeaff - The average cost of a family insurance plan is $28,000, counting premiums and deductibles. Under single payer, that cost goes away, totally, leaving the family with $28,000 in their pockets with which to pay a lower amount in taxes. It's estimated a family could save $6500 a year.
If someone has employer provided insurance, whatever amount the employer pays is immediately taken right off the top of any wages or benefits the employer would/could otherwise provide.
OK, to clarify:
(Disclosure: My wife and I are on Medicare)
Medicare For All (MFA)
is a first step, giving partial, imperfect but fairly effective, medical coverage to everyone. Medicare expenses out-of-pocket are tax deductible (Parts B & D including drugs). Medicare already negotiates some lower prices for its 'group'. This might require passing limits on doctors' right to refuse Medicare patients. Companies could still offer extended coverages.
Single Payer (SP)
should mean the government pays all covered expenses and can negotiate flat rates for all of us for treatment and drugs. Big Pharma will hate that, but it works in about half the world. Again, doctors may be required to accept SP patients, although 'concierge' plans covering more might be allowed. Companies and self-employed would stop paying healthcare directly. Insurance company roles would be vastly reduced.
Taxes would rise in both cases, more in SP, but the net savings would be real in MFA and potentially enormous in SP. Phasing in either system over 5-10 years might ease the displacement, for ex. at the health insurance companies that currently add about 25% in non-medical cost to the nation's health bill.
4
How strong is the Physicians Lobby? Medical school is expensive, drug production is expensive. Why do these two lobby groups, the physicians and the pharma industry, want to transfer the costs to the patients (and health insurance)?
1
@Petey Tonei, I know friends who want their kids to become doctors cuz there’s money in it. Same with dentists and lawyers.
I was recently on a tour of the St. Lawrence Seaway and the cities along it.One of our Canadian tour guides , while being quizzed about the healthcare system in Canada said "if you've got the bucks, you can get anything you want anytime you want it... just like in your country"She went on to explain that in the rural regions there was virtually no waiting for medical services while in the cities there was an occasional backup for less serious medical problems.She added that she pays more in taxes but she felt it was well worth it.
Yes,there is rationing in Canada.There is also defacto rationing,based on income, in the US.Kaiser Hospitals only provides two chemotherapy drugs to cancer patients.Dermatologists at Kaiser make 450K per year.A cut of 12% would leave them with a paltry 400K.
I'm not sure why, with the Republicans giving a trillion dollar tax cut to the very wealthy,we're so concerned about our taxes going up under some universal healthcare plan.The government could certainly revise it's bloated budget to cover things other than defense at current spending levels.They might also consider taking a bigger tax bite from the super rich and corporations.If middle income workers ever had to pay the total cost of the health insurance provided by their employers,they'd be screaming for Medicare for All.The issue and the solution are much simpler than this article states.
3
This is what is called “concern trolling” on the internet. The authors assure us that they want good things too, but then proceed to raise a series of “concerns” that they think the rest of us dummies haven’t considered.
Single-payer or Medicare-for-all are slogans that express two perfectly clear principles that must guide healthcare reform: First, that for-profit private insurance is the heart of the problem and must be replaced with a tax-supported system like Medicare in which we are free to choose our own doctors and; Second, that coverage is universal.
“Concerns” that people will not support this because they “will not be able to keep their old insurance” or will have to pay “higher taxes” are just insurance company talking. People don’t want health insurance, they want healthCARE and not to have to fight with their insurance company to get it paid for. Similarly people understand that paying higher taxes to avoid all of the nonsense of copays, deductibles, in-network and out, etc, will ultimately be cheaper for everyone except shareholders in insurance and pharmaceutical companies.
If we recognize that healthcare is a right for all, it follows that there should be no room for private insurance which serves no defensible purpose.
6
Explaining what the words mean and detailing pros and cons is not concern trolling. It’s also not propaganda impervious to fact, for which I’m sure we all want to express our sorrow.
2
First, you have to change the notion that Medicare for All means one kind of Medicare for the elderly and another kind of Medicare for everyone else.
The benefits of Medicare -- from the point of view of a man with 11 years with Medicare as my medical insurance provider -- should be obvious -- every doctor with so much as a lick of sense accepts it, the treatment is excellent, outcomes are similarly excellent, and no pre-existing conditions restrictions ever.
Provide those benefits to all Americans, while still allowing people to have private insurance, would quickly decimate the private insurance people.
Then move on fixing the major drawbacks of Medicare, mainly by reducing or eliminating c-pays, and you suddenly have a system that everyone would be glad to enter. Taxes would go up, yes, but the net result would be a substantial reduction in the cost of medical insurance overall.
What's not to like about that?
5
There are more people in the US with single payer than private health insurance:
Medicare
Medicaid
Veterans
Federal, State, etc. employees
Military and Tri-care
Seems to work OK.
11
It’s not who pays but how the payments are structured. Fee for service encourages more high cost diagnostics and interventions. Capitation encourages prevention and population health improvements. It can work for long term care as well.
People love to demonize healthcare providers and insurers, but the key point is creating the right incentives. Unless you are in a Medicaid managed care state, Medicaid is fee for service. Despite Obama’s thoughtful Accountable Care model, Medicare pays everyone except Accountable Care organizations and managed care Medicare Advantage programs on a fee for service basis under which the more you do, the more you’re paid, regardless of population health.
At first glance, this article looks comprehensive but is amazingly simple-minded. We are so spoiled from hearing "no new taxes" from so many blowhard politicians of both stripes that the notion of having to pay for something we all want and need seems absolutely terrifying. Yes, some kinds of taxes might have to go up, but that has to be weighed against not having to pay the current types of premiums, co-pays, and deductibles and not bearing the costs of treating the now "uninsured" through higher insurance premiums and increased local taxes. Nor will we collectively be forced to bear the various costs of millions of people who cannot afford medical care and are too sick or disabled to work or even live without assistance. Virtually every other industrialized nation in the world already has some form of universal insurance and they seem to be doing all right. On another point, many workers now spending their lives trying to minimize usage of health insurance policies will be able to find more useful work in other fields or in administering the new health system as a governmental agency rather than a profit-making enterprise. Which leads to the observation that all the hand-wringing about "government (or socialistic) health care" is simply nonsensical, because we already have extensive government involvement and would be hard put without it. Almost everyone my age agrees that the best government program ever invented is Medicare.
11
This is about the most-thoughtful article I’ve seen in the Times or anyplace else, and for its size, the most detailed. And if you’d troubled yourself to read it intelligently, you’d know that it pretty much says the same as you just said.
Be careful what you wish for. Let the buyer beware.
Our politician's statements should be taken with a large grain of salt. Campaign promises will be made, but they must be closely scrutinized. Empty promises will not help. Our health care system is so incredibly complicated and non- transparent that building a new improved model will be a daunting process. Mistakes are likely to be made and the implementation process will be at times be chaotic. Our lawmakers and citizens both need to be better educated on the whole topic of healthcare, so that a new system will work for everyone. Education has never been more important. Great patience will be needed. An updated healthcare bill will inherently have flaws and be far from perfect.
However, we must try. Common sense says our current system is broken. Common sense says we will need a tax increase, but that the decrease in out of pocket medical expenses will put more money in our wallets overall. We need to take the plunge and even though there may some temporary pain it is still a Win, Win!
5
Medicare for All is a place-holder for the idea that healthcare is a basic right of all citizens and the US government will ensure that every citizen is able to enjoy that right. Let's start with that, then fill in the details. So far we don't even agree on the concept that healthcare is a right of all US citizens, so how can we then fill in the details?
This country really needs a mechanism for a national referendum that lets the people, in an unfiltered manner, vote directly on important concepts like this. When we vote through our elected representatives, it gets corrupted by the big money and special interests that hold sway over Congress.
7
The concern about doctors' income brought up here needs to be spelled out more precisely. Many doctors get massively wealthy by providing unnecessary testing and procedures, often harming patients in the process, as documented extensively by Atul Gawande and other journalists. "Reducing doctors' income" in the sense of regulating this sort of profiteering should be a feature of any meaningful reform, rather than something to worry about. On the other end, primary care doctors don't earn enough because of the perverse incentives of our payment system, leading to a primary care shortage. This is generally a non-issue in countries with some form of single-payer or universal coverage.
4
I firmly believe that our starting point should be an acknowledgment of the concept that healthcare is a basic human right. No one enjoys being injured or sick, and it is more than obvious that healthy people are happier and more productive. As such, regardless of what you want to call it, we should be working toward a system that is simple, consistent, efficient and - above all - effective. While I would agree that doctors need to be fairly compensated for their education and skill (though we should also be mindful of the roles robots and algorithms are playing), profit should not be part of this equation in any way, shape or form. Also, technology has now brought us to a point where healthcare can be administered without excessive bureaucracy and complication. A key aspect of heading toward a new healthcare future is a shift in attitude about what healthcare should collectively be for all of us.
5
As a physician, mother of 3, and patient, I am quite familiar with the intricacies of the current system.
Perhaps I can't speak for all of my colleagues in medicine, as most of them surely make more than I do, but I, for one, would welcome a 12% pay cut if it meant healthcare was provided for all. $20K is a small price to pay for that peace of mind.
Additionally, it just dumbfounds me that people fear a tax increase in this case. Anyone with the capacity to do basic addition and subtraction could easily see that any increase would be offset by massive savings on premiums, copays, and deductibles.
The system, as it stands, is broken, and not just for patients.
Dissatisfaction, "burnout" (I hate that word, it seems like victim blaming to me), and the abandonment of clinical care are at an all time high for doctors. Not a SINGLE one of my colleagues is happy with the way things currently stand. The only people pleased with the current arrangement are hospital administrators and insurance executives. Trust me when I say that the vast majority of doctors are not.
I can only hope that this is the tipping point.
17
The politics about this are all about competing policies, usually economic. What else is new about any complex issue? Regardless, as Massachusetts knew, and Congress learned through the Affordable Care Act, changes that increase money to the insurance and health care industries are easy; changes that are revenue neutral are possible; any change, no matter how seemingly minor, that decreases revenue for either the insurance industry or the health care industry even if we consumers might benefit, is usually "D.O.A." in legislatures because of the power of the insurance and health care lobbyists.
People also need to remember how difficult it was to get Medicare and Medicaid enacted. Medicare made it partly because it does not cover everything and does not eliminate significant business for private insurers to cover all those "gaps" in Medicare. The "fundamentalists" (many in the G.O.P.) who have always opposed Medicare and Medicaid have not gone away.
2
Just remember this. From the Obama White House web site:
"If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."
Once the government gets its grip on healthcare, efficiency will drop, quality of care will drop, and wait times for everything but emergency care will rise. How is our government doing with the VA?
5
@SML
I'm veteran and wouldn't dream of using the VA for medical care. I'll keep paying for my medicare and policy. I've little to complain about with what I have and there are too many complaints about the VA.
4
Minor tech detail: from the NHS in England, to Canada, to more-mixed sustems such as that in France, every...other...industrial....country offers equal or better outcomes more cheaply.
kaiser family foundation proffers first rate studies on this. I recommend reading them.
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@SML Clearly Obama did not anticipate the roadblocks private insurers and their networks would raise that would pre-clude the keeping of one's doctor. He also wisely realized that during a financial crisis was a bad time to divest the country of the entire private insurance market. He attempted to compromise with unwilling Republicans by devising a health plan in the image of their own Heritage Foundation style solution...and this just added complication and cost.
10
Well wouldn't you know it. First there was the threat to thousands of people with jobs in the tobacco industry. And now comes along a new, even bigger threat to many more thousands of workers and investors in the private insurance industry.
Don't people have any sympathy? Why are they so intent on their own darn well being?
1
@Rea Tarr: Human beings are basically animals and have been so for millions of years. Thought is a very recent veneer.
It's another commie idea just like that pinko socialist, Franklin Roosevelt, forced on us (like Social Security and other such programs) in the 1930s.
5
@JerryV: “They are unanimous in their hate for me—and I welcome their hatred.”
2
@C. Neville, You are correct. But FDR's enemies hated him for what they thought he was betraying: the comfortable, moneyed class to which they and FDR belonged. Trump has no class.
Bring it, but be careful what you ask for. Everything in Canada and the UK has a 17% to 21% VAT; thats a cost on top of the goods and services. Everyone pays it, rich and poor alike. Makes no difference if you are on public support. I love the idea of everyone (rich and poor) paying their fair share of health expenses. Also, tobacco, marijuana, alcohol, and everything else that is unhealthy also have higher taxes. Also good. So for upper middle class, non-smokers who are health, will pay less over the course of an entire year. The working class and poor will pay more.
3
@Sean "Bring it, but be careful what you ask for. Everything in Canada and the UK has a 17% to 21% VAT;".....What does that have to do with anything? No matter how they pay for healthcare the bottom line is Canadians annually pay 40% less per person than we do. We are already paying for our healthcare, and if we go to a single payer system like Canada we will pay less for our healthcare. Who cares which pocket the money comes from if we pay less?
8
@Sean Nope, not even close.
Canada addressed distributional concerns by applying a zero rate to certain necessities—including groceries, drugs, and rent—and adding a refundable credit to the income tax.
https://www.taxpolicycenter.org/briefing-book/what-canadian-experience-vat
Overview
An exempt supply is not taxable. Thus, a supplier does not collect the Goods and Services Tax or the Harmonized Sales Tax (GST/HST) on sales of exempt supplies. The following are exempt supplies.
Health and dental services (only services performed for medical or reconstructive purposes are exempt. Services performed for cosmetic reasons are not exempt.) This includes:
• hospital and nursing home services;
• medical devices prescribed by a medical practitioner **;
• diagnostics, treatments and other health care services prescribed by a medical practitioner;
• ambulance services;
• nursing services;
• dental hygienist services.
**A medical practitioner is a person who is entitled under the laws of a province to practise the profession of medicine or dentistry.
• Day care services for children less than 15 years old.
• Most supplies by charities and many supplies of a public service nature by public service bodies.
https://buyandsell.gc.ca/policy-and-guidelines/supply-manual/annex/4/4
1
@Sean
Not so! There is no tax on basic groceries and the highest sales tax is 15%.
1
Greetings from Canada.Eventually you will get a system of publicly funded heathcare.Because like us,you are honest rational people with a strong business ethic.Unfortunately all the talk parameters in this article and others like it misses the cardinal point.The emphasis on a public health system is on a healthy population that is available for work and advanced education and career participation for all to grow a small business and especially not to worry about timley intervention when a major catastrophie happens.I am just old enough to remember when health insurance was private in Canada and that difference is still starkly brutal in my memory.Health care is not communism it is common sense.
24
@John Arthur Feesey
"The emphasis on a public health system is on a healthy population that is available for work"
What part of Canada's population is in the country illegally? How many are working off the books and not paying taxes? How many are receiving medical care and not paying for it? (My county gives our two hospitals nearly a billion dollars to subsidize the emergency rooms) How about the birth tourism folks flying in and giving birth and then leaving with their new citizen and stiffing the hospital?
The situation is much different here. There are way too many free loaders and we have a government that cannot be trusted to follow the laws it passes.
2
@John Arthur Feesey: “It is common sense” Ay, there’s the rub!
@John Arthur Feesey Oh, how I wish I were as optimistic as you. I'm looking at New Brunswick where my Loyalist 5th great grandfather is buried. Can we come?
It is a total mystery to me how an "exceptional" country like the USA thinks it cannot do what every other civilized country does for their citizens and has been doing for ages. Exceptional, indeed.
24
The slogan should be "universal coverage" rather than "Medicare for all." What we cannot continue to have is a significant segment of the population who are afraid to call 911 when they are having a heart attack because of anticipated crippling medical bills and when they do agree to be taken to the hospital the bill is enormous, usually not paid and contributes to hospital bankruptcies and closings. What we need to change is our current bury our head in the sand system which pretends that you can simply throw people off of insurance and you save money. Those people do not cease to exist. They still get sick and still cost the system money. The current chaos is both confusing and inefficient.
19
My costs are $800/month for me and the same for my wife. So that's $1600/month for 2 adults. Our co=pay is $15 per visit and $10 for prescriptions. We have no known medical problems and do not have prescriptions and are in our early 60s so soon to retire. My employer pays half of the monthly. How is this more affordable than coming up with a universal plan based on taxes and small premiums? With that said, health care for profit is the elephant in the room. The whole for profit model in education, prison, and whatever else can be sold to the public is against the best interests of the vast majority. Vote in only those who will work to reform this madness. Vote in only those who will enact campaign finance reform, term limits, universal health care, low cost post secondary education, the abolition of the electoral college, and term limits for the Supreme Court. Your power is in your vote and your wallet.
23
The reality is that healthcare in America is very expensive with worse outcomes and access to healthcare is not readily available for all Americans. Healthcare should offer Medical treatment and care without going bankrupt.
In America, healthcare is a really big Business and all involved learned how to feed at the trough of healthcare. This includes for profit Health Insurance Companies, Hospitals, Physicians, Pharmaceuticals and Medical Devices, this leaves very little monies to actually offer Healthcare for our citizens.
The ACA was an excellent beginning from nothing, which is what we had and more or less, what is left after continual shredding by the Republicans is again nothing. If we were not such a selfish Nation, we may have truly attempted to make the ACA even more efficient and effective but the wealthy donors, who support the Republican party, want their taxes shielded for their own use.
Universal Healthcare is a commitment of all citizens to work together to achieve access to and a good healthcare standard for all. As a healthy Nation, we could all benefit.
8
@Carol
Carol why shouldn't wealthy people keep their own money for their own use? Wealthy people don't love you. I am sure they wish you well though.
Politicians of both parties have lied for decades about health care. The lies are beginning to catch up with politicians. Voters begin to doubt that politicians are telling the truth.
Why did Hillary Clinton lose? One reason may have been a perceived flip in her position on health care. She started out pushing for single-payer as First Lady. But by the time she was a presidential candidate herself she was arguing against Sanders and single-payer. Yet many of the poor fall through the cracks. There are shortages even in Medicare coverage. And politicians are unwilling to fully discuss the reasons why.
I can put forth a hypothesis and back it with data, although the latter is impossible in 1500 words.
It has to do with illegal immigration and immigration in general. Since 1986 when the last Immigration Reform Act was passed the US population has grown from 240 million to 326 million, an increase of 36%. This is mostly due to immigration, both legal and illegal. But illegal immigration increases population more than the numbers suggest because of higher fertility among illegal immigrants and chain migration.
The impact on resources has been profound. It has shifted funding away from universities and medical schools to K12. The result is fewer doctors per capita.
And that causes shortages and higher costs.
But Democrats will not allow a rational discussion of the impact of population growth. Instead they want to characterize any such discussion as racist.
5
I personally love people that say you are paying 10k a year for your health Insurance and they are going to raise your taxes by 6k for medicare for all. They never tell you that the 10k bill goes away.
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@gene....Right on. I have been trying to tell people that for years and somehow a great many don't seem to get it. One more time - Canadians have universal coverage with better healthcare outcomes, and they pay 40% less per person for their healthcare than we do. Single payer costs less!
2
@gene
Can you explain this further? Or direct me to where I can learn more? Friends are advancing this fallacy and I'd like to be able to counter their argument intelligently.
@quagmire
Simple if we get single insurer health care you end up paying 6K more in tax and you get to stop paying the 10K you have been paying for insurance.
1
For the tens of millions of Americans on Medicare they know exactly what Medicare means. It means better and vastly cheaper healthcare and emotional and financial security. Those were the reasons the law was written and passed. Medicare isn't perfect & can improve. If the whole country had it the cost savings for everyone would be massive. Yes, the insurers "profits" (why do they need to have profit) would go down & doctors may not make 5 million a year. So?.....
1
@Bob
I don't know that Medicare is vastly cheaper since we and our employers were prepaying premiums during our work years and we still pay premiums after retirement for Medicare and a policy to pay for what Medicare doesn't cover as well as copays.
1
I think Medicare-fo-All would pass Congress if the medical. plans for Senators, Congressmen and Presidents were cancelled to pay for the huge deficit increase caused by the Republican tax cut. Spread the pain to our politicians!
1
What this article fails to mention is that:
(1) people on Medicare receive, on average, far more care than they paid for and thus the program is unsustainable (it's much more generous than many foreign programs), and
(2) more and more doctors in the U.S. are declining to accept Medicare due to the low payments. In foreign countries doctors are accustomed to a much more modest standard of living as essentially public servants, whereas here they expect to paid as high qualified professionals, which they are.
Democrats fought and won their Obamacare. Congratulations. Now enough is enough, enjoy it and stop asking for more.
2
@DRS.... It is a fact that the administrative cost for Medicare is about 2% while the administrative cost for private healthcare insurance is more than 12%. No matter how it is funded Medicare delivers the same service at a lower cost. Period. Further if everyone is on Medicare, no doctors will be able to decline Medicare.
4
@DRS
Agreed. But they will never stop---just like children
I think the important point for Americans is simply access to healthcare. When you are dying, going blind, slowly bleeding to death from a tumor and the Emergency room keeps telling you to go see a local PCP so you can get an appointment with a local specialist (who isn't taking any new patients) after a six hour wait and a quick shoddy fix to keep you standing up... it really doesn't matter any longer whether Medicare or "the Government" pays the bills or if you are putting your family into a "neo-slavery" for the rest of your life to get the bill paid. What matters is staying alive. It matters even more when you feel you've spent every day of your life working for yourself or for companies unwilling to insure all their employees.
Why is this political point so hard for Americans to grasp. Have you never stood at an ER desk with a family member who has returned because of a leaking catheter that was put in the night before by a short handed under-trained privatized hospital crew only to be told to wait five hours and you "might" be seen? You want the parties to argue about these two types of payment when neither one will address the real problems millions of Americans are facing in getting healthcare for their families.
This is why Trump exists--it is called a "Reality Check"... and it is a really awful and absurd one but the above experiences are helping a lot to drive it and we can't even get the right conversation going in our media systems.
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@Jane Smith What you describe is exactly the quality of care we now have in Canada, and it is not an acceptable level of care for most people who pay for this fiasco with their tax dollars! The only people that have easy access to healthcare here and quality care are those who go beyond our healthcare system and pay out of pocket for what is not available for all.
1
I don’t mean to be unkind, but why is somebody who’s terminally ill in an ER like this? And how do you know the folks who put the catheter in didn’t know what they were doing?
@Robert ... it isn't unkind to ask questions. This was an absurd thing to experience. That is my point. Most people don't realize what is happening to people on the fringe of the systems. 1) The patient was bleeding to death slowly from an untreated cancer with complications--because there were no other viable options for treatment without private medical insurance or personal funds. At the ER the catheter was inserted, no tests done, and he was realized with instructions to find a local PCP. We went to the only clinic in the area; also with the patient standing there dripping from the poorly placed catheter (blood and urine)... and then told he would be assigned a PCP in two months when they had one available. Without a PCP we couldn't make an appointment with a private urologist (who was not taking new patients even if we did get the PCP). 2) When the catheter was inserted no one ran a blood test even though the person was bleeding profusely. His hemoglobin count was a 4 (minimum is around 12) when we finally got the ER to take us back in two nights later (after some furious phone calls on my part). I'd say the person inserting the catheter didn't know what they were doing (by their own admission it was their first time) and didn't have sufficient support or an appropriate level physician reviewing the work. Common sense dictated a blood test minimally.
Medicare is a good deal, but it isn't free. It costs about $130/month per person. Since that money usually comes out of a Social Security check, very few people ever notice it.
2
@Jim S.....The point is that Medicare delivers healthcare at a lower cost no matter how it is funded. The bottom line is that government run single payer costs less.
2
@Jim S.
It will cost more for each of us because it will be paying for all necessary medical treatments but still be within reason.
@Jim S. - The CBO says it would cost $20,500 for seniors to buy a Medicare-equivalent plan on the private market. I'll stick with Medicare.
“Medicare for all” means everybody’s covered by Medicare, regardless of age.
How is this complicated?
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@Skippy "How is [Medicare for all] complicated? Well, for starters it means significantly reconfiguring a whopping 18% of the world's largest economy (by GDP), affecting approximately 326 million somewhat diverse people. If that's not complicated I don't know what is.
6
@Skippy I just wonder if your senator and his or her family will be getting exactly the same Medicare coverage you and your family will be getting?
3
@Skippy are you aware the Medicare recipients are charged monthly according to your means ie. minimum is$135. And a supplemental plan for what Medicare doesn’t cover runs about the same monthly. Personally, my cost before drugs is almost $5,000./annually.
Not free. Joan
2
The richest and the greediest control every aspect of lives in America.
They control every branch of government.
That is why we don’t have a reasonable healthcare system.
9
@Grove, they evade taxes too; they find loopholes so they don’t have to payback what they owe.
One thing is obvious, our healthcare system doesn't work very well. It's fragmented, inefficient and unaffordable. Compared to other advanced countries, Americans pay approximately 40% to 50% more for healthcare that is no better and all too frequently worse. The cost of drugs is a national scandal perpetuated by Big Pharma's army of lobbyists, the biggest in Washington. The country's doctors, particularly specialists, are over-compensated compared to their European and Canadian counterparts. The administrative and other overhead costs of private insurance are ridiculously high. The vaunted power of "competition" to lower costs is virtually non-existent. But according to Republicans, this self-inflicted mess constitutes freedom. Yes, the freedom to go without care, file for medical bankruptcy and die prematurely.
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@Innocent Bystander....The power of competition to drive down costs is real, but it only works when you have informed consumers who have the ability to delay or with hold a purchase when the price is too high. So if only everyone had a medical degree and a heart attack wasn't a healthcare issue that demanded immediate attention; then yes, competition would work to drive down cost.
1
I happen to be on two JPA boards for health care and other bennies. Admin costs are 4-6%, tops, unless the reams of financials we get are all phony.
Experts in the field put average insurers’ overhead costs at between 12% and 18%. Medicare is closer to 2%, in part because the system can piggyback on Social Security infrastructure. There are complexities, of course, in making these calculations. But there's little doubt a single-payer-style approach would result in substantial savings.
Here’s what it means! Every American would have access to comprehensive health care coverage identical to the coverage currently available to Medicare-eligible participants.
How to make it happen is a no-brainer! The administrative infrastructure is already in place, awaiting political will.
Presently, the federal government sets the rules for Medicare coverage and administers Medicare directly. Private health care insurers also administer Medicare as Medicare Advantage providers. In effect, the private insurers act as subcontractors to federal Medicare administration.
Medicare for all would be initiated by allowing Medicare Advantage providers to sell unsubsidized Medicare coverage to the public for competitive, cost-based premiums. The Advantage insurers would sell their health care insurance in the Obamacare marketplace. The Obamacare subsidies to assist purchasers of health care insurance would still apply.
Employer-provided health care coverage would evolve into premium subsidies for Medicare Advantage coverage. The various piecemeal federal/state health care programs like Medicaid and CHIPS would be subsumed into Medicare as premium subsidies for Medicare Advantage coverage.
Medicare for all extends our most reliable and popular health insurance coverage plan to all Americans. It would not disrupt our familiar patient/provider relationships. It can be achieved by lightened management of our existing administrative infrastructure.
3
Have you read the bill?
I'm tired of hearing how 'difficult' the health care problem is. It isn't, in fact, difficult. What is difficult is taking money and jobs away from people who are feeding off the health care dollar without providing benefit. For instance, did the pharmaceutical company lobbyist who lobbied against the ACA deserve her annual $8 million dollar bonus? How did that help patient care?
Medicare For All is simple. The structure is in place. Enrollment could occur over years by lowering the eligibility age by two years every year and slowly increasing the tax rate and/or premiums to pay for the program. This would give time for the insurance companies to ramp down and for hospitals to lay off the 70% of administrators who are un-needed, and the hundreds of thousands of insurance coders whose jobs will become obsolete with a single payer/medicare program.
All other civilized countries have figured this out. Many models exist that work, including Canada. Health care isn't difficult at all.
6
Good to hear from a doctor. But costs need to come under control and I'm not sure getting rid of the execs and billing clerks will do that. Seems the docs will have to "take a hit" also. But I'm sure we can work it out. As you say, it is not that hard. The will and the voting both will have to be critical here.
These countries have universal health care of some sort.
Norway, New Zealand, Japan, Germany, Belgium, United Kingdom, Kuwait, Sweden, Bahrain, Brunei, Canada, Netherlands, Austria, United Arab Emirates, Finland, Slovenia, Denmark, Luxembourg, France, Australia, Ireland, Italy, Portugal, Cyprus, Greece, Spain, South Korea, Iceland, Hong Kong, Singapore, Switzerland, and Israel.
United States was technically in that list when "Obama Care" had a mandate. The capitalist crack-pots killed that mandate so we can't be said to have any national plan now.
Trump does not understand any of this and his ignorant comments of national health plans being "socialism" are absurd. Look at some of the excellent countries that have a national plan -- do they seem like horrible places to live? No, people are actually happier living in many of those countries than here. Socialism is when the government owns the hospitals and all the doctors work for the government; Britain.That is only one type of national health plan. In most countries private companies provide the care. Different systems are possible.
When governments pay for health care, they work to ensure doctors and hospitals provide quality care at a reasonable cost.
We need much discussion and we need to get this done.
See some more myths and facts here:
https://www.thebalance.com/universal-health-care-4156211
4
The 32 countries I mentioned are 32 out of the richest 33. Many more countries have some kind of national health care.
1
The first point to make here is that the Republicans clearly are not in this debate except as barriers to progress in covering all Americans. They have no policy ideas worth a fig and are simply not interested in helping Americans gain worthwhile health coverage.
Second, the Canadian system as a model is not bad but it has some problems. The non-partisan Commonwealth Fund which studies health care around the world rated Canada 10th out of 11 developed countries on a number of quality-related metrics (needless to say, America was 11th).
Third, promoting single-payer or Medicare for all simply gives the GOP its usual talking points about socalized medicine, raising taxes blah blah blah. (It will mean raising taxes but then we won't be paying premiums for insurance either). We should instead think about incremental steps such as putingt serious proposals forward for extending Medicare or something like it as an option for the 55-65 old group which would help those most in need and relieve some pressure on the private insurance market.
Finally, in the near term we need to bolster the Affordable Care Act and undo the damage wrought by the Trump administration whilst expanding premium supports to more income groups.
Building on our current system, flawed though may be but which incorporates the ACA (which has many similarities to many successful systems in Europe) should be our first priority. There's plenty of time to talk about where we go from there.
Democrats saw a deeply flawed Kavanaugh, Republicans (especially women) saw an unfair attack on a presumed innocent man.
Similarly, Democrats want to fix a predatory healthcare system, but Republicans only see these efforts as an attempt to give free healthcare to immigrants, welfare queens and others at the taxpayer's expense.
Opinion pieces like this one only preach to the choir, they never reach anyone who's not yet convinced.
It's the ongoing divided America problem.
2
@Brewing Monk Agreed. Far lefties all over this board cannot state what you said so briefly.
1
Just the idea of moving in the direction of Medicare for all is a start.
Our current system is an absurd house of cards that has little to do with healthcare.
Insurance providers only exist to make money.
Their existence is totally parasitic and fueled by greed.
1
My republican rep has been running commercials claiming are dem challenger support's Bernie's health care plan and cites all the large dollar amounts that go with it. However, her dem challenger does not support Bernie's plan and has offered alternatives including attempting to fix the republican-crippled ACA. I would never vote for such an obvious liar, and it seems that is all the republicans do on a host of issues including health care.
1
If Medicare is taken away, then there will be riots in the streets. This is no joke. You can't take away entitlements like Social Security and Medicare and expect people to accept this. Bush's ridiculous proposal to take away social security thankfully didn't pan out. I guess the GOP really wants to gut the middle class, and kick the poor to the curb. Does Trump's base know or care about this? Some of them would be the first recipients of this downright cruelty. Your vote counts in November--free us from this tyranny of sycophants and ruthless politicians. Your vote matters!
1
If it comes from Trump people will accept it.
What it means? First of all, why do you label Bernie Sanders as a "renegade candidate for the 2016 Democratic nomination for president, Bernie Sanders"? He was a candidate just like everyone else ... Secondly, just give us the facts and stop trying to scare people ... having Government control health care like it does not do that in the VA or with Medicare or Medicaid already? And no one said it was Free ... most people would rather pay taxes than pay high premiums ...
3
As with everything else since 1965, the taproot issue is who pays for it all.
2
@Margot....We are already paying for it. In fact we are already paying at least 20% (probably more like 40%) too much.
@W.A. Spitzer
It's more like several hundred percent too much. Our pricing structure is almost entirely fraudulent since deregulation.
@W.A. Spitzer
Um, yeh, define "we". Half of the country pays ZERO and some of those even get money from the half who do pay taxes every April 15th.
It is a loser. The costs will crush the system.
2
Medicare for all is LESS expensive than for profit health care, the most expensive health care in the world.
3
@Zejee Look up the stats. It will over inflate usage while cutting payments across the board to providers. That had spelled disaster.
@Bob
The current system is 50% more expensive than any other rich country's system. Medicare for all can easily pay for itself and give money back from current spending levels. There really is that much fat to cut.
And there's the rub, because all that fat is going into someone's pocket, and those people own your représentatives.
Turn that system upside down.
#medicare4all
1
As long as we have a delivery system staffed by prima donnas whose sole interest is money it makes no difference to patients what saystem one uses to deliver bad medicine.
1
Dr. Rosenthal's book has detailed the amazing complexity of the healthcare system. With very little standardized, the process is bedeviled by haggling and lobbying as to which drugs are on which approved lists, which devices are covered, the apportioning of costs on procedures crossing medical specialities, and on and on. Medicare is too expensive, but at least a Medicare-for-all process would force standardized rules and procedures. The worrying downside is that a cost-controlled single system may stifle innovation
@Gary The ^stiffling inovation game^ is nonsense! there will still be profits but not the appalling racketeering profits everyone involved in the health racket is making and which make America a pitied laughing stock in Europe
For more info on healthcare, see Atul Gawande's series of insightful and informal articles in the New Yorker.
For instance:
https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right
https://www.newyorker.com/news/news-desk/if-the-us-adopts-the-gops-healt...
5
It’s too bad that the NYT has too seldom or hardly at all provided an unbiased description of other countries healthcare systems. This article is not an unbiased interpretation of the term "Medicare for all". The NYT has to do a better job of reporting.
The US system does not provide universal coverage, a large percentage have substandard coverage, the jargon of deductibles, co-pays, co-insurance, donut-holes, Platinum, Gold, Silver, Bronze, Part A, Part, B, Part C, Part D add to confusion and apprehension and not to any real value, our outcomes are universally worse, our individual and collective costs are way above the rest of the world, and longevity is decreasing relative to the other industrialized world. Our system is broken and non-sustainable. The core problem is that the medical-industrial complex can bribe politicians of both parties without a shred of conscience and we allow this legal corruption.
8
What about the public option? Obama ran on it and won.
"You like your plan or your employer plan, keep it. If you want to buy into a plan like Medicare, that will be available too."
Start with the public option, and let private plans compete.
OR: Medicare for all is probably too big a bite. But Medicare for over age 55 seems doable. Get the bugs out, then lower it to 50 etc.
And always include a public option.
80
@Eric. Yes, but he and his pet Congress could deliver a public option.
@Eric - I agree. I think the starting point would be a public option, where people could buy into Medicare by paying premiums. The premiums would inevitably be lower than we pay to insurance companies, because we don't have to pay Medicare to make a profit or provide dividends for stockholders and gigantic salaries and bonuses for officers.
1
@Eric Obama ran away from the public option. And created the giant Obamacare mess nobody supports.
"After decades in the political wilderness, “Medicare for all” and single-payer health care are suddenly popular. " With all due respect to the authors-----Only for those willfully ignorant people who choose to ignore the experience and cost-benefits seen by most of the other advanced nations worldwide.
Let's call this what it is: A concerted billion-dollar effort by the so-called "health insurance" industry to generate profits by skimming dollars out of the system rather than provide real health care for working Americans. Profits matter more than people----its the new American way.
7
This article should have led with the fact that Medicare for All, single payer healthcare costs less in taxes than private health insurance costs in premiums while covering everyone, and then discussed the point that taxes would have to increase to balance the ending of premiums for insurance that doesn't cover everyone. Scaring people about the increase in taxes without first informing them that there would be no more premiums causes unnecessary alarm.
5
Out of the 33 developed countries, 32 have universal health care. Guess which one of these 33 does not have UHC?
You gave a sort of review of the pros and cons on these types of plans (essentially 3 different types) but did not refer us to major written discussions. Why did you not give us a link to the Bernie Sanders plans which is quite detailed. Please remember this for your next article on this subject.
We must keep talking about it; it is coming and must be done right. People are "sick to death" of our lousy capitalistic society failing us in this critical area.
4
This is very educational. It brings clarity at several levels. We have loved following Ms Luthra at Kaiser health news, our premier go to when it comes to health care! Nice work.
1
The problem with the American system, as evidenced by the conversations on this board, is that we are all looking at COST instead of HEALTH.
We always seem to be thinking about the dollar, not the life. We pay more for our healthcare, yet the Europeans and Canadians live longer, with a better quality of life. Why? There are probably many reasons, but paying more for healthcare doesn't seem to equate better health.
Also related, we should boost another government program that would help our general health: the FDA. Private sector solutions seem to seek to feed us based on profit motive, and not nutrition.
So, apparently you don't ALWAYS get what you pay for, but you ARE what you eat.
Just spoke to my friend in Toronto. He has not been feeling great.
Made an appointment to see his doctor ( no long wait).
After initial appointment, Doctor made an appointment for blood work and MRI (no long wait).
No bill, no wait, no hassle.
His comment," I love my Canadian healthcare".
Wish I could say the same for USA.
It's all about the GREED here in the wealthiest nation on Earth.
J
418
@Joseph M. While I do not dispute your friends story at all, what he could not do if he deemed it necessary what to say "shove it, you're wrong." "I'm going somewhere else, and we'll see if I pay you". Please don't discount the power of being able to advocate for yourself.
Out of the 33 developed countries, 32 have universal health care, so what makes it such a radial concept here.
269
Answer: Ignorance. I lived in France for 34 years. The health care was excellent. Americans have been sold a bill of goods by right wing politicians who are as ignorant on the subject as their constituents. It is truly amazing how many people in Congress do not have a clue how the rest of the developed world lives.
3
@Steve
the united states is not really an independent country we are a colony run by the 1% of the world for their own benefit.
3
@Steve
Simple answer: Billions in profit dollars skimmed by the middle man. In today's Trump / GOP world, profits matter-----people, not so much.
3
Well, come on. We have models to choose from all over the world. We're the outliers here, and acting as if some nebulous never-been-done-before scheme is necessary is disingenuous. The only thing lacking is good faith, and some people in office intelligent enough to do it. Neither of those is forthcoming from the republicans, and we'll need democrats who are not beholding to the money of corporate takers. Write an article about that; that might be useful.
6
It's important to note that the government already controls 50% of the insured health market. The political management of system has resulted in wildly high costs vs outcomes that cater to a variety of special interest groups (doctors, hospitals, drug companies, etc)
The eco-system that exists today is a direct product of government regulation and oversight. It's a fantasy to believe that with full control, it would somehow become efficient, lower in cost and better for consumers. As a small example, We face a perennial shortage of doctors and nurses lowering access and driving up compensation ($400K average Dermatologist pay?) The government regulates the number of doctors (DOE, training slots, and accreditation), In fact, there are 2x the number of qualified applicants than education slots. Yet, the problem persists driving up cost & lowering access. This could be fixed with a stroke of a pen but a system that is politically regulated caters to it's constituent - in this case the AMA - to preserve compensation. It's no different than Congress prohibiting the negotiations of drug prices. Medicare for all would be a feeding frenzy for the entrenched providers
If my wages were taxed 7.5% for Medicare and I no longer had premiums or co-pays, I would save about $10,000 per year for my family of four over my current medical costs.
19
It's actually very simple.
Every single U.S. citizen would have basic health care insurance at a reasonable cost. One can pay more to have more extensive coverage just like with original Medicare, which has plans from A to G to choose from. The program is administered by OUR U. S. government and was designed to benefit patients - not insurers.
One can also buy supplemental insurance to pay deductibles, co-pays and other original Medicare doesn't pay for. They are administered by private insurers under government regulation.
The "advantage" plans are only an advantage to insurers. Deductibles and co-pays virtually bankrupt individuals and families if they get ill. Insurers get a flat fee for each person who enrolls and it benefits them to keep actual care down. They are a consumer ripoff.
However, before we can implement Medicare for all WE THE PEOPLE must demand that serious regulations be put into place regarding provider billing. They find all sorts of ways to cheat OUR U.S. Government, which pushes the costs through the stratosphere.
One perfect example is when a patient goes to a "clinic" or group practice. The providers own the clinic but both the clinic and the individual provider bill Medicare as if they are separate entities. Group clinics with multiple departments and providers bill you as a "new" patient every time you see a different doctor within the same clinic. Getting rid of those two billing scams would greatly reduce the cost.
4
Until America can figure out how to get the profit sector of insurance out the equation, nothing's going to change.
I'm Canadian, 68 years old and have been lucky to have good health. Aside from a minor hernia operation 30 years ago, it's just checkups and a few trips to emergency that everyone has at some point. When I worked the premiums that I paid were extremely low. Here's a breakdown.
The health premium ranges from $0 if your taxable income is $20,000 or less, to $900 if your taxable income is more than $200,600. The health premium is not linked to OHIP and does not affect a person's eligibility to receive health care in Ontario.
No one goes without. Your health card is just like a drivers licence, with photo id. (good for elections because everyone has it).
$590 billion for defence in 2017 in the US?
When you read about Americans going bankrupt, losing their homes, dying early from lack of care and all the other horror stories, it makes you wonder why so many are afraid of universal health care. Propaganda works quite well.
But politicians enjoy full health coverage but deny that to millions of their fellow citizens. They have no shame.
Vote.
31
Mr. Brown, America will not figure out how to get private insurers out of the equation because the system is built on it.
However, WE THE PEOPLE can demand serious regulation of them - and providers. Right now they work together to keep costs high and increase their wealth.
There is a reason Warren Buffett is fully invested in the insurance game and that he and Jeff Bezos are "colluding" to build a new health system. One thing we can be sure of - it will not benefit WE THE PEOPLE. It will benefit only them and their supposed "investor" brethren. Let's call it what it is - theft of OUR hard-earned dollars.
1
As always, "the devil is in the details", and what sounds good on the surface may be terrible when you drill down deeper. But it's great that Medicare For All, or Single Payer, are becoming more and more possible. Health care and insurance costs are the biggest hidden tax on the majority of Americans. And that's exactly what it is: a tax. So when the wealthy and corporations complain about possible tax increases to fund such a system, they're really talking about keeping their tax obligations on the shoulders of the 99%.
But as important as this is, now is not the time to be debating it. The most critical issue now is breaking the monopolistic hold on our government by Republicans. All other issues and concerns pale in contrast. If the Democrats don't win at least the House, if not the Senate, Single Payer, abortion rights, immigration, job creation, and all other issues, will be non-starters.
Vote Blue and take back America!
4
How will Democrats persuade voters if they don’t offer something for the voters? “Not Trump” won’t do it. Medicare for all is a vital issue for most Americans.
American voters- especially the 10% decisive undecideds!- recoil from complex policy talk. This article is a valuable start but leaves out key factors. Whether universal coverage emerges from a regulated private system or a pure Medicare4All expansion- there are some clear benefits:
1) with everyone chipping in - this largest risk pool reduces the threat of high cost patients & freeloaders
2) universal care prevents uninsured patients from flooding ERs
and getting much sicker with treatable conditions that require costly acute care
3) relieving employers of the fixed overhead burden of providing health insurance will make US business more competitive, employees less enslaved for benefits.
4) economies of scale would reduce cost of medical equipment & pharmaceutical supplies
5) overhead administrative costs to advertise, pay big CEO salaries, pay shareholders (in for-profit insurance companies) and 'manage' who gets care (managed care- a market 'efficiency' has done nothing to control costs after 30 years) would be drastically reduced by MCare4All
Yes- there could be a gradual expansion of Medicare to minimize the dislocation of private insurance employees. Yes there could be supplemental plans- a 'business class' option' for the 1%. Yes- most MDs would earn less (requiring a revamping of student loan rates or universal free med ed like NYU !).
But for the GOP to pretend that a fragmented competitive Market approach to healthcare is a solution betrays all Americans.
5
@G
"...Right now I pay over $650/month for coverage that provides none of the above guarantees. And that same plan will be almost $800/month next year."
I pay less than half - with all the guarantees and prescription coverage to boot. It's called Medicare and I'm thankful to our government for the foresight to pass this legislation in the 1960's.
Medicare for all is a simple and elegant solution to healthcare as a right. All the money needed is available by - establishing fairness in the tax structure. Everyone pays their fair share. That's not popular with the top 10%.
- Then, eliminating the unconscionable profit(s) by drug companies, medical device manufacturers, health insurance companies, administrators. Put the money in the hands of the caregivers.
It's simply a matter of re-allocating our resources to the many, rather than the few.
2
Let's be clear. Medicare is not free. For a couple there is a $268 per month part B deduction. Supplemental for Plan F is another $440 per month and Part D prescription is another $80 per month. Adds up to $788 per month or $9456 per year. Not cheap by any means. It's unlikely that with Single Payer or Universal Health care that cost comes down. Plus that is the cost if you're healthy and don't need expensive drugs. Americans are unhealthy, obesity and have poor lifestyles. Drugs keep us alive longer but at a lower quality of life and great expense. How about a little personal responsibility for your health.
4
@Howard Plus cynically flood the country with poor immigrants (for voting purposes) to add to the 150 million or so poor Americans and you have a recipe for disaster.
3
In Sen. Sanders proposed Medicare for all bill he states you can keep private insurance, this article conveniently leaves that out.
2
There's no question that universal healthcare is the way to go. While, it's true that you wait for elective procedures if your doctor doesn't think you need them, on the whole, you get what you need. A case in point, my spouse was examined for cataract surgery last week and is getting his first eye done next week. Again, when he needed a new hip he got one inside a month. Of course the main reason for our system is for the big stuff. A family member was diagnosed with a brain tumour and was operated on 9 days later. An operation like that might have bankrupted us. Finally, you don't get the frilly stuff like nice private rooms and you are encouraged to get on your feet and home, as soon as possible but you are treated with kindness and efficiency. At home my spouse got free nurse visits after his hip operation. I can't imagine how Americans can live with their system, It's too precarious.
11
@annberkeley2008
There are only 2 countries on the planet with single payer/universal care: Taiwan and Canada, each serving a respective population of 25 million and 35 million. Every other nation has a public/private buffet much like the U.S. system. Our problem is we are too many - we are overpopulated.
The U.S. is a population of 330+ million, half of which does not pay taxes but does already receive most of the federal mandatory and discretionary spending. Going forward, especially with 1/3 of the nation that's low income immigrant, is that we are in DEBT to our eyeballs since Bush and Obama wasted the Clinton economy that got both the budget and debt under control. In order to pay for anything new, the U.S. (which also means the states, btw) will go further into debt. More than 85% of the country receives health care via their employer. Obama ramped up Medicare rolls to 70 million of mostly able-bodied youth Millennials. Veterans benefits are covered under discretionary military spending. The self-employed middle class continues to pick the tax tab for freebie subsidized Obamacare 20 million. Where do you propose we get the money to revamp again the system and pay for it all - unless costs are controlled, which means both rationed and back to the wall forcing of doctors, hospitals and Big Pharma to agree to less money in their pockets. Good luck with that, it's been the stumbling block ever since the 1960s.
2
@annberkeley2008 There is no question it will bankrupt the middle class. Asking the middle class to pay for poverty stricken immigrants on top of poor Americans is cruel and inhuman, but hey Democrats want all the votes they can get.
3
@Margot In our system the money for universal healthcare comes out of our taxes. People grumble about paying but don't begrudge what the money is for. As well, many of us support specific hospitals with small monthly donations. We are comfortable with supporting each other - even new immigrants - probably because we're used to it. It's a kind of safety blanket. Some Canadians complain when their doctors don't give them the elective surgeries they want when they want them but nobody in need goes without them. The doctor is the gatekeeper and s/he decides when you get what treatment. Basically, if everyone's health is taken care of, then society's better off. An important point now I'm getting older is that the old get the same treatment as the young. It's a good system.
I am an American living in London since 1985. I’ve never seen a bill or been asked how I would pay. I also have had cancer for 6 years and have received state-of-the-art treatment, including DaVinci robotic surgery, 33 IMRT radiation sessions, cataract lens replacement, multiple urinary tract surgeries, and hundreds of GP visits (max wait time 15-30 mins).
This also costs Britain ONE-THIRD as much per person as the USA spends.
16
Medicare is not cheap if you have other incomes. It has premiums, copays, etc. It pays so poorly to make it decent you need a supplements. Supplements are a gift to wall street healthcare. My cheap medicare is almost $500 a month.
The predicted cost of Medicare for all is 32 trillion in 10 years. In 2017, the cost of healthcare in the US was 3.5 trillion or 35 trillion in 10 years.
4
@Bill - The CBO says it would cost $20,500 to buy a Medicare-equivalent policy on the private market. Other than a policy to cover drugs, you dn't need a supplemental policy. Policies for younger people come with a 20% co-pay and various deductibles, no different from Medicare. Younger people aren't buying supplemental policies.
At this point, Medicare-For-All is just a slogan that signals the value of healthcare as a basic human right (versus healthcare as a marketplace). That's fine, of course, but the payment model is largely irrelevant because the big economic lever isn't who pays - it's the price.
http://hc4.us/PriceNotPayer
Footnote: Part of the problem is the sheer ambiguity of the phrase "universal healthcare" because it's too easy to bend to a political POV. The better phrase (and goal) is universal health 'coverage.' Also worth noting - ColoradoCare (single-payer in Colorado) was on the ballot in 2016. It got CRUSHED by almost 80% - so the fiscal challenges of single payer are daunting (and all too easy to paint with the toxic brush of 'socialized medicine'). What we really need/want - and the big eeconomic lever - is single-pricing healthcare - and (no surprise), the delivery mechanism for that is universal health coverage.
2
Medicare for all (MFA) means reducing the eligibility age to zero and leaving everything else the same.
Health care in US costs what it cost -- about $10 - $20k per person -- but all costs are not equally visible.
When a business must recover, say, $20k per employee to provide "free" insurance to each worker, it must pay him / her less or risk losing business to foreign competitors that pay nothing.
Insurance companies are guaranteed 20% profit by the "Affordable" Care Act & vast bureaucracies are maintained at all levels of government which exist only to decide who is covered & for what.
Once MFA has run for, say, a year & all of the overhead costs are reduced to that required to process payments and prosecute fraud, we will know whether more revenue is required.
Revenue not generated by improved competitiveness can be augmented as necessary by tariffs or valued-add taxes.
The total cost of health-care will go down, not up; it will just be more visible.
4
I was talking with a friend of mine who retired from the military after 20 years of service. He and his wife will have health care for the rest of their lives, earned through his service. But he was really upset that his daughter, who has serious health issues, is about to age out of military health care. He was angry that she can't stay on the military health care system.
He said he always voted Republican because the Republicans take care of the military. He said he never paid attention to health care debates in this country when he was on active duty because he and his family had full coverage, so it didn't affect them. Now that his daughter is about to age out, he and his wife are having an "Oh My God" moment. He is livid that he and his wife will not be able to afford medical care for their daughter, at any price. She is uninsurable.
He said something else that I thought was telling. He said that the government should provide free health care to him and his entire family for the rest of their lives as a result of his military service. I laughed and said, wow, a republican that supports universal health care!
But then he said no, he doesn't support it because the country can't afford it. I then asked, why do you feel that only military members and their families are entitled to lifetime health care? What about Americans that can't serve in the military, but serve in other ways? Shouldn't all Americans be guaranteed cradle to grave health care?
He had no reply.
21
@Josa
The reality since the draft ended in 1973 is that most men and a few women who signed up for the volunteer forces did so for the benefits, which as you articulate are a form of welfare/social services. Everyone in America wants it now and wants it free - as long as everyone else pays for it.
1
This is the same problem that the US has had since 1935, when FDR decided that socialized health insurance was politically too risky. That was unfortunate. But we can't time-travel to undo that error.
Then the following problem recurs every 20 years or so, whenever Democrats have power: American voters are dissatisfied and vague about healthcare. Democratic politicians must pay attention to complex policy details involving high stakes trade-offs not solved by slogans. Republicans will try to wreck the policy process, as always.
It has ever been thus.
1
@Aaron Lercher I have a copy of a 1938 headline that has a lead story titled " AMA opposes FDR's health care for all as socialized medicine....." It's greed brother …..
Yes people balk at the thought of their taxes going up. However, people are delusional. When you tally-up the cost of insurance premiums, deductibles an co-pays isn't that a tax?
The sad part about that is that it isn't a fixed tax, it's variable from year to year depending on your healthcare needs at any given time. Slip on some ice, sprain your ankle and go the emergency room; you are levied with an unforseen "tax bill" of $1500 bucks.
I have excellent insurance, however I needed routine surgery and my young son needed orthopedic surgery as a result of a minor injury from soccer. Our co-pays for both procedures comes close to $6000. This is our portion with insurance! The average American can't afford to get sick, even those with insurance.
I welcome any plan that will improve equality, access and certainty to health care.
21
@Obonne It will go up much more for the middle class because half the country PAY NO TAXES.
2
@MM
Get away from that FOX propaganda machine and no one will get hurt.
You are referring to INCOME taxes, regardless of the exact number. I think your "half" figure includes all people who reasonably can't work; physical, mental, disability, age. So, right there, you are very, very wrong.
Anyway, most of the poor pay some taxes. Property via rent, gasoline and highway via owning a car or using a taxi/Uber, sales taxes, etc.
So, please stop with the lying.
@MM - Every single working person pays FICA taxes on every penny of their income unless they make more than $128,000. It's those FICA taxes that pay for SS and Medicare. We can pay for universal health care in many ways. One way is to increase the FICA tax. For less money in taxes than people spend out of piocket for premiums and deductibles and co-pays, we could have health care for everyone.
Many doctors in the Denver area will not accept new patients who have Medicare. Some require that their long-time patients find new doctors when they start Medicare. Medicare for All will require Doctors for All, which may not be achievable unless the current paperwork requirements are reduced and payments are increased.
5
@fourthestate
Or, doctors who refuse Medicare will have no patients and will change their practice or go out of business.
Bully for them if they can't keep up with the market!
3
We need the following:
1- Universal- meaning everybody.
2- Federal- meaning not different from state to state.
3- Not for profit- meaning run lean and efficient.
4- Portable- meaning it works overseas. Many countries with universal coverage honor each other's coverage.
5- Health Insurance- meaning Medical, Dental, Optometric, and Psychiatric.
Call it what you want.
When the money question comes up, remind everyone that it will replace what you already have, so:
1- Employers will no longer be paying for self coverage or to a third party.
2- You will no longer have insurance deductibles taken from your paycheck that go to a private insurance company.
3- We can roll VA, CHAMPUS, TriCare, Medicaid and other federal health programs into the new program and eliminate the duplicate overhead and administration.
One tax ,one system, one standard of care for all.
Allow those with a Green Card to buy in to the system and negotiate reciprocity with countries overseas so expatriates, military assigned overseas and tourists no longer have to buy a travel medical policy.
And while we are at it and the Feds are paying for care, let there be one standard of licensure for all of the allied health professions. In some states you can use radiation for the diagnosis of disease without a license, for example and that is crazy. If you need a license to do hair, you should have a license to do a CT Scan.
21
@David Gregory
We need more people paying taxes, everyone with some skin in the game as to personal responsibility to the nation and for their own care. Most of the freebie health care goes to the irresponsible smokers and obese that then have a laundry list of lifetime chronic (read: ongoing and expensive) health problems that only end when they die; these issues run in those families, as well, all the way down to expensive child health issues).
Half of all births in America are already paid for by taxpayers via Medicare. The largest demographic is millennials - all in their prime breeding years and going at it like rabbits.
1
@David Gregory
A point or two
Medicare is not a new program we are talking about adding more people to an existing program.
The "Feds" are not paying for care, We are. We pay for everything the Feds do.
Like all those millions and millions wasted by traitorous republicans in efforts to do us harm and prevent us from using our government for our own benefit by launching fraudulent investigations into issues they invented. That BTW is where El Trumpo gets the idea to jacuse the press from and why it sounds so legit to his supporters. They have been doing it for decades why not just take the last step and pretend everyone is?!
It's beyond the pale, that the U.S. does not provide universal health care for all its citizens and legal residents. Granted, it is very expensive, so the question is whether the majority of Americans would be willing to pay additional income tax to fund it.
My impression is that they won't.
2
@Michael
Please define "expensive." One way or another it will cost. We already have and have seen the results of unequal taxation. While not a panacea, Universal Health Care [a better moniker than Medicare for All, IMO], it evens out a lot of the radical bumps.
At some point, that tipping one, We The People will rise up against such blatant inequality and reason will prevail. p.s. I hope this isn't a legal marijuana state resident just talkin'.
3
@Michael
Michael, we actually pay significantly less than our American neighbours for health insurance. Consider that the premiums Americans pay for their private health coverage is a "tax."
2
@A proud Canadian
@A proud Canadian
Many Canadians do pay less, but everyone is covered, regardless of whether they pay a health care premium or not. But that many of us pay less is partly due to the fact that the salary levels of our doctors and nurses are generally lower than what their American counterparts receive. And their higher salaries are part of the reason that health care is so unaffordable for so many.
Yes, some Americans pay more health tax via their employers. But then again, there are many working poor who don't have those options and are unable to pay the required premiums. And there are many working poor who fall through the cracks and don't even qualify for Medicaid.
I have an aunt in Ft. Lauderdale, who has a severely disabled daughter. She had worked full-time for many years, but could not obtain adequate health care coverage to cover the expensive medication required for her daughter. She ended up paying out of pocket, which was very difficult. After many years, of letter writing, she was finally able change that.
America's health care system works for people who can afford the premiums via their employers or private insurance plans, but their are millions who do not have that luxury.
Only way the U.S. is will establish universal health care, is when everyone's health care premiums are determined via their annual income tax returns. And as is the case in Canada, many lower income Americans wouldn't have to pay anything.
Designing and funding a Medicare for All or some other single payer look-alike system can be done fairly easily without increasing our total national healthcare expenditures. However, it cannot and will not be done until we all accept the fact that, creating a viable and sustainable system that yields better outcomes than our current system, will require a redistribution of $'s among the various players. In other words, there will be winners and losers. The primary winners will be patients. The losers will be many of the current players in the healthcare industrial complex, including some physicians and hospitals.
Do we, the Public, have the will and fortitude to accept that there will be losers in order to achieve a greater good? To stand up to the onslaught of propoganda and misinformation that would come from those that gain so much from the current system? More to the point, do the career politicians have the will or fortitude?
3
The best healthcare systems in the world are hybrid: Basic health coverage organized by government, with a private (company offered) health insurance on top providing services like private hospital rooms and direct payment. It keeps hospitals well funded, and avoids averaging down the service level.
When I lived in Belgium, my GP who lived a few houses down had his practice in his converted basement and he answered his own phone calls. Appointments were made over the Internet, insurance/prescriptions were end-to-end digital. The gross price for a visit was about 30$ (i.e. what someone uninsured would pay, like an American tourist).
The first time I visited a GP here in America, the doctor was surrounded by several nurses and administrative personnel. After learning I'm from Europe, the doctor went on to talk about how ridiculous it is that ski passes in Colorado are by default only 3 days as opposed to 7 days in the Alps, because of the difference in holidays. Needless to say the bill for 10 minutes of his time was well over 100$. It's a shame most Americans lack the perspective of how ridiculous that is.
8
Private medical insurance companies make billions of dollars every year and their executives each make millions every year. How could replacing those private for-profit companies with a government run non-profit program fail to save money? A nationwide government run program is basically a cooperative in which we would all be members. It's like comparing a for-profit bank with a credit union. Our government will certainly not be making billions of dollars on the program and no civil servant will be making millions either. Expand Medicare, use the Canadian model or a hybrid of other models, but do something! It will save people money and provide healthcare for all. It will make America a better place.
3
According to the World Health Report, France has the best health system in the world. Why not just copy that model?
2
@R.Singer
Because: the AMA lobby, the American Hospital Association lobby, Big Pharma lobby, Big Insurance lobby...
https://www.beckershospitalreview.com/finance/top-20-healthcare-lobbyist...
2
It could be phased in gradually by initially dropping the age of enrollment to say 60 (or maybe 0 to 5 years of age) and gradually bringing more people in. Younger people would not be quite so expensive as most expenses by far come in the last decade of life.
2
@JerryV
Americans over the age of 22 and under 55 are the largest demographic in America and are also the new gobblers of govt. insurance and health care. They are nowhere near as healthy as GenX and Boomers. Millennials are obese, addicted and shoving the costs of their offspring onto taxpayers. They have expected shorter expected life spans for a reason. Imagine how costly they will be when over age 60 to the current kids of GenZ.
I am a physician (and a specialist) and I favor single payer Canadian/style. But do note the Canadian system has restrictions which will be difficult for Americans: one must be referred to specialists, health care is often restricted to the district you are in it does not pay for 3 or 4 opinions (insanely common in NY) it covers legal BUT NOT undocumented immigrants, etc....
will not really be all that easy
10
@honeybluestar The American description of the healthcare system in Canada is often woefully superficial, including this article. The basic premise is that quality healthcare is a right a country's citizens should have, and we all pay to ensure that system is there when we, or our neighbours, need it. The US is the only developed country that doesn't have a universal healthcare system. In 1966, the Canada Health Act brought in sweeping changes, ones that benefited patients/consumers and, in the short term, penalized physicians. However, even they soon realized the amount of money they were losing to administrative and malpractice insurance costs; the transition was relatively smooth.
50+ years later, no one in "the system" questions the value or the reimbursement he or she receives. If anything, there is a movement here to increase the type of services the government, i.e. we the people, pay for. Beyond free physician and hospital care, plans are being considered to include Rx meds and prescription eyewear. No system is perfect but Canadians sincerely value the thought that no medical condition, however catastrophic, will bankrupt them financially, or emotionally.
7
@honeybluestar
Other salient point: Canada only has a population of 35 million. That's equivalent to just 3 or 4 of the largest metro cities in America.
2
@Margot....What is that supposed to mean? Canadians have universal coverage, they live longer, they have a lower infant mortality rate, they have higher customer satisfaction, and they pay 40% less.......What? Are they that much smarter than we are?
At this point, who cares? Clearly the Republican position is no health care for all. Clearly the Romney style plan of market driven health care for all that became Obamacare can't work as long as there are Republicans in America.
Democrats can work out the details later, if they ever win elections. The appropriate time to work out the details is in congress, not on campaign.
There should be a law that congress, the president, and cabinet officials get coverage under the worst healthcare plan available in America.
9
@DB - Are you aware that a Grassley amendment to the ACA required that all members of Congress drop their FEHBP insurance and get their insurance through a state insurance pool for the ACA?
The German healthcare system is mentioned herein. This is a superior approach to anything in USA, because the vast majority of Germans trust proven empirical science compared with a similar percentage of Americans who trust their own often irrational beliefs before science.
In short: Americans are focused upon 'alternative medicines' and 'alternative practices' based upon their alternative beliefs. Therefore single payer, if it were to pay for only peer reviewed science based treatments (as Medicare does) and only generic drugs unless special requirement is demonstrated, is doomed to failure.
5
@Jim The average healthcare is better and much more affordable in most European countries compared to the US. However, the sky high salaries here do attract the best physicians. This means the outcome of health problems among rich people is the absolute best in the US. This aligns their interests with the doctors, pharma, insurance, ...who profit most from the US system.
3
The "Medicare for all" debate is much more complicated than it seems. The Republican model of market solution is, surprisingly, best represented in Obamacare with its large copays and deductibles. If we are to gain any control over costs, we have to treat medical care as a right, but one that has to be paid for by the consumer, not Blue Cross or Medicare. Patients need to be selective about how they spend their money. Our current model expends far too much money on unnecessary expenditures.
1
What it means? Doubling the size of the federal government, with at least $4T in new taxes and expenditures. What more does one need to know?
4
@Michael Which we will spend on basic healthcare for all Americans rather than putting it directly into the pockets of the hospital, pharmaceutical and insurance industries which now make a few obscenely wealthy while leaving millions out in the cold.
5
@Michael
Any increase in taxes would be far less than what every American pays in premiums, deductables and co pays.
2
@Michael. Most people spend far more than $4k on health insurance premiums. So it would be a net positive for almost everyone. I am on Medicare and spent $135/mo for Part B along with $400/mo for a supplemental plus co-pays on medications bringing the total to $550/mo. That comes out to $6600 per year! I’d rather just pay an additional $4000 in taxes.
5
"What ‘Medicare for All’ Means'"?
It means SOME sort of universal coverage for ALL citizens along the general line of what virtually ALL other "First World" nations provide -- and have provided for a long time! That's pretty simple isn't it?
The specific plans vary widely in specifics -- Austria, Switzerland, Canada, Japan, England, etc. all work differently. But the simple common denominator is government-provided, and/or government-required healthcare for all.
Why murky the waters about the general idea? 'Medicare for All' means government sponsored or provided healthcare for all!
12
what is should mean is eliminating the hundreds of millions of dollars paid to insurance company executives that do nothing but deny care and lower reimbursement; eliminate the hundreds of hours that every provider's office spends negotiating differences between payers for reimbursement, and provide more care to more people, starting with preventive care, for better outcomes
the rest is commentary
5
@true patriot
Medicare and Medicare Advantage programs deny coverage, too. Being on Medicare is a lot of complicated work, with tight rules at hospitals that can be a big trap for the "customer."
There are no easy fixes.
1
It's a catch-all phrase that suggests national "universal health care." Among those of us who support the concept, there is no single plan, no specifications, that everyone on the side of universal coverage agrees upon. Among most Americans, there is no understanding of what this means, or how other developed countries handle health care.
One of the issues is that doesn't sell well is that it does cost more to insure more people. Much more under the current non system. It doesn't get cheaper because fewer people use the ER. Or because people get preventive care. More people covered means more use of medical services, and it costs more.
Many physicians might opt out of cooperation if facing a decrease in income potential.
A vast for-profit healthcare empire of insurers, administrators, and employees handling billing and payment -- and the towns and cities which benefit from their payrolls - will resist change.
Wealthier people - and those with fine benefits from employers - will not want to give up their own advantages - or to be taxed to help others.
The biggest challenge: How are we going to get a Congress willing to work together to set priorities and compromises needed to make such a plan work? It requires evaluating services provided, maybe even putting restraints on some in order to expand others; setting reimbursement levels - prices; finding dedicated funding that stretches into the future, allowing medical providers to make year over year plans.
I wish the proponents of a single payer system would describe it as a "public option" instead of "Medicare for all". I think that would resonate better with our "low information voter" population.
4
Single payer healthcare will be much more expensive in the US than in any other country for one reason: we did not adopt it before the growth of the insurance industry and the concomitant steep rise in doctor's fees.
Doctors, especially specialists, have very large incomes, far more than is the case in Europe or Canada. Their practices are financed with the expectation that those incomes will continue. Hospitals as well are financed with the expectation of large revenues.
Single payer healthcare in Europe and Canada pays the equivalent of Medicaid rates to providers. If Congress were to enact the Canadian plan, many practices would go bankrupt and hospitals would be forced to close because they would not be able to make their financing payments. Obviously that is not a viable solution. Higher payment schedules would have to be legislated, and that translates into higher taxes. Much higher taxes, including on the middle class.
Now some would say those taxes would be offset by the lack of having to pay health insurance premiums, but the fact is that most employed Americans don't contribute a significant amount toward their employer-provided health insurance. And the way business works in the US, it is highly unlikely that employers, freed from the expense of paying for health insurance, would pass that savings on to their employees.
Single payer and Medicare for all are slogans, nothing else.
9
@njheathen "Doctors, especially specialists, have very large incomes, far more than is the case in Europe or Canada. Their practices are financed with the expectation that those incomes will continue. Hospitals as well are financed with the expectation of large revenues."
Don't forget that in the U.S. medical professionals have exhorbitant student loans to repay. Do other nations have such high cost training for their medical personnel?
1
@Pearl-in-the-Woods.
I mentioned incomes because it bears on the cost of switching to some kind of single payer system. I don't fault doctors for charging fees high enough to pay off their loans. But that part of the system is just one more item that will need to change. College, graduate school, law and medical school tuitions are way out of control and will need to be reined in.
@njheathen....You start with the fact that the administrative costs for Medicare is about 2% while the administrative cost for private healthcare insurance is more than 12%. If that was all you did - transfer everyone to Medicare - you would immediately save money. Of course, over time, there are many other things which could be cost saving..
Government control often requires what we do not believe in, and bans our own choice.
2
@Marvin Zinn Change your "we" to I. Now, doesn't that feel better?
1
@Marvin Zinn Feel free to not go to the doctor if we have universal healthcare.. Meanwhile, my taxes are still paying for Saudi Arabia to slaughter Yemeni children and murder and dismember journalists.
2
@Marvin Zinn
So, insurance companies, with all their deductibles and lack of coverage on many procedures don't limit your choice? Yeah right!
1
I live in Ireland, but have also been lucky enough to live in London and Paris. I have always taken affordable healthcare for granted. I have a chronic medical condition which has to be managed carefully. I have to have regular MRI's the cost is paid by my health insurance company. It has been between €225 - €250 in the ten years I have been having MRI's. When researching my condition online I found a blog by an American woman with the same condition. She was waiting to have an MRI but had to wait for six months as her provider would not allow the test until then for whatever reason. I asked why, given the distress she was in, she would not just pay for the test? The answer, the cost $3,000. That was in 2008. It is probably more now. That is an extraordinary difference. My clinic is very new, with state of the art facilities and continually updating what it can offer patients in it care.
It seems to me, from this distance, that costs are out of control and until and unless they are brought into line with norms around the world, healthcare will be more expensive than it needs to be and the best outcomes for all patients, irrespective of their income will not be achieved.
9
The question in front of us is whether we prefer private profits and benefits for the few to the health and well being of most people (or all).
In a democracy, there would be no question about which one brings more value to society.
It's at best doubtful that the US can qualify as a functioning democracy anymore.
15
This article fails to mention what should be the first "test vote" on what improving healthcare for all should be: requiring Medicare to negotiate prescription drug prices. If we can't do that, either practically or politically, then we can't do anything.
4
@Forrest Chisman Congressional Budget Office has examined whether negotiated prices would save money. Answer has been “not much.” For one thing, Federal law requires Medicare to cover all cancer drugs and drugs for a handful of other expensive conditions. CMS has little bargaining power if it has to offer the therapy. It’s not a silver pill, eh, bullet.
When you get health insurance through a job, your employer takes that premium into account. Your salary is lower because of that premium the company is paying. That's your pay going to health insurance. Don't people see that?
19
@Carmen
I pay approximately 4000.00/year for health care. That includes my employer portion. I do not want to pay anymore than that and i certainly do not want to pay more taxes for other people.
3
@Carmen..."i certainly do not want to pay more taxes for other people.".....You won't. Right now, today. We are collectively paying 40% per person more for healthcare than Canadians. If we paid 40% less for our healthcare in the U.S. we would save $1000 billion dollars annually, and some of that would end up in your pocket.
Medicare for all means exactly what it says: Universal health insurance for everyone. Time to stop all the futzing and putzing around and get this done. Its the ONLY way forward. Anything else is just tinkering around the edges and it will get picked apart. It may take us 5 years to sort it out but , so what ? In the meantime we will do what France, the UK, Italy, Canada,Germany ,Netherlands, etc have done. Which is to provide health care to ALL of its citizens. Blow up the current system begin the single payer system.
10
In the confusion surrounding our recent, (last few decades), approach to health care we have allowed the pharmaceutical giants to write their own ticket and to take over the storyline. Now there is a hydra-headed monster laying waste to the land and threatening all other budgets.
Now I'm told that if we reduce drug prices to levels that can be justified, and that a national health care system can afford, then the economy itself will be threatened.
Once again, the interests of the people come last.
5
Opening up Medicare to those under 65 would bring into the system not only younger but healthier people who hopefully would not face serious health issues for many years, if ever thus reducing costs over the long haul.
People under 65 would be required to sign up for Medicare Advantage Plans administered by private insurance companies making the transition smooth as most already are in an HMO or PPO type plan and the government yearly cost would be far less per person in this group.
Employers would non longer have the huge cost of providing private health insurance and employees would have low Medicare monthly charges, a win-win for everyone.
I pay for Medicare based on percentage of my income. Medicare negotiates the costs of my physicians; tests; physical and occupational therapy and surgical procedures. I pay a percentage copay for my medications and my university hospital based treatments. I choose my own care providers.
I have been covered for Medicare since 2007; two years after becoming permanently disabled following severe grade 5 SAH. Medicare has never denied me services. 2 bluechip major medical insurers denied my inpatient and outpatient rehab and refused to approve out of network physicians and treatments.
I carry only original Medicare and Plan D because traditional insurers overcharge permanently disabled stroke survivors like me.
I typically have over 100 medical and rehab appointments annually. I track my spend. It is within my means. The ACA closed the plan D gap that priced my 3 neurological medicates at $2000 each.
I know Medicare and I will support its expansion even if I have to pay slightly more.
6
@Maureen
Wow, 100 visits a year at premium prices are why taxpayers like me cannot afford even one doctor visit and other health care for single mom, self-employed and middle class me with my one child.
1
@Margot
Then you should be in favor of Medicare For All
They really want socialized medicine.
5
If by “socialized” you are implying socialism, you are mistaken. The dictionary definition of socialism is that the state owns the means of production. Having the state provide medical insurance does not meet that definition. These scare tactics are no longer effective.
13
@Robert Goldschmidt
so·cial·ized med·i·cine
the provision of medical and hospital care for all by means of public funds.
@Robert Goldschmidt
There is a difference between socialized medicine and Medicare. As noted several times in these comments, Medicare is an insurance policy. Socialized medicine is like the VA--government owns the hospitals and pays the doctors and nurses, etc., a salary. The two systems have very little in common.
In our discussion of this matter--as Medicare for all becomes more in the news, I think the distinction will become apparent to more of us.
A comment above mentioned (correctly ) that Medicare is an insurance policy with the same
issues about governance that private insurers have--either government employees or the managers of private insurance companies will determine what coverage you get.
After the midterms, McConnell has publicly stated that he intends to return us to the situation where coverage can be denied for pre-existing conditions. If you vote for these people, you are voting against your own interests. Whatever the solution is, it is not more money in Trump’s pocket.
5
Will someone please tell me what "single payer" means? Who, or what, is the single payer? I see the phrase all the time, and there never seems to be an explanation.
1
@CKent....Single payer means that there is a single insurance policy (Medicare) that covers everyone in the country.
1
@CKent
Taxpayers pick up the tabs for everything and everyone.
The current trend of huge insurance companies merging with other huge insurers to form mega-huge insurance companies is on an asymptote trajectory with Medicare or any Single Payer system.
The goal of these mega mergers is to increase risk pool sizes. Spreading the risk (cost) over a larger pool of people to include those who cost the least to cover: the young and healthy.
We are down to what, three or four (?) of these mega corporate insurers? When it gets to two, or a single hybrid with monopolistic power in services and medications, we will pretty much have a Single Payer or Medicare for All... only it will still be based on a for-profit model.
The for-profit corporate model is rooted in "making the absolute most profit for shareholders" ideology. Generally, if a corporation can make another 2% by moving its operations to Mexico, then off to Mexico they go. Or China. Or Vietnam. Or, or, or.
But health care (caring for patients) can't be outsourced. So the companies must do everything they can to maximize profits domestically. This industry, next to the industrial-military-complex, is the richest and most powerful lobby in corporate America.
It will be a very, very, steep uphill battle to change our current system to one that is modeled to be comprehensive and cost effective for consumers.
4
The difficulty America has with any government run system, is that it flies in the face of Ann Rand individualism. And we see Americans riding that certainty of their destiny right over the proverbial cliff.
12
It's quite simple, if you know what Medicare is and understand the word all.
It's not rocket science. Don't lawmakers know how to read, consider options, and formulate programs?
Oh, right.....
1
It doesn't take a degree from the Wharton School of Business to know that any for-profit system will cost more that a non-profit system. Our current private health insurance system cost so much because vast amounts of money are syphoned out of the system to profit a few. That's why Medicare is such an affordable and well structured health system that is highly popular with those over 65. The Koch brothers and their libertarian think tank did a study to show the a Medicare for all system would bankrupt the country, only to find out that there would be a net SAVINGS of tow trillion dollars over ten years if we moved to such a system. It really isn't rocket science. The rest of the industrialized world has figured this out and out 51st state to the north has had it for decades with excellent results and actually better outcomes than our own system. But the "bugaboo" of big government and socialism is used to scare Americans. The same people would scream the loudest about "big government" don't seem to have a problem have government protect us from foreign enemies by our military. Why can't we protect our citizen's health too by using a well tested and very efficient and popular program already run by "big government" called Medicare? Saving two trillion dollars, and getting a great healthcare system that covers everyone seems to make a lot of economic sense.
6
Americans are averse to higher taxes because...let’s face it....only those who actually deal with health issues and the healthcare system realize what a messy and expensive and uncertain nightmare it is. At any given time, perhaps only 15-20 percent of the population are dealing with the healthcare system and realizing that. The rest have healthcare as a low priority because they do not need it at the moment, or they are on Medicare already, and hence the lure of lower taxes (and all the pretty toys one can buy with lower taxes) proves to be more alluring. It will be a brave government that puts single-payer with higher taxes in place, and will probably pay a heavy price at the next election. Their decision will be applauded by future generations, though, as America finally starts to look like all other developed civilized nations in term of providing security in health to all.
3
It's about time to start making it happen, for the common good as well as to catch up with the rest of the civilized world. Affordable? Some caring people have asked if that tax cut for the rich has been "affordable" and if a defense budge larger than budgets of the next eight countries combined is "affordable." Yes, it's about time some rearrangement to reset the priorities for the majority of the country's citizens.
5
It seems that people have forgotten that, if their taxes go up to support universal healthcare, they will also not have to pay for their own insurance premiums, which vary based on your employment status as well as how generous your employer is.
Certainly, to cover everyone, we may have to pay more in taxes than we currently pay in healthcare premiums off our paychecks. I believe this is worthwhile if we can attain a society where people do not seek medical care due to their finances, as is the case in other developed countries!
4
The fundamental problem is that health care is a big business and Americans have the most expensive health care system in the world. You can try to rework the payment system however you like but until that problem is fixed we won't see progress with cost effectiveness or better health outcomes. Treatment is the cash cow of the system - not Prevention. Everyone makes money when someone gets sick -- not when illness is prevented.
1
Start with the integration of the Veterans Health Administration into local community health centers. This could be one huge step for cost containment, instead of our current parallel and redundant systems to treat ailing citizens. While maintaining the ability to treat uniquely combat related problems, e.g. TBI and PTSD, this approach could provide a much more efficient utilization of the costly VHA system to focus on the 95% of medical issues that Vets share with their fellow citizen taxpayers.
I'm part of a management team currently negotiating a labor contract with one of the 3 unions our employees belong to. Every time healthcare comes up in our discussions, I think about a single payer system, whether Medicare based or not, and imagine how much better it would be for all of us than to have the current job based system which costs employers and or employees so much. Most people have no idea what the full costs are so of course they assume that a publicly funded system would cost them more.
NYT, would love to see a real deep analysis of health insurance costs for individuals and their employers with side by side comparisons to Medicare. Give us some data.
22
@LaLa
Yes, yes, yes!
I keep reading comments about how it will cost more, but people don't realize how much it already costs. (and I'm sure these are people with employee-paid/subsidized insurance). They don't realize that employers are covering much of the costs for the well-employed and the government is already picking up much of the costs for the indigent and uninsured.
Without regular access to health care people don't go to doctors until they are truly ill and end up needing more complex and expensive treatment.
To say that employers will pay more is dishonest. The employers (see Walmart) who don't provide insurance and let government foot the bill for medicaid are freeloading off the employers who provide insurance (especially the smaller ones that don't self-insurance) and the taxpayers.
I don't understand why so many of the large corporations such as GM, GE, and the large financial companies haven't fought for universal insurance. I'm sure they would have savings even if they had to pay more in salaries and/or a per-employee tax.
2
This is a whitewash of the Bismarckian system in France and Germany (and Israel) where insurers are not-for-profit -- genuinely not-for-profit, unlike US equivalents -- and premium rates are set by income. It's a good system but it's a long way to get from here to there.
The point about "Medicare for all" is that it builds upon a system that has broad bipartisan support and (aside from companies like Rick Scott's defrauding it) is fairly good at controlling costs.
5
We remain the only industrialized country in the world without some form of universal health care. The arguments against adoption of one of the systems utilized in either Canada or Europe are propagated by the insurance industry because they fear that they might become obsolete. This leaves room for all of the actors receiving financial support form the industry to muddy the waters and create boundless fear of making the change.
6
@William Stuber
Americans have been haggling about healthcare since Truman was President and despite the fact the rest of the industrialized world implemented some form of universal care decades ago, the haggling continues. It is mind boggling. There are countless examples from which to draw yet, the same idiotic questions continue to be asked, questions that can easily be answered by just looking to the outside world for examples of how to do it! You either elect politicians that are unencumbered by lobbyists money and have the political will to FINALLY do something about it, or forget it and continue along the same 70 year old path to mediocrity and an even shorter lifespan!
Then again, in terms of dollars spent, when the healthcare industry is now the NUMBER ONE lobbyist in Washington, all done to maintain the "status quo", columns like this persist, most Americans remained uninformed and the haggling continues.
3
This article does an excellent job explaining the imprecise use of Medicare for all. As a long-time supporter of single-payer, I remember when the term was first used. It was another term for single-payer. When I refer to Medicare for all, I use it to mean a single-payer system.
A public option should not be used when discussing Medicare for all. A public option will keep our current dysfunctional health care system. The health insurance companies will figure how to enroll healthy people while leaving the sickest for the public option. This would be the worst of both worlds. The government and taxpayers would be stuck with the sickest people while the insurance companies would make huge profits on the healthy people. A public option would end up just being corporate welfare for the insurance companies.
5
Simply stated, there should be a truly affordable health care system. To make it so, we need to estabish "reasonable" out-of-pocket percentges: what people can truly afford to pay based on their income. We do this for tax rates already, and there is a decent amount of consensus that these rates are fair, albeit too high on poor incomes.
Understandably, affordability is an arguable point. But a fair, rational discussion about it should not constitute rocket science. Basically, have a sliding scale based on income. Low income beneficiaries could have 5% as a maximum out-of-pocket for premiums and deductibles/co-pays. A person earning $20K per year would have maximum out-of-pocket of $1,000/year. It could come right out of their paychecks, with refunds at the end of the year to compensate overages.
Similarly, a person making $100K can afford significantly higher premiums. Still, however, we might want to try to limit premiums to 30-40% of yearly-averaged expenditures.
True, all this can get demagogued to death by fear groups. But a strong argument can be made that answers are out there and specific proposals would actually work well. At least play with the numbers and give it a try!
I'm an American living in the UK. I make pretty much exactly the median UK income, which isn't that much. I pay more in UK taxes than I would in federal income taxes in the States, true. But when you consider state taxes - never mind insurance premiums - never mind insurance DEDUCTIBLES - I pay much, much less.
What do I get in exchange for that? A system where I can book a doctor's visit, walk in, and walk out, without once even seeing a bill. Done. A system where when my husband had a debilitating spinal injury that required specialised in-patient rehab for months, and I hesitantly asked whether there was a cost, the doctors looked at me like I was insane. "Cost? This is the NHS," they said. Words can't express that feeling of relief.
That peace of mind - knowing you're going to be taken care of when you need it, that you won't have to fight with insurers when you're sick - for less in taxes? A no-brainer.
14
@Laura
Can my family come live with you? ;-)
1
medicare for all means,... "medicare for all". gradually over4- 8 years lower age from 65 to 45, then to "all". it is not too complicated. what is complicated is how private insurance companies and bg pharma are going to screw us over.
pamela
er nurse
7
Those of us who support MFA understand that our taxes will probably go up, but that our overall healthcare costs will go down as we are relieved of insurance payments, co pays, etc.
If anything, an expanded national insurance program will give us the power to set prices and reign in costs...that $17,000 MRI that my daughter got last month is a simply ridiculous cost.
Indeed jobs will be lost in the private insurance industry...many of the rank and file can get jobs with the new entity and they are doing all the work already, and its "so long it will be too good to miss you" to the bloated executive class...we have tried to play ball with them, but they are too greedy to share and have brought on their own demise.
329
@Jeanne Prine
But what kind of health care will we be getting under medicare for all? That too is an important question that I rarely see discussed. There are often multiple treatments for a condition, multiple determinants of diagnosis -- medicine clinical care are complex and will we get the most effective or the least effective? How will most effective be determined? In order to ensure good quality of care will it be necessary to buy a private insurance policy? The devil will be in the details.
@Jeanne Prine ... I'm living in the UK now, and have prostate cancer for 6 years. I’ve had at least 10 MRIs, many more CAT scans, etc.
I’ve never seen a bill or been asked how I would pay. I'm treated quickly and with state-of-the-art equipment, including DaVinci robot-assisted prostate removal, 33 separate IMRT computer directed radiation sessions, many drugs and chemotherapy treatment, countless other surgeries and treatments.
My cost = 0.
5
@dlbBut...."what kind of health care will we be getting under medicare for all? That too is an important question that I rarely see discussed.".....Canadians have universal coverage, they live longer, they have a lower infant mortality rate, better customer satisfaction, and they pay 40% less.
1
The selling point would be this:
"As of this moment you are paying $500 a month for health insurance. You with families are paying $50 extra for each dependent. Under the new plan: each month you pay $250 a month extra in federal taxes, plus $25 for each dependent."
Sold!
3
The fact that single-payer (or similar) has worked well for over 300 mil people in Europe and Canada is enough proof that it will work well in USA. That "US is not Canada or Denmark" is just a cheap talking point. If Dem party brings single-payer to its party platform and campaigns for it, it will win the support of majority of Americans (though of course, they wont do it). That single-payer didn't succeed in a small state like Vermont is misleading: do you think private insurance would have succeeded if it existed only in Vermont? That's why we need a policy at the national level, to spread the risk. Finally, if a an economist like Ken Arrow thought single-payer was the best among other options, I don't need to hear anything further (https://promarket.org/there-is-regulatory-capture-but-it-is-by-no-means-... )
1
It depends how you define success.. profitable? Then yes, the insurance industry is profitable.
@Dora Minor
Well, I indeed meant profit! But the point is if private insurance existed ONLY in Vermont and nowhere else in US, the insurance industry would have gone bankrupt pretty soon! The small state of "Vermont" can't sustain this industry for too long ans still make profits. The same is the story for single-payer if it existed only Vermont.
O, for the love of Pete. Two people deeply invested in the status quo do not reporters make. Don’t ask Goldman Sachs if they’d like to go to jail for trashing the financial system. Anyone who’s stepped out of the country and then gotten a bad cold knows that most nations have Medicare for all and it works very well for good public health and avoiding bankruptcy among the citizenry. Thanks for giving these lizards a forum. Now how about the rest of us?
3
The claims of superior quality of care abroad are ridiculous. The citizens of those countries are used to their care, which involve waits and being told 'no' to certain things that are wasteful. I argue with patients every day about why an MRI or some other study is of no value, but they want it anyway (largely because they do not pay for it).
Our biggest problem is that there is a near monopoly- the feds pay medicare and medicaid. This drives up costs by removing competition. And yes, the market forces would work if people paid for care. Who would buy health insurance, or pay for a hip replacement if costs were too high? Nobody. And costs would come down. But with underpaying monopolies, we have to gouge other people. Add to that the fact that we have a huge influx of illlegals in our ERs that nobody on the single payer side wants to get rid of and we have an unsustainable situation.
You will get what you pay for. And you won't like it.
7
@Ny Surgeon...."the market forces would work if people paid for care."....No. Market forces would only work if everyone had a medical degree, and if no medical treatments were time sensitive.
1
@Ny Surgeon
Many people do not believe that citizens of countries ever hear no, that it will be just like it is today only “free”.
@Ny Surgeon - Those are all talking points. My husband waited 4 months for hip replacement in the US. In Canada, the average wait time for hip replacement is 90 days.
1
What I know is that I’m on Medicare, supplemented by my union’s retiree healthcare plan and it is a heck of a deal... $34 a month for my wife and me, extremely low deductibles and fantastic coverage. Thank you, UAW.
5
Until "medical costs" are drastically cut, no plan is going to work.
7
Can we all agree that as our current healthcare system stands, it isn't working for the vast majority of Americans?!
From there we can work towards something that does.
Soon!
Under our current system 45,000 Americans die each yr. from lack of care. 1.5 million ea. yr. declare bankruptcy due to medical bills. 100 million are afraid to use, or cant afford to use 'cause of expenses or expected costs. Another 40 million are not covered.
Yes, taxes might be higher. But you won't be paying premiums, co-pays, nor out of network etc. costs. Expect to pay 1/2 of what healthcare currently costs. Estimated, of course. No more billing for months/yrs. after said service. No more Insur. co. middle men deciding if you qualify. Dental, Hearing and Vision covered.
Too good to be true. Possibly. But examples of working examples are all around the globe in other OCED countries.
Just not ours.
We are tossed into the deep end and handed a weighted jacket to go with it.
M4A~! It's time.
https://live-berniesanders-com.pantheonsite.io/issues/medicare-for-all/
1
"Optimism without specifics carries risk, as Barack Obama learned after promising that people wouldn’t lose their doctors under the Affordable Care Act. "
I can't believe you're spreading this old, worn out lie. Obama was entirely correct when he said this. There was a grandfather clause in the bill which let people keep their existing policies and the coverage networks for them if they wanted. But it was the insurance companies who withdrew those policies, which disbanded the associated coverage networks, because the policies were junk and didn't meet the essential care guidelines in the ACA. Now the Republicans want to bring those deficient policies back, which would put people at significant risk if they get seriously ill or injured.
Please get your facts straight before you write an otherwise excellent article like this.
2
Halloween is coming, the scariest thing for most Americans is taxes... stumped on how to make it a costume and open to suggestions ;)
@Frank Salmeri
Costume for taxpayers = a blank check made out to the Dept. of the Treasury.
What's the big mystery? Medicare for all is that people under the age of 65 will be able to buy into Medicare! All the price controls and all the income rules still apply!
Republicans are gnashing their teeth and wringing their hands about costs but my vision is that once every person in America has medical coverage I'm going to be able to drop the medical liability coverage on my car insurance and my homeowner's insurance. The school and all the government entities can drop their medical liability coverage and when they do they'll lower our tax burden. The money each of us will save doing that will more than cover a modest tax increase! There will be money in my pocket for a change!
5
We are a country that now thinks you can get everything for "free", whether it's health care or tuition or whatever. Details are so boring, don't you know. It's so much easier to just hear some vapid promise from a politician, read a meme on social media or be "informed" by some late night talk show host or skit on SNL.
But, while achievable no doubt, it would come with major disruptions and bubble bursts! "Free" is still paid by someone, usually, ideally, of course, someone else. Just shrugging off costs, expectations, etc. by sloganeering is not a solution. You can't make doctors work for nothing, or engage in specialties they don't want to, you can just order hospitals to become public if they're private now, etc. - pesky things like laws and the constitution rear with ugly heads of reality.
What we need in order to achieve this is to stop believing fiction, that other countries do it perfectly with no problems and easy access at no cost at all to patients and without unacceptable waiting - and too few of our politicians are willing to speak the truth on these critical issues (look at how many won't even sit for interviews, a red flag if there ever was one) because deep down they down any transition with be painful and have unpopular elements. Again, though, the public meds to disabuse itself of the notion that a quickly passed law with simply solve it all with no pain - it won't happen.
7
@George S They don't do it perfectly, but they do it better than the US for half the cost and with far greater accountability than the for-profit providers, insurers and middlemen in the US. It's up to defenders of the status quo to explain what's so special about American healthcare that it costs twice as much while leaving millions behind.
1
@L.B.
Much of that is true, but it often involves other details deeper down...things like legal liability, litigation, medical schools, who can act in what capacity (not everything takes an actual MD, for example), myriad laws on drugs, treatments, etc.
My point really is that it’s far more complex that many want to acknowledge and you can’t just transplant a foreign system here without addressing a lot of legal and practical differences.
I am Canadian and our healthcare is not free. they call it free healthcare but it's actually prepaid healthcare. Regardless, universall healthcare should be a right. we need to look after each other and people should not lose their homes over an astronomical medical bill. the United States is the richest country in the world, you can afford universal health care. You need to take the profit out of it and use generic drugs for a start. I always remember what Bill Clinton said, "even bugs take care of each other". Are you (US society) smarter than a bug?
2
Bernie Sanders was on WNYC yesterday to explain this and his inability and unwillingness to discuss the funding of this enterprise was disturbing. As was his attempt to gain support by linking opposition to this program to Trump. Sure, Trump opposes it. But he's not the obstacle. This has been debated for decades and nobody has found a perfect solution. And he seemed to suggest that country would come out ahead by saving the money paid to insurance company CEOs without acknowledging that CEO compensation, while outrageous, is orders of magnitude less than overall healthcare expense being discussed.
More disturbing is that no proponent of this plan will concede even a single trade-off. A single thing that would get worse. A single person who would not benefit. This is the mistake Obama made by promising that people could keep their existing plan under the ACA. This was a silly promise as people's plans/doctors changed fairly regularly under the status quo. Of course plans would continue to change in terms of cost, coverage and doctors. It's the same thing here. Only more so. Americans with insurance have ready access to more doctors, specialists, procedures and drugs than the countries being held up as models. As someone in the UK if they can get whatever procedure they need. As someone in Canada how many months it took to get an MRI. Maybe we're willing to make these trade offs for universal coverage. But someone needs to make this case.
6
@SJG, imagine a world where the Trumps would not evade taxes for decades. Imagine if Jared Kushner family had paid their taxes in full. Just imagine.
1
Remember, defenders of for profit healthcare racketeering, when you have a sudden, alarming health emergency, to make sure that as you are gasping for life, you research your symptoms to make sure they represent a condition that your insurer in your state will later reimburse you for. And that you have tens of thousands of dollars set aside in liquid accounts as a precaution if they don’t. That’s your free market working for you. A recent innovation by some insurers to attempt to claw back ER costs. Isn’t it great?
2
One point that fails inevitably to get mentioned is that the idea that federal taxes would have to go up is probably entirely false, because the US system of private and public health insurance is so incredibly inefficient and wasteful. Certainly the single biggest area of that old mantra “waste fraud and abuse” there is outside the Pentagon.
In fact, if the US were to match what the UK spends per person on the National Health System, the total cost of a single payer system that covers anyone would come to very slightly more than what the federal government spend on Medicare, Medicaid, and the VA. Despite the high profile headlines, the VA still has the highest ratings of public approval in the country, I believe
So, not only would tuxes not have to go up, but the vast sums companies spend on you employer health insurance could simply be folded into your paycheck instead for a big boost to you paycheck instead
Of course, Americans are far more likely to maintain their incredibly expensive paranoia of the public sector and throw their money down the private industry rathole instead. We might have children dying of easily preventable diseases in this country, but at least we have a LOT of superyachts! This is America.
1
I am all for Medicare for all, but the Democrats cannot be for Medicare for All and Open Borders at the same time because tomorrow all the sick of the third world country would come for treatment in the US. Already ER rooms have millions of illegals and citizens who cannot afford health insurance to treat for free.
9
@alexgri A straw man argument built upon a factually inaccurate assertion. The reason poor people end up in ERs is because they can't get treatment when it's easier and cheaper to do so.
1
@alexgriI hear this complaint about the Democrats over and over--that they are for "open borders". No, they are not. But they do want humane approaches to managing illegal immigration and also improved management of the border. And Democrats recognize that addressing the problems causing the migrations has to become more effective. There are millions of migrations going on all over the world and no one can blame those who are fleeing war and famine and violence. No one has perfect answers, but again, no Democrat is advocating "open borders".
2
@alexgri......I don't know anyone who is for open boarders. Being opposed to separating children from parents who cross legally and request asylum is quite another thing.
2
First, we have to be able to have a discussion about it. Somebody says, "Medicare for all" and the response is "Socialism!!!!". And the discussion is shut down before it even begins. We have to learn to talk and bandy about ideas once again, first.
In talking to friends who are ardent supporters of Medicare for All, and pushed hard for a ballot initiative in Washington state, I found that they were unwilling to even consider incremental steps (read compromise) to reach that ultimate goal. It is that attitude of blinders on that has gotten to us to where we are today, a society polarized on every issue and anger (read hate), not civil discourse, has disappeared.
1
@kaferlily....Could you introduce me to a Republican who is interested in incremental steps?
Medicare for All will bankrupt the country and cause a middle class revolt against Democrats. Here is the recipe:
1) Half of Americans have no money;
2) Most immigrants flooding the country are poor;
3) Flood the country with even more immigrants in poverty;
4) Ask the already dying middle class to pay for the program (which will cost more than double their skyrocketing Obamacare premiums).
There are not enough rich people in the U.S. to pay for Medicare for All and it would fall on the backs of the middle class. Watch middle class Americans leave the country in droves if it ever happens.
5
@MM......You need to check under your bed for a boogie man.
1
@MM - I hope those who oppose universal coverage WILL flee the country in droves. The average family, which pays about $28,000 a year in premiums and deductibles will see that amount zeroed out and for less than that amount in taxes, we can insure everyone. Meanwhile, those who are able to get health care for the first time may be able to stay or get healthy and work and pay taxes.
1
Thank you President Johnson and the Democratic Congress for my health care, Medicare. I guess I even have to thank GW for his Big Pharma gift of Medicare Part D.
The average non-Medicare citizen has no idea how it works, what may be covered, what may not be. I recently chastised a twenty something for his inadequately understood position of Medicare being an entitlement.........yes, one we paid for and all income tax reporting citizens pay for.
And yet, it is no give away. Part A is an 80/20 coverage. Have you seen what "Medigap" insurance costs? Ditto Part B, but we have to pay about $115/mo for that.
I use Part C, the "Advantage" programs. Still, cataract surgeries cost me about $1000, and ditto for a knee replacement. To say nothing of the, again, almost $1000 in Physical Therapy copays after the knee surgery. So there's $3000 in uncovered costs in four years. Free? Not exactly.
As a voice that was drowned out by "Medicare for all!" what we need is "Medicaid for all!" Much closer to single payer and full coverage.
Americans are arguing all about the trees in the forest. All we have to do is look at the forests of other nations health care and its obvious we have the very worst. Almost anything would be better for more Americans.
1
I take care of my mother's finances because she has dementia. She would have significant medical bills if she didn't pay for a Supplemental Medicare insurance policy as Medicare doesn't pay for everything. Most of the people I talk to, especially young people, equate Medicare for all with "free" and comprehensive health care - which it's obviously not. Politicians need to clarify the policies they're fighting for, not just toss out terms that are open to interpretation.
3
When people say single payer or Medicare for All would cost too much, I wonder whether they realize that medical care in the US is among the most expensive in the world, and over the past 50 years has been growing at a frightening, economy-dominating rate. More accurate to say, I think, that in the long run we can't afford not to go single payer.
While we're at it, yes, your taxes would go up. But the question that should be asked is "how would the sum of my taxes, insurance, and put-of-pocket medical care costs be affected?" At the same time I wonder if most Americans are aware of how much the current system of Balkanized care networks with no or limited out-of-network coverage is damaging America's workforce mobility.
2
The biggest single difference between the US and OECD countries, regardless of country, is that prices are highly regulated and everybody in the countries that still have private insurance is that everybody pays the same thing.
The problem is that commercial insurers in the US have not been good at controlling prices to the point that in some markets - central Indiana is good one - where the local health plans are paying 300% of Medicare. This huge overpayment has led to high costs, huge profits and tremendous over capacity.
Then you go to someplace like Rochester, NY that has done an amazing job and limiting capacity and excessive payments. Costs are much lower and they probably pay a fraction of what is paid in Indiana.
How you resolve both the regional variations in commercial reimbursement as well as the overall high level of commercial payment rates is critical to any solution.
We have to cut costs. There will be losers and they will scream to high heavens and swear the sky is going to fall. But there is so much money in the US health care system is it crazy
To me the question is accountability. There is nobody accountable for fixing this problem. It has to be the government to solve this.
2
over 50% of all children in the US are birthed under MEDICAID. It is by far, by an order of magnitude, cheaper than all other insurances, and doe an efficient and great job. Medicare has 3% overhead, a stark contrast to the insurance propelled fallacies in this country. We find Medicare advantage programs corrupt, after signing on the healthy, then denying coverage for those that get sicker (the purpose of Medicare). Now, 80% of all medical costs come in the last stages of life, with expensive heroic measures that don't prolong or enhance much. I know this. The writer of this knows this. Do you think that ALL medicines slowly incrementally cost more, after being on the market for decades, is. a good idea? Do you think a formulary that allows for hip replacements and diabetic meds a good idea? Insurance post ACA/Obamacare will be "all hat, and no cattle", meaning they will promise much, and deliver as little as possible.
1
This article does not address certain basic issues that are important to our medical care discussion.
Can our selfish society decide that everyone deserves good health care? Until this is decided we will be doomed to endless discussions that skirt around the need of us all.
Our current piecemeal health care system is a product of this indecision. Instead we are all subject to the whims of emergency rooms and insurance companies who care only for the bottom line.
Yes, Medicare for all seems only a slogan now, but only we can make it or some other effective plan a reality once we are united in our desire to make it happen and our need for it.
2
We are ensnared in this dysfunctional system and this column points out many of the problems. Americans hate taxes but want great services and they are not too keen on standing up for the common good. When I retired and went on Medicare the quality of my coverage decreased considerably. It was also necessary to buy a Medicare Advantage policy that's also out of network as I work part of the year in another state. Even with this co-pays for specialists are high. Go to the hospital you have to pay out of pocket for the first 5 days. The paperwork is insane for everyone. And try getting a reversal of a denial. But I will say it is better than not being insured. 17% of my county is uninsured as NC refused to accept Medicaid expansion. Neither Americans or their politicians like complicated so they just say things like Medicare for all and lets face it there's no Lyndon Johnson around to twist arms which is why we have any Medicare at all.
2
The authors are right of course that this could basically be one of two things, the first being single payer and the second being some sort of option for people to buy into medicare. But this is not really the issue they make it out to be.
Two points:
If a tax to support a national health plan seems repugnant, most of us had premiums for our health care deducted from our payroll checks for health care provided through our employer (with much heftier amounts if you wanted to cover a spouse or a whole family). Canada's 7.5% tax sounds idyllic under those conditions.
And I'm not all that concerned about the salary of physicians, either. America pays its physicians far too much. I don't see why medical doctors should grow wealthy on the backs of the sick. 200-600K and up per year strikes me as overpayment. Physicians can live on 120K just fine for their skilled labor.
@Wilton Traveler
You won't have any doctors and few nurses. Did you know that PA's and some nurses easily make 120,000/yr. Good luck.
1
@Driven
Exactly the problem, as I said. We overpay healthcare providers.
There are a large number of distortions and dysfunctions in our current healthcare arrangements, but what lies at the heart of all of them is the fact that we have allowed healthcare to be treated as a commercial product rather than as an essential public service. The ACA was a very ambitious attempt to apply enough reforms to our current healthcare system to make it work. The result, while significantly improving access for some people, was in the end a demonstration of exactly why the for-profit health insurance industry does not, and will not work for the public. For every abuse of patients the ACA outlawed, abundant new abuses and work-arounds were devised to keep the profits up, and costs continued to soar uncontrolled. Human lives are not just another commodity to be bought, sold, traded and manipulated in the marketplace. Do I want my healthcare to depend on a public agency instead of Wall Street? You're darn right I do!
11
This article misses the point of cost benefit analysis completely.
All major undertakings of the federal govt are funded disproportionately by the wealthy including defense . Defense spending is funded by income taxes which is paid largely by high income earners.
Medicare is also funded by high income earners and their employers while all eligible senior citizens enjoy the same benefits.
Past presidents introduced these taxes income tax(FDR ) and
Medicare tax (LBJ) . to solve the defense and health issues of the US.
These programs were introduced based on vision for the future with very modest cost benefit analysis.
It is the responsibility of congress to tweak and modify large on going programs for success .
Individual candidates may propose changes to existing programs, but no large program has never been signed without presedential leadership (Defense, Social Security, Medicare) .
Medicare for all has to justified by a President based on his vision for a better America . Cost benefit analysis will follow.
I never saw any president in the last 60 years go to war with a cost benefit analysis. It was based on a vision with after the fact cost benefit analysis.
Since most of the people affected by this health insurance issue are poor unskilled workers I doubt very much the Republicans will take this on. The Democrats are paying lip service. This has become a Govt of the rich for the rich
3
@Sankaran The democrats did take this on already with the ACA which has worked remarkably well and had a lot of cost benefit analysis for behind it. It has worked well in spite of the GOP trying to sabotage it at literally every turn. So democrats are not just 'paying lip service' to the idea they have actually done something while republicans have actively tried to maintain the status quo. The problem is people who pretend both parties are somehow equally to blame.
@Bill smith
Most - about 11 million - of the ACA sign ups already had health insurance, another 9 million were shunted into Medicaid, with a piddly 2 million Americans receiving (free) health insurance who'd had none previously. Then came the bill and the reality that insurance, even when paid for by others for you, isn't the same thing as medical care.
In a perfect world. ROFL. Just like having car insurance doesn't mean you wake up to a Mercedes in your Christmas stocking.
Progressives understand that, like Obama, most of the current crop of candidates will be for single payer while campaigning, but will soon drop it once elected.
Progressives also know the few candidates who are sincere, and understand that their numbers need to grow exponentially in order to get a functional single payer program in place - the current group of corporate-owned politicians we have now would certainly put together the world's worst single payer system.
Doctors are not qualified to speak about the administrative intricacies and nuances of health insurance, they are qualified to assess, diagnose and treat diseases. Support staff are the folks on the front lines dealing with insurance companies and physicians lean on those employees for their expertise about insurance. We assume that doctors know everything, even about insurance, but that is not the case. Interview the employees who are tasked with dealing with insurance companies all day and getting the run around on behalf of the patient and they will tell you that a Medicare for all healthcare system would include less hassle than working with an insurance company. Does Medicare require a lengthy prior authorization process to be undertaken for an MRI of the brain? No, it doesn’t. Does Blue Cross Blue Shield request an authorization for the same imaging? Yes they do. Working with Medicare is easy behind the scenes and working with insurance companies slows patient care and frustrates all involved so the insurance co can make exorbitant amounts of money at the pt’s expense. Let’s work together to provide everyone in America a basic foundation of government healthcare and if people desire to pay money to supplement their government health plan like folks with Medicare Advantage plans do, that can be their prerogative. Doctors aren’t the only ones with solutions to healthcare related problems just as lawyers are not always qualified to solve all political problems.
2
Contrary to the writers' assertions, it's not rocket science. EVERY advanced (and many developing) nation in the world has a universal healthcare system for their citizens. EVERY. SINGLE. ONE. It's not complicated.
All any be has to do is look at the models of universal healthcare in Norway, Sweden, Finland, Denmark, The Netherlands, Switzerland, Germany, Japan, UK, Canada, Portugal, Austria, France, Italy, Spain, Cuba... The list goes on.
Furthermore, We The People are demanding that our representatives in Congress figure out how to transition America to a transparent, no- loopholes single payer system -- that is WHY we elect them, that is what they are being paid by We The People to do.
And, by the way, our Congress gets free Healthcare with dental, vision, hearing for life paid for by We The People. They can start by giving us the same benefits they enjoy.
19
@Humble Beast Did you even read the article? The point is that as you put it "EVERY. SINGLE. ONE." has a different system for delivering universal healthcare. Furthermore, none of these countries is an exact proxy in population or country size for the U.S.
He's arguing for UHC, but he's saying they need to dig into policy specifics for it to really work rather than using it as a cheap slogan.
3
Whatever reforms are made and they must be made to our patchwork grossly inefficient and massively unaffordable and unfair healthcare system will produce both good and bad results. We could federalize the entire healthcare system, making all doctors either federal or state employees or simply government contractors. But this would also involve making every healthcare institution, hospitals and all ancillary services as part of the same bureaucratic monoculture.
But there are certain imperatives for our redesigned healthcare system. First, it must be truly universal and truly comprehensive. Every citizen and legal resident but be guaranteed affordable access to high quality healthcare including behavioral health, dental and eye care, physical therapy and eldercare. We have issues related to funding all of this, including taxation and resource allocations independent of market forces. Compensation issues are also paramount along with high to continue and incentive medical innovations. There are supply and access issues, manpower issues, and treatment issues which need to be accomplished within particular budgets.
But other countries are able to do this. We do have many successful healthcare models around the world. The first step though is to commit to universal affordable access to comprehensive healthcare for the entire population, making it a right of citizenship. The second step, much harder, is building a model that has efficacy for everyone involved.
3
Without a "Free at point of service" healthcare system, the U.S. will slide further down the competitive scale. There are millions of Americans squatting in jobs they hate simple because of health insurance. They are unable to start up their own businesses for fear of being bankrupted by healthcare costs. They remain stifled in jobs instead of finding jobs that they would thrive in. The whole country suffers because of this. Across Europe, healthcare is never a concern when looking for jobs, and nor should it be. In America, however, it's often the primary concern.
And I know a little about healthcare: I was exceptionally fit my entire life. At 44 I was running mountains with a 50lb Bergen, 60 pull-ups before breakfast kinda guy, training for re-entry to the military. Working seasonally for the U.S. Government as a firefighter I had no insurance at the time. One day, stomach pain on a run turned into peritonitis and four operations. It wrecked my life. Herniated discs, spine fusions, bowel obstructions from scar tissue, constant, often debilitating pain daily, from the moment I get up till three in the morning when I wake to experience it all over again. My only worry now is healthcare and how to keep it. And that is no life at all.
20
One of the biggest problems with the Medicare-for-all concept is the same thing that's wrong with traditional Medicare: It basically hands the healthcare consumer a medical credit card and says, have fun! True, there are price regulations and bundling of some services, but traditional Medicare does nothing to dissuade the patient from doctor shopping or using the ER at will. We had a Medicare patient recently who had been to the ER 56 times in one year despite our best efforts at changing her behavior. (We eventually dismissed her from our practice.) Any financially sustainable Medicare-for-all, single payor or public option plan will have to have a managed gatekeeper aspect to it, and that is always the hardest pill for voters to swallow.
8
As usual this article wanders around a lot. Medicare for all means that everyone gets the benefits that Medicare offers to the elderly. That means its lower payments to providers. Now how it would be paid for is a great question, but paying much lower income to many providers means massive changes. Some providers are already not taking any insurance, and that would increase under Medicare for all. The US is not Canada or any other country, Medicare for all or single payer is foolish, let some state try it and if it works others can follow. I bet a massive failure, Mass already tried and would have failed except the ACA replaced it. Focus on improving care and health, nothing else will be effective.
2
@vulcanalex
Single payer is foolish and will be a massive failure? Every other civilized country in the world, who spend less on healthcare while delivering better outcomes, will be surprised to hear this.
4
Government is best suited for providing emergency and pay-it-forward services. This is why municipal rather than private hospitals are the primary providers of emergency health care services.
The largest cost savings result when health care is used to maximize quality life span (pay-it-forward. By detecting and addressing chronic diseases such as diabetes, obesity, heart disease and COPD early on, not only would we reduce lifetime healthcare costs, but improve quality of life and worker effectiveness.
Currently many patients enrolling for Medicare at 65 are medical basket cases with untreated chronic diseases that have spiraled out of control. This places a much larger burden
Medicare for all would also eliminate the
need for businesses to release older workers because of healthcare cost considerations. This age discrimination currently forces older workers who are experienced and effective out the door.
4
Before we get too excited about government run health care, we need to address the biggest elephant in the room -- comprehensive women's health care issues. Those include fertility treatments, pregnancy, childbirth, contraception, and abortion. Would a government run plan pay for any/all of these?
Also, if we have government run health care, our medical providers would be government employees, be in a union, and receive a pension.
Which party is automatically against all of this? And which party's adherents can be persuaded that this is all communist socialism?
" the Kaiser Family Foundation found that support for Medicare for all dropped when respondents were told that their taxes might increase"......The fact is that by any measure, everywhere they are employed, single payer systems are far more cost effective than what we are doing in the U.S. Collectively as a country Canadians pay nearly 40% less for health care then we do. Canadians have universal coverage, they live longer, have a lower infant mortality rate, and their healthcare delivery system has a higher patient satisfaction rating than ours. Further, in the U.S. the administrative cost for Medicare is about 2%, while the administrative cost for private healthcare insurance is 12% and more. Do the math. Medicare for all would save (SAVE) the country at least $200 - $300 billion dollars annually. The point that is too often ignored is that healthcare is something we are already paying for; it is not somehow a new expense. The "your taxes will go up" is nothing but a scare tactic. Medicare for all would save (SAVE) the country a lot of money.
7
I have lived in both Canada , UK and here. By far Canada and the UK have a better system than we do at a far lower cost
Currently Health care is 20 percent of GDP compared to 12 percent in the other countries. It’s getting worse every day some 20 percent of new jobs are in the Health Care Sector we are all paying for this increase either in Employer programs, Government programs etc One f the reasons our manufacturers are not competitive in global markets is high health care costs.
So what to do
Our clear objective must be to agree Health Care is a right and that all Americans should be protected.
We should first contain costs by enacting legislation to enable Government and Insurers to negotiate prescription drug prices to European Japanese Canadian levels.
We must keep the ACA particularly protecting pre existing conditions.
Incidentally President Obama and Nancy Pelosi achieved this protection for most Americans.
Introduce a single payer option for uninsured using Medicare infrastructure and existing subsidies. It must be self funding.
These actions ensure coverage is available for all and will reduce costs.
Then we need a panel of Health Care experts to recommend a way forward that provides health care for all at reasonable cost
Politicians cannot do this,proof our current mess.
Last but not least we Americans need to face up to our real issues in addition to health, infrastructure, tax code,education
13
@Carsafrica But they have much different populations, both in general and in the providers. If you want health care as a right, amend the constitution. Good luck with that.
1
No constitutional amendment needed, just the political will and some commonsense adjustments. The Canadian and US populations are very similar. The Canadian single-payer system is actually a patchwork of systems organized by province so that adjustments can be made through the ballot box. Similar healthcare provision could emerge in the US state-by-state, if a majority of the people want it.
2
Bottom line, we need to get insurance companies out healthcare. Insurance companies have inflated prices over the decades. They demand "discounted" rates, so in order for labs to get the $45+ it actually costs for blood tests and labs, those businesses must charge $750+. Doctors must charge twice as much to get the actual cost for their work. Same with imagery and other diagnostic labs, hospitals, etc. Add the in-network/out-of-network scam, and getting affordable and competent healthcare is impossible in many areas of the country.
Privately operated healthcare businesses work well in the rest of the world. A single administrator or a few regional administrators for a single plan greatly reduces costs. Eliminating the sham of "discounted" rates and instead reflecting actual costs further reduces expected expenses.
6
At one point my family was spending over $17 thousand a year on health insurance. Seventeen thousand! That's besides the deductibles and co-pays. How can taxes be any more onerous?
14
Yes, taxes would go up if we had Medicare for All, but not as much as all the alarmist and nay-sayers try to make out. And remember, there would be no insurance premiums, co-pays and other surprise expenses. In a Medicare for All system that everyone belonged to - that is, not just the old and sick - premiums or taxes would be less than what people are paying now.
Every other successful Western country has embraced some sort of national health system along the lines of Medicare for All. They can't all be wrong. We don't have to be pioneers - we need only copy the best of them.
16
The term "medicare for all" is a useful carry-all for reforming the medical system, but real reform goes far beyond the question of who pays for medical care, and when they pay it. A serious effort to root out hospital and medical firm monopoly; reforms of the patent system; dealing with drug firm research, advertising and pricing (not to mention rampant dishonesty); doctors' monopoly over care and the mispricing of GP and specialist services; etc. all deserve attention, and intelligent reform of any one of these issues, or of others I haven't mentioned, would bring pricing more into line with rationality and the public interest.
5
Cut health insurance lose from employers. Take that yoke off their neck, tax the money they now spend on premiums (a huge hidden subsidy). Then let's see how many workers, including top tier executives, start calling for Medicare for All. Of course, most people don't understand how medicare works now...There are still premiums, still insurance companies administering the rules, still copays. What we really want is MEDICAID for all. Raise taxes, no premiums or copays. Still some limits though. Oh, and regulate drug and hospital prices.
1
How about this: Pass a law that allows anyone under 65 to enroll in medicare by paying the average cost of providing the coverage. It is by definition revenue neutral and it does not force anyone into anything.
2
@SierramanCA Average cost for what population? Otherwise I like it but I bet over 800 per person per month.
1
@vulcanalex, I meant literally what I said. That means the average cost for the new enrollees. Whatever that cost is, I suspect is less than commercial health insurance since the cost of managing medicare is less than the cost of managing commercial health care insurance.
This discussion would have more clarity if we thought and spoke in terms of government health insurance rather than government health care. Medicare works and people should have the ability to opt in. Then, let the market decide.
1
@Frank When you assert "Medicare works," do you have any thoughts on why, if it "works" so well, 98% of the people forced to use Medicare by our tax laws, then feel the need to buy one, two or more additional mostly private insurance policies ... just to be... you know... insured against the financial ruin that Medicare by itself can cause?
And given that you are from Colordao, maybe you can explain why when it was on your state ballot the people of Colorado voted against it?
@Dennis Byron Sure. What was on the ballot here was not well though out and obviously wouldn't work. I doubt 98% of Medicare recipients purchase supplemental plans. Managed medicare, offered through HMO's is a good option for a lot of people. For one thing, Managed Medicare has an out of pocket maximum; a feature noticeably absent from Medicare. This goes a long way to avoiding health care bankruptcy.
If you do not acknowledge the root of the problem, talking health futile.
Show me as system ( private or Government ) can give 320 million a good health care, nope.
There is no easy way to do that.
Medicare for all, which will in effect mean Medicaid for all, also means less Medicare for seniors. There is a finite amount of money to be spent and how that will be distributed is the question. As for single payer, the question I have is how comfortable are you with Donald Trump owning your medical care? My fear is that it will be subject to all the political wheeling and dealing that goes on and that all sorts of quack interests will demand to be included.
Jake,
Gov. pays the bill. They don't make the medical decisions. (supposedly) As is stands now, a for profit corp. decides whether you are worthy of care...or not.
1
If I paid 7.5 percent of my income toward health insurance, as the Germans do, my annual premium would be $3900. As it stands, my employer currently pays the entire cost of my health insurance through Florida Blue Cross - $6400 in 2018, according to my recent benefits statement.
1
@Steve You actually think Germany and Germans are comparable to the US? If so you don't understand either.
1
@vulcanalex....Please explain how they are not comparable? How can you possibly know what the real cost of healthcare should be if you refuse to make comparisons? Comparisons may not be perfect, but it is a fact that everywhere universal coverage/single payer is used, the country pays significantly less for healthcare than we do.
1
@Steve
That means your employer could give you a $5,000+ raise and you'd both come out ahead, right?
What is said in this article about the German system insurance rates is incorrect: depending on the insurer, we pay around 15 1/2 % of our income, that is to say, the employer pays about 7.3 % and the employee about 8.2% and anyone who earns somewhat over 5000€ can have private insurance and get special treatment. The system works, but as an employee with a normal salary, you sometimes have to schedule foreseeable appointments with specialists months in advance. In an emergency, the doctors are required to see you.
5
All too often in politics, specifics are a negative and credibility doesn't matter. Republicans have long understood this better than Democrats and in the Trump era they've taken this strategy to new heights (depths?) Rather than set up another circular firing squad on the left hand side of the political spectrum why don't we all just join hands and begin chanting "Medicare for all and we'll make Canada pay for it!"
3
For doctors, a reduction in revenue is not a reduction in income. A huge part of revenue goes to processing claims, usually as much staff as actually helps the doctor. Another huge part goes to services unpaid, because of insurance claim denials and patients who just can't pay.
The net effect will vary from one medical practice to another, but the gross numbers spent on claims processing and uncollectables suggest a huge benefit to doctors.
Medical malpractice coverage costs most doctors something in six figures. Medicare for all could include some provision to reduce cost to doctors of their own insurance. This could be for example by policing doctors with substandard care, limiting their participation in the system. It could also reduce claims, since a significant part of many claims is the cost to the patient of future medical procedures.
Hospitals too have huge costs for claims processing, and even bigger costs for patients who cannot pay.
Doctors and hospitals could do quite well under this plan. It is not done at their expense, which is why over half already support it.
Notice that in other systems that cost less, the doctors are paid quite well. Doctors are paid well in Canada and Germany both. They are just as skilled as ours here, too.
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@Mark Thomason...
You make valid points, Mr. Thomason, particlarly on the matter of malpractice insurance. Your thinking on practice administration and billing needs more substantive study since practice administration and billing will still be a requirement unless you are suggesting that "Medicare for All" take over the scheduling, record keeping, and billing classification with bureaucrats co-located in the offices of the medical professionals.
Far larger issues are access to care and quality.
One of the knocks on the Canadian and British versions of healthcare...indeed on the systems of a "universal" is timely access to elective procedures. In our system, you may have a two-to-three week wait to see a specialist for, say, a bad knee or hip, and another one-to-two to have surgery. In Canada and Britain, it can take months to get the appointment and up to a year for the surgery itself. Neither the Canadian and British approaches is particularly "responsive".
Another knock on those systems is the dive to mediocrity. The focus is on dispensing, leaving innovation and technique development to an even narrower slice than we have today.
And as for the ability to get rid of poorly performing practitioners? You have to be alarmingly incompetent to get struck off on a "universal system. Why think a MfA system would be different?
And since Vermont and California chocked at the cost of universal healthcare recently, do you really think Congress will be any different?
1
@Mark Thomason Good point, but there will be large lay offs? And I bet that they could process those claims much better as well.
@vulcanalex.....Are you saying that we are not as smart as Canadians?
Any kind of medical delivery program will require employees to run things. Give employees in the health insurance industry first dibs on the many--hopefully Civil Service--jobs that should be available in the new system. A tax increase, at least for me, would be a small price to pay with no more worries about prescriptions, procedures, exams and tests.
7
What this article does not include is information about how the UK is able to attract doctors to be a part of the National Health Service. First, they only require 5 years of education to get a medical degree, eliminating the need to study subjects that will have nothing to do with their medical education. Secondly, the cost of tuition is extremely more affordable than it is here in the US. My guess is that the common sense of the UK to both limit the time required to become a doctor as well as the cost will never fly in the US where greed and selfishness are the norm.
5
@George Not to mention they import doctors at a rate more than we do or would want to do.
1
@George...
There is a valid reason for a lot of what doctors have to learn in this country.
And if you have ever had a complex illness, one that crosses the boundaries between many specialties, you are monumentally thankful that that resident or fellow had the training necessary to have recognized a connection that was crucial to your recovery.
It is a subject certainly worthy of discussion amongst the medical schools and professional specialists, but I would think that the current default is far more beneficial to the patient than would be a wholesale reconstruction of the curricula for an MD.
@vulcanalex
Yes, that correct, many of the doctors Canada is importing are coming from "America". They have had it, "up to here" with the crumbling American healthcare system.
Medicare is no cure-all. In fact, it is not even single payer. First of all, it doesn't cover everything, so that a supplement through an insurance company is necessary, and this comes with co-pays and deductibles. A different private part covers medications. Second, it comes with premiums through reductions in social security, so it isn't free. In fact, as it now stands it is a kludge, and if you were to go to the hospital for an illness you would get paperwork for months from all the different entities telling you that they will or won't pay this or that. And the overall cost per year is not that much less than having a private insurance plan. The main utility of Medicare seems to be in not allowing medical providers to charge what they want; CMS cruelly reduces the allowed charges, sometimes by 90%.
1
@Elwood...
I am all in favor of limiting the ability for hospitals and practitioners from charging what they want.
But I am not in favor of limiting that ability to the point where hospitals are no longer able to afford to operate.
Note that there are many hospitals that are closing or reducing their number of beds to get their costs in line with their revenues.
The hospitals can certainly be accused of overcharging patients. Indeed the entire medical industry can be accused of that.
But, Medicare and insurance companies can also be accused with a great deal of validity of under-compensating the healthcare providers.
It is interesting to note that according to the American Hospital Association, the nations's registered hospitals have expenses just under $1 trillion a year, roughly $83.3 billion a month.
Let's assume for argument purposes that it takes a fixed three months from service rendered until the hospital is paid. That means that the hospital systems are floating approximately $249.9 billion every month to patients' accounts ($83.3b * 3 months), and having to pay no less that $747 million interest on the financing necessary for extending the credit.
And since the hospitals are still going to have to code-up any charges for services, they really aren't going to see much in the way be benefit except int their collections departments.
A lot more analysis needs to be done before "Medicare for All" replaces one nightmare system for another.
A more pertinent question might be why are the mature, "responsible" people in American journalism -- the one who missed the financial crisis, and have no demonstrable understanding of how the Federal budget works -- so terrified that the U.S. might get a decent health care delivery system, like the rest of the civilized world.
Okay, it's true our system is two to three times the cost of the competition, with worse outcomes, and regularly bankrupts our citizens.... But it's all we can afford! Besides, look at the deficit!
6
I don't think people care about the terminology so long as they cab avoid going bankrupt and turnover a life times worth of hard work to the medical community and insurance companies.
6
Excellent article! Informative, balanced and clearly written. It gives me, as a voter, a better understanding of the issues surrounding health care. Thank you!
I’m a retired, British-trained physician, now a US citizen, who spent 20 years working in Canada. Thus I have direct experience, both as a patient and as a medical practitioner, of the British, Canadian and US healthcare systems. From the point-of-view of the patient, it is clear to me that the Canadian system is the outright winner. This is because it produces high-quality care with a minimum of barriers and eliminates anxiety about availability and affordability of care.
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A rhetorical question. How many illegal aliens are in Great Britain and Canada vs the US of A who’d be covered if we had a national single payer system.
Dr. Fletcher...
Than can you explain why the wait times in Canada are sufficiently long that patients elect to come to the US for procedures instead of waiting at home?
Or is it because there is the US as a relief valve that the care in Canada is "the outright winner". Is it possible that, through self-selection, a lot of the cases with more complicated chances of success aren't burdening the Canadian system?
This is a legitimate question, not a troll. It is a factor of the Canadian system, and that factor's impact needs to be part of the calculus in determining the validity of your claim?
@The Owlhttp://www.pnhp.org/news/2002/may/phantoms_in_the_snow.php"The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care. Additional findings from the current study showed that a small amount of cross-border use was related to proximal services, primarily in rural or remote areas where provincial payers have made arrangements to reimburse nearby U.S. providers. Finally, information from a sample of "America's Best Hospitals" revealed very few Canadians being seen for the magnet referral services they provide.
What an incredibly depressing issue, that should have been addressed on a national level when FDR was in office. It’s not “conservative” to allow for the levels of financial bloat/waste which are so pervasive in America’s system of healthcare.
The lion’s share of waste in the medical industry is a combination of Big Pharma costs, and the current model of health insurance structuring.
If life is meant to be worth protecting, then why don’t we? It is far more fiscally responsible to mitigate the influence of insurers and drug manufacturers than is to follow their lead.
8
It's true that many jobs would go away with single payer. Every doctor's office has several "insurance experts" to sort through the Byzantine system, huge health care complexes are devoted to betting on who will get sick. Many pockets are lined with this artificial complexity. It is non-productive work, a drag on our economy and the disruption in job changes would be very real but necessary. Let's do this!
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@Ken Wallace
I heard some years ago about two hospitals in the Pacific Northwest, one in Seattle, one in British Columbia. Both of the same size and typical uses. The American hospital had 100 people doing nothing but trying to figure out and fight with the insureres.
The Canadian hospital? Five. After all, SOMEone has to submit claims, don't they?
18
@Ken Wallace That’s fine, Ken, as long as you’re not the one losing your job. Btw, do you do “productive work?” It is the height of hubris to think someone else is not out there gunning for your job for the same reason as you stated. Because... there exists that person looking to cut costs.
@Ken Wallace Did you ever nail it! Thank you!
The conversation really needs to take a step back and address the real understanding problem and how to deal with it. Fundamentally, 'insurance' is the wrong model to use for health care. It works fine when considering major surprise events and illnesses, but falls down very quickly when one considers the chronically ill, of whom we have a lot.
There's an interesting parallel in the flood insurance space.
Fundamentally, we need to decide if we want to be a part of a society that cares for its citizens, or one where we don't mind if those who are chronically ill are just left to die. If the former, we need to reimagine a system that allows us to create that society. If the latter, I should move.
11
Should have read 'underlying' not 'understanding'....not sure why it changed? Maybe lack of caffeine?
Medicare for all is easily attainable. Small tax increases can fund it. Currently you are eligible for Medicare at age 65 or if you are disabled. It would need to be implemented gradually giving younger people such as those age 55 the ability to buy into it if they desire. The cost would be affordable for most. (compared to the current cost for a 55 year old to purchase health insurance). This is where we start, allowing younger people to buy into the existing Medicare program. Not complicated.
8
@Marc A...
This is entirely reasonable.
But if you think that a Medicare buy-in price is going to be reasonable, think again. Seniors already pay $128 a month from Social Security benefits, a $1536 annual bill for the privilege. With the increases needed by the Medicare administration to handle the entire populations, the break-even model is going to suggest that that figure is unacceptably low.
And understand this, Medicare works because the entire working population is taxed, and the moneys collected go to pay for the care of seniors who have contributed to the Medicare program for a good part of their working lives.
With the entire population of the nation receiving benefits, the aggregate funding will lose any cushion that might exist. And only through government borrowing, i.e. increasing the national debt through deficit spending, or through a substantial tax increase.
This whole Medicare-for-All proposal, I think, is a fine example of what the liberal and progressive have been doing for the past half-century:
Offering noble and compassionate programs that have very low prospects of becoming public policy and almost zero chance of ever working even minimally as the noble an compassionate program is intended.
Pie-in-the-sky is one way of describing it. Terribly naive is another. But best description is probably "Twilight Zone".
Medicare for all will be a disaster for all including those who currently are on medicare. Why so?
1) Many private providers of health care are dropping medicare coverage. It is not as profitable for provides to provide coverage.
2) Medicare does not cover the entire health care and therefore most have to get supplemental coverage.
3) Most of those that are covered under medicare have preexisting conditions while enrolling on medicare but on the positive side they have paid into medicare most of their lives without receiving any benefits and so if you now enroll the young in an imaginary medicare for all then there will be those who have not paid into the system. Also the youth have a higher incidence of self inflicted sickness.
4) The Dept. of Health and Human services has the highest budget of all Departments and still does not cover health care for all. Add to that medicare for all and the national debt that is 20 T until Trump took office will double in no time without provision of optimal health care for all.
Anyone who is running in the mid term promising Medicare for all deserves to be defeated and never again run for any office.
On the other hand what I have been proposing for over 2 years now is a hybrid of private health insurance for those who can afford it and government managed health care for those who have limited means to afford private insurance.
If only Obama had managed to pass public option without the draconian penalty it would have been ideal.
2
@Girish Kotwal.....1) Many private providers of health care are dropping medicare coverage. It is not as profitable for provides to provide coverage.....By not profitable what you mean is that people in the medical profession would no longer be able to command (extort?) the excessive incomes they now have. Further with Medicare for all they would have no choice but accept all comers and receive a still high, but more reasonable, compensation for their services.
2
I feel Medicare for All and Single Payer are euphemisms for beginning an honest talk on getting every American a basic level of health care – regardless of age, gender, ethnicity, income level, profession, etc. –.
That may be all government or a public-private option of which there a plenty of real world examples outside of our borders to study.
We need to get beyond the Republican belief that health care is a privilege (definition: a special right, advantage, or immunity granted or available only to a particular person or group of people). Every single American needs health care at some point in their life and the thought that it should only be available to a “particular person or group of people” is horrifying to me.
I know it’s an unfamiliar phrase but making health care truly available and accessible to every American is in our “greater good.”
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This excellent article highlights among others the American's ignorance of the tax and health care systems around the world.True, the taxes there may be higher than the tax rate in USA (especially after recent tax cut, the cost of which we will have to pay in the years to come). For example, in a Scandinavian country I where I spent considerable time, there is no real estate tax (or minimal) nor separate state tax . On the other hand the tax they pay to the central government covers health care, education (through university level) and reasonable retirement benefits. Many employers as an incentive offer additional benefits but they are not essential to well being. My wife had to spend one day in an university emergency care hospital and our full bill (including all tests, doctors' fee, i night in the hospital, medications) was about 500 dollars which is comparable to one visit in a doctor's office here!!! If we had local insurance (as everybody there has) the bill would be almost nothing (there is a small copay). Beats Obamacare and certainly Trump-No-Care!!
7
"central cohesiveness ...detailed, workable plan is formulated and sold to the American people"
That is a rational, cartesian approach which is rarely if ever how legislation, much less change, is enacted in the real world. It may be logical in some commentors' minds but only works in centrally planned economies with authoritarian governments, In case anyone hadn't noticed those have officially gone out of fashion and the suggestion is simple political naievety.
5 year plans are necessary but make peoples' eyes glaze over, while action drives change. Action only gets in motion when people get motivated by inclusive slogans like "Medicare for all". So drawing up and selling a 5 year plan might be appealing to those who mean well but literally reads like the definition of insanity to me ie keep trying the same approach hoping for a different result.
#Medicare4All
2
Really excellent reporting that gives both sides of the issue and provides links that go beyond the article. The hard truth is that many who say they have strong morale values deny poor children health care because taxes may go up need to find a better approach. God forbid the Republicans who have had 10 years to come up with a plan would do something. Also the Democrats need to run on an improvement to th ACA with specifics.
1
There are really two issues with health care that need to be dealt with. One how do you control costs and two how do you get everybody covered. Perhaps if we viewed health insurance as a government service instead of a private commodity - that could help alleviate costs. By having the government be in charge of providing insurance they as a non business and a large monopoly could control health care costs which have increased so much over the last decade
3
The vast majority of Medicare members have supplemental plans - just like Canada.
Senator Sanders has proof that his plan is better than what we have now with no increase in taxes.
If that is the case then please submit that plan to the CBO for analysis.
What are you waiting for?
I support MFA but unlike many I know my taxes will go up.
@K Hunt I think you're right that there'll be a tax increase, but as the article implies, your prices for services, deductibles and co-pays could go down.
Another possible offset to the increase in the Medicare tax should come from eliminating the need for employers and employees to pay premiums for private insurance. The ACA limited the percent of private insurance premiums not passed on to health care providers to 20%. In Medicare, it's about 4%. That is, Medicare premiums are less costly. Eliminating the employee share of premiums will directly help paying any Medicare tax increase. Government needs to look at how to direct some of the employer premium savings toward employers also paying more in Medicare taxes. Given the percentages of costs in private and Medicare premiums, it should be possible to fund Medicare and save money for both employers and employees. And, yes, less paperwork for employers, employees and health care providers. Of course, we all know where the devil is... Let's beat the devil and do this!
Does anybody really believe the USA is not capable of doing this? Please.
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@K Hunt
Do you have any proof that most Medicare recipients have Medigap plans? My observations and gut sense tell me that isn't the case.
My parents did, but I don't, my sibs don't, and no one that I'm aware does. The plans aren't cheap and the cost is like life insurance.....as your age goes up, so does the premium.
I would have to spend essentially two months of my SS income to get a Medigap plan. At "only" age 72.
2
@Jus' Me, NYT
Everyone i know does since they don't want to be on the hook for 20% of the cost.
Why does no politician (or Elizabeth Rosenthal) describe the way our current Medicare Program is funded. During our long work lives we pay about 6% of our income to the Federal Gov. specifically for Medicare, (separately from the percentage we pay for social security). When we are 66 or 70 and continue to work, we continue to pay that Medicare 6% on our income). I am 80 years old with my own development business - in the years that I make a bit more money, the medicare people let me know that I am going to have to pay an extra $100 to $300 dollars a month the following year..... I think this is a very fair system.... It could work for everyone, because those making more would pay more during their working life and be protected if they fall into bankruptcy. The rich would also be allowed to buy supplemental health insurance of any kind. This kind of program will not cost more money or raise taxes if it is implemented gradually over a period of 20 years. My facts are not be researched, so tell me where I am wrong.
1
This is a shockingly dishonest column. Medicare for all means just that: national health care offered by the government covering all Americans. Indeed, the name "Medicare" came to us from Canada, which decades ago implemented Medicare for all.
And Canada, far from the this side and that side arguments these columnists present, offers superb quality healthcare to everyone in Canada, and at a fraction of the cost of American healthcare.
It's not difficult. It's just that conservative pundits are strenuously attempting to claim that it is.
26
@Sean Medicare and Medicaid were enacted in the U.S. in the mid to late 60s. Canada's national health plan was enacted about that time or a little later. I don't think we borrowed the term "Medicare" from them, but I may be wrong.
@Sean
You are wrong about the origin of the word Medicare. Not only was it used in the bill President Johnson signed in 1965, WAY before the Canadian program, but as far back as 1956. Wikipedia: "The name "Medicare" was originally given to a program providing medical care for families of individuals serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956"
1
I have always regretted that the "public option" was dropped from the ACA. To expect the entire health insurance industry to be restructured in one act of legislation is unreasonable. It would be enormously disruptive, and probably impossible. Also, many working people would prefer to keep their workplace insurance. With the public option, people could buy into Medicare if that was the best choice for them. And finally, lowering the age for Medicare would do nothing to address the health insurance needs of most Americans.
3
Recently, United Health (an oxymoronic name if there ever was one) told subscribers that it would no longer pay for exercise gyms for seniors. I suspect this will boost short term profits for the CEO whose compensation is based on share price, but this decision is counter productive for seniors and the expenses they will incur if they can no longer afford exercise gyms.
This is just another example why medicare should be expanded to include all citizens and insurance companies removed from the process. If the US is to compete with China, it needs a healthy and productive workforce.
McConnell, however, is now advocating paying for his $1.2 trill tax cuts by slashing medicare and SS. While Trump belongs in a mental institution to resolve his emotional problems, McConnell belongs in jail for abrogating his sworn duty to the people of this country.
VOTE!!!
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Thank you for this column. Slogans don't provide great health care or pay the bills.
What Republican governing has taught us is nothing has to be actually paid for. Deficits only matter when Democrats are in the majority. The flip side of that is even though Republicans won't fund our government with taxes, will they actually appropriate deficit spending toward a single payer system when they govern? I don't think they will and this is a huge risk for Democrats. We are either going to raise taxes by a lot or have high interest rates and inflation, lots of it.
If you move people off of private health care most of it provided by employers into a public system and the care isn't funded, those people will not be happy. They represent a large portion of the population.
Health care may be a right but good health care has to be paid for and provided by highly skilled people. We aren't entitled to health care for free and there is a sick notion that single payer is free. It's not. It has to be funded by the Federal Government along with State governments through taxes. We all must pay them.
2
@HL
(Head slap!) What, it's not free?
Please, find something of substance to talk about. Most of us libs understand that education, present or proposed, or health care is not free. Honest to goddess, my "free" education taught me some critical thinking, ya know?
1
After my mother needed surgery recently, I became acquainted with Medicare. The system has done an outstanding job providing for her surgery, in-patient rehabilitation, in-home physical and occupational therapy, home health aide and visiting nurse. All organized and paid for by Medicare. I have rarely experienced such effectiveness and efficiency from any organization. I am quite interested to learn more about how I could trade health care premiums and co-pays for an equal or smaller payroll tax that keeps all Americans in one big pool - no cherry picking, the same premium for everyone.
10
Trump recently gave the rich and corporations a tremendous tax cut that will inevitably increase the federal budget deficit to amounts never seen in the history of this country….in the trillions. The 2018 budget deficit has already risen to $779 billion, a 17% increase from last year. Just think about all of that money being used for the good of the country and humanity instead of someone’s pocket. Think of how these dollars could have been used to enhanced Medicare or create a single payer system along with supporting our failing infrastructure, social programs, education, etc. Yet, the GOP claim there is no money.
Instead, we have the rich and the corporate world getting richer while the rest of the country gets crumbs, if any.
Vote November 6th.
20
@A.A.F. The tax cut by itself didn't increase the federal budget deficit by billions. Trump and the Republican majority increased spending by billions. It's the combination of cuts and increased spending that is raising the annual deficit year over year by 17%.
One of the thing elections are about is not just how we tax but what we feel is in the best interest of the country to spend on. The Republican majority has decided to vastly increase the spend on the military and border security over health care.
Citizens have to make a choice. Do they want both higher taxes and more government spending on health care along with lower spending on the military and border security?
1
People are worried that their taxes will go up to pay for a single payer healthcare system. They will but for an employee with company coverage their salaries can go up to cover that. According to the Bureau of Labor Statistics, benefits costs were 31% of employment costs for a company. Not all of that is healthcare, but a major part is. If your salary went up 15-20% you could afford the 9.5% tax proposed in Vermont or the 7.5% the Germans pay. For those who do not have employer paid healthcare individual coverage is extraordinarily expensive and the single payer price for coverage is likely to be much lower than what they now face.
3
Taxes might indeed go up with the addition of a single payer healthcare system. But you will actually be getting something for those taxes. People who already pay for healthcare plans through their employer or buy one on the market know that those aren’t for free. You have to contribute or pay thousands of dollars a year for them. And then you have to pay every time you use your plan except for that once a year physical exam or your flu shot. That is money you won’t have to pay anymore. For most people the total cost will go down and not up. Costs will decrease dramatically because there is no middleman making a profit off of it. And those old health insurance jobs? Many can go to work for the new nationalized health care system.
My husband had a knee surgery when we lived in Sweden. We paid the equivalent $50 out of pocket for it. That included rehab and a taxi ride to work everyday until he could walk and take the bus or drive. He got to pick which doctor he wanted doing it too. Obviously we were paying taxes that helped fund this. But when I compare our tax burden from Sweden to the percentage we have taken out here for taxes, healthcare, dental insurance, social security, Medicare, and a retirement plan, it seems we pay more here while getting less. In Sweden you get all of that under one tax umbrella and you also get college tuition for your children, a working infrastructure, and much more. Here it seems my taxes mostly fund rich people.
91
So a straw man argument about a vague straw man who fills in for all fear about universal health care. All you say is “higher taxes” without mentioning not paying health insurance premiums. Omaha would have no jobs...HA! Welcome to capitalism? Did you not know this might happen?
4
I have an idea what "Medicare for all" means: the unsustainable social program that currently costs $583 billion, or about 14 percent of total federal government spending, would double or triple (or more) in size, adding trillions more to the national debt and hurtling America that much closer to actual, devastating, calamitous bankruptcy. OR, it means the end of sickness, peace and harmony, rainbows and unicorns, and lovely walks in green, green parks.
@Ed L. You are making the same mistake I've seen made by many others. You're forgetting the benefit side of your cost benefit argument. First, companies would no longer provide medical care. So profits would soar or that same money would be paid as a tax to the government. Second, people would no longer pay premiums if they are buying their own insurance. Third, the profits of the insurance industry as well as many "for profit" hospitals, urgent care providers, would go into the governments coffers. I have yet to see those benefits quantified. Once we do we can then have an intelligent discussion about single payer in this country. The fundamental reason for our ridiculous level of health care costs is that we have allowed monopolies to develop in all aspects of care. Hospitals cannot be freely opened. We train doctors as if they were going to do research on genetics and not just treat the flu or a broken bone. We constrain the number of medical schools. I could go on and on - better that you give it a try. Fix those things and the savings are enormous.
6
@Ed L. It's impossible for us to go bankrupt spending on a program run almost entirely by Americans. Where do you think health care spending (public or private) goes?
3
@Jonathan
How do you think we acquired a $21 trillion national debt? I'll remind you: we consumed more than we gathered. When an animal does this it dies. When an individual or her government does it, they eventually go broke and declare bankruptcy and face ruin. See Greece or Brazil or better yet Venezuela for the new benchmarks in socialist calamity.
"This will cost too much; where will we get the money?"
These questions are brushed aside or not even asked when a new aircraft carrier is proposed or a new tax cut is approved. And, as many have pointed out, we already pay more for healthcare and get worse outcomes than other developed nations who cover everyone.
Government will always collect taxes and spend it on something, and nothing is more important than our health.
18
Once again, the focus must first be on the cost/price model, not on the insurance/payment model. Americans don't use significanlty more healthcare services than citizens of other OECD countries, they just pay a lot more for them. That's primarily because Big Healthcare tends be made up of publicly traded corporations with fiduciary responsibilities to Wall Street to increase profits quarter after quarter after quarter. It's also because Congress has rigged the marketplace in favor of corporate profits over people. Our next-door neighbor in California was the CIO for Blue Cross, and he regularly told us that Big Healthcare's model was, "You get well, we get rich." That's good if you are in the owner/investor class, but it's bad if you are an individual trying to pay for healthcare. The good news is that globalization has standardized drugs, devices and procedures, and all of the other OECD countries have set cost standards for virtually every medical procedure, device and drug used in American healthcare. Medicare for all could easily set benchmark cost targets to match the average or even the highest of these cost standards. Once the cost models are fixed, the insurance side will sort itself out, but the chances of this actually happening are ZERO. Congress has been completely captured by corporate wealth thanks to a Supreme Court which has also sold out to the capitalists. Only when America suffers a "healthcare depression" will action be possible.
4
@Jack
It's simply not true that American use less healthcare than other developed countries. We use more. Much more.
A friend in Canada had to wait 3 months to schedule and MRI and then had to fly across the country to get it. In America, people who have health insurance are used to relative greater access in relatively less time.
On a recent trip to Spain I was shocked to see people walking on crutches. Crutches! This a rare sight in the US where we have grown accustomed to seeing walking boots and fancy scooters. Is there anything wrong with crutches? No. But they are cheaper.
People in the US with insurance have more access to more procedures than the countries provided as benchmarks. Is this a good thing? I'm not sure. We probably consume more healthcare at greater cost than we should. But an honest debate needs to acknowledge this and there should be a requirement to explain how we'd be just as well off if the equipment and procedures we're used too, were less available.
@Jack,
Well said. I believe many healthy individuals could support the Medicare system by adding dollars through premiums. We know Medicare covers those over 65 and this age group often comes with more medical issues than the younger population. Healthier individuals participating in a system that caters to the elderly can only help boost the system
2
@SJG. The thing about Spain is that it has it's own set of "haves and have-nots", people who are included and excluded from the system. I lived in Andalusia for several years while working at the Rota Navy base. During that time it was not unusual to see Roma gypsies living in cardboard box neighborhoods just outside of Rota or Chipiona and daily searching through our garbage in an upscale neighborhood in Puerto de Santa Maria. Even if you discount these disparities, the OECD cost standards apply to those solidly in the middle class and above. The identical device, eg a knee replacement device, costs several times more in the U.S. than in Germany and requires a company representative be present during surgery. The cost of the identical pharmaceuticals is multiple times higher in the U.S. than across all the OECD countries. That's just the low hanging fruit in getting costs under control.
I think it can be pretty simple. Everyone gets Medicare for which they pay a premium based on their income. Private insurance companies provide "medigap" coverage: supplemental or advantage plans as they do today. Employees can negotiate with their employers to pay all or part of their Medicare premiums just as they now negotiate for private healthcare coverage.
The response to the nay-sayers, including many commenters here is also simple. If other countries can do it, why can't the U.S.?
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@LSR
Why? Because those countries underpay their doctors, and more importantly, Americans will not tolerate being told no. I have worked in Europe. People do not get anywhere near the number of tests etc that Americans demand. Oh, and the citizens of those countries do not have the ability to sue for a jackpot when things go wrong. Do you want to get rid of that and put the lawyers out on the streets?
1
"some worry the terms “Medicare for all” and “single payer” are at risk of becoming empty campaign slogans"
If those terms ring empty with some voters, they clearly haven't been listening. It's hard to imagine any adult who cares about medical insurance costs isn't aware of the benefits and lower costs of Medicare that benefits those 65 and older. And "for all", means to extend that benefit to everyone.
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@cherrylog754
Not sure if you are aware that those over 65 have been paying into medicare for 40-50 years.
@cherrylog754
Many people think Medicare is free, but it does come with a premium
Medicare for all doesn't mean all health care is for free. Currently 80% of Hospitalization and doctors care are covered providing you have a credible prescription payment plan in effect. Yes, you have to provide a prescription plan, whether it's paying for Part D or an outside program. The individual pays the 20% and for prescription drugs. Current health care spending is approximately $3.8 trillion. That amounts to just about $12,000 per man woman and child that are citizens (assuming a 320 million population). That is a serious number.
There are structural costs that would include "availability" of the system itself, hospitals, clinics, doctors offices, drug production costs and the list goes on and on. Also there is a high price to pay for the litigation that exists including legal bills, malpractice insurance and all the lawyers.
Before we deliver one minute of health care, the "health care infrastructure" is enormous. There are those who argue they don't use the health care system very much. They rest easy knowing the actual system is in place if they should need to engage the best health care system in the world. Entire industries have been created just to provide this infrastructure. So who should pay for this "availability"; only the sick or anyone who wants to have access to the system or both? And just as important who is to pay for the 20% Medicare doesn't cover?
Its not as simple as "Medicare for All" slogan. Our health care system needs to be addressed.
3
California decided in 1879 that every child deserves the right to a public education, supported by the community, and free at the school door. Most communities believe public safety is an inalienable right and created publicly owned police and fire departments. Applying the same right to health care has been a progressive platform since the days of Teddy Roosevelt.
The principal issue is becoming self-insured through a public fund like California did for education with the Free School Provision in our constitution. The payment side can be single or multi-payer, payment plans the authors should have more fully clarified. France, Germany, and other countries with multi-payer systems collect premiums through payroll taxes but regulate the third party administrators. The principal regulations are insurance companies must operate as nonprofits, mutual insurance companies that are organized like credit unions and owned by the members. Secondly, the insurance companies must place everyone in a single risk pool with comprehensive benefits available to every member. Finally, the medical community must accept all insurance plans as a condition to practice medicine.
Progressives are beginning to relearn the CEO and janitor cleaning the office at night have the same right to healthcare, supported by the community and free at the hospital door. We still have time to get it right, so we can see any doctor accepting new patients and be admitted to any hospital they recommend.
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It’s hard to explain why most people believe when told we have the best healthcare system in the world. Just one point, there are far to many people getting paid with monies that have absolutely no part in delivering hands on medical care. The paper work alone is a massive problem costing billions that includes errors that are enough to send you to a psychiatrist, that may not even be covered. Enough is enough, stop for profit predatory health care. It can be done.
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@Dave
Psychiatrists usually do not take Medicare or insurance. Pay in cash or forget it. I don't blame them.
Few are facing up to the profound changes Medicare for All would entail. Once implemented, it could be wonderful, but the changes are so profound that no one wants to talk about it.
We have enormous medical bureaucracies that would be abolished and whose elimination would result in enormous savings -- and enormous unemployment. There are 50 different state medicaid programs, countless plans for state and local employees (active and retired), countless union plans and private employer plans. There are countless private insurance plans. Have one Medicare plan for all, and you do away with all these programs. What about the insurance companies that go out of business because they are not needed? What about the loss of control by unions and loss of jobs and careers?
If MforA were fully implemented, business would stop providing health carer to their employees, but then the employers would no longer be taking tax deductions for the costs of HC, so the employers would pay somewhat more taxes than they do now. States would not longer be involved in HC, resulting in major reductions in expenses for state governments.
Properly implemented, MforA should lower our nation's HC costs, make our country more competitive in the world economy and reduce taxes in the long run. But we are addicted to the current system. Maybe we'll see gradual changes leading to something like MforA over 20 or 30 years. Short term, MforA sounds good, but may be just a chimera.
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