Infrastructure and prison reform could pass with bi-patisan support - Do these first.
I lived in France from October to December in 2005. I came down with pneumonia. My experience with the French medical system was eye-opening as far as medical care is concerned. It cost me 20 euros to see a doctor. The doctor had no receptionist, and no staff to process insurance forms. He had a computer. He gave me a diagnosis, type a few entries into his computer, and printed out the bill. He gave me 3 prescriptions, and the bill for all three was 26 euros. Later, I had a chest x-ray that cost 38 euros. How can the French do this for so little? First of all, college is free, so doctors graduate debt free. French doctors also do not have the expectation that they will be able to buy a Ferrari by the age of 35. In addition, the French don't have our legal system and culture of turning personal tragedy into a lottery jackpot. Also, I think the French don't have the expectation that they can get whatever they want whenever they want it. They recognize the limitations of the system and realize that they may have to wait for a non-emergency surgery or procedure. In addition, France, like most European countries, negotiates down the cost of frequently used drugs. Their system is not perfect, but what system is? Americans have made big pharma, hospital corporations, and insurance companies rich. It's time for these "free-market" thieves to take their ill-gotten gains and disappear. It's all up to our elected officials...from both parties.
23
Oh Please, shore up affordable ( laugh here) care??
You mean shore up insurance companies deep pockets
and all because they pay a heck of a lot of money to
lots of democrats to do just that.
No, we need Medicare for all NOW. The price tag has been deliberately inflated, by the corrupt Democrats, it is not 31 trillion in addition to the outrageous amount we pay, it is instead of, and it saves 1trillion dollars and ALL are covered and thecare has a much better outcome.
Do you know we are pitied by all the 11 nations who have it. It is torturing our citizens to have them go broke for not very good health care or dying for the lack of it. And the darned Congress has some nerve getting their great healthcare that WE pay for, and we cannot have it. Gee why did we let them get away with such arrogance?
8
I am an anti-partisan strong supporter of free markets with fair competition. Nevertheless, I support lowering the age for Medicare coverage to 50 or even less.
A free market in medical care does not produce the economic efficiencies that it does in most activities. It is impractical or impossible to shop for much of the medical services we need when we need them. It is also difficult if not impossible for consumers to assess the quality of most of the various different medical providers. Similar to natural monopolies, medical care calls for either government regulation of private providers, or else direct government operation. Government control of the price for medical services is essential to prevent the price gouging that has become rampant.
Obamacare is a disaster, fatally flawed both in design and operation. It is outrageously expensive while leaving millions of people still uninsured. Those who are insured have poor coverage that often leaves them still unable to afford needed medical care. Obamacare does nothing to control prices.
Price controls are an integral feature of Medicare. Price controls alone are not a solution, but they are a necessary part of the solution.
9
When is even the most hypocritical stubborn conservative alive going to at long last add two to two and equate that Democrats are always tasked with fixing what Republicans break or ignore??? There's a reason every social program, including health, we've had in this country's history is because of the diligence of Democrats expensing the political capital to make it happen in spite of Republican resistance.
6
Opponents of a federalized healthcare payer are missing the obvious:
* the areas with the worst ACA problems are rural states, often with a large population of the elderly and low-paid rural workers. Due to low population density, healthcare is more expensive to deliver. Republicans insisted on maintaining state control of ACA markets; with that they created the cost-and-availability crises in such states. Put bluntly, federalization would subsidize them much more.
* Yes, Medicare for All (MFA) would demand a "big tax increase." The stupidest failing of those advocating for it is not explaining that this isn't new money; most of it is redirecting where current healthcare insurance costs go.
If it makes people feel better MFA could be run by a Fannie-Mae-like entity: most of the money off the federal books. The variant Medicare schemes mentioned here are variations on this idea.
The biggest problem with Medicare for all schemes is that at current medicare reimbursement rates a lot of medicine will collapse. Anything like it must be implemented gradually, and other measures taken to make healthcare more efficient and affordable.
Critical to keeping the system going is to relieve the huge debts of medical school, that then direct physicians into make-big-bucks specializations. We need to subsidize training, in exchange for the production of the practitioners we need. We also need to look hard at what healthcare practice rules are just guild maintenance.
4
The only way to fix health care in this country is to have single payer. anything else is crumbs thrown to the masses and a gift to the "health" insurance industry. Not to recognize this is ignorant and barbaric. When making a profit and paying CEOs tens of millions is the priority while at the same homie people suffer and die and go bankrupt, when congress people take money from the "health" insurance industry and big Pharma,and then write and propose legislation it is a travesty. How many people have to see loved ones, in their own homes, suffer and die, before single payer stops being a joke?
9
Get ready America. The newly Democrat controlled House will insure that single payer health care will be the order of the day. Likewise they will insure that the federal debt, already at $21 trillion thanks to The $10 trillion spending spree that was the result of the Obama administration, will skyrocket to pay for socialized medicine. Oh, and your federal taxes to pay for it all? Don't ask, because the news will not be good. Not good at all...
2
Fix immigration first as asking US taxpayers to pay for anyone crossing the US border would destroy the country. Sweden has very strict immigration policy and so does Denmark, Australia, Finland, and all other countries progressives like so much.
5
The indisputable fact is the ACA expanded healthcare coverage for all Americans -- no American can be denied insurance based on his or her personal health. Moreover, the ACA prohibits insurers from canceling anyone's insurance if he or she becomes ill and costly to cover. The ACA also bars insurers from charging higher premiums based on personal health or preexisting conditions. Finally, the ACA made health insurance more accessible and more affordable for millions of Americans.
Improvements can be made to the ACA, but blaming it for the consequences of sabotaging it is disingenuous.
Right from the outset, red states refused to expand Medicaid, throwing the poor and more unhealthy folks into the marketplace which drove premium costs and deductibles and co-pays up. The GOP (under Trump) successfully defunded insurer tax-subsidies nationwide, which is driving premium costs and deductibles and co-pays up. The GOP (under Trump) repealed the penalty for not complying with the individual mandate through "tax reform" which will result in fewer healthy folks in every state's marketplace. This too will drive up premium costs and deductibles and co-pays. Now, the Trump Administration is pushing "junk" insurance as the solution to the problem Trump and the GOP created. This "solution" will also result in fewer healthy folks in every state's marketplace and will drive up premium costs and deductibles and co-pays for everybody else in the insurance marketplaces.
4
Whatever is passed, I hope it works extremely well, and is impermeable to attacks from the inevitable return of Republican rule in Washington. Everyone working on it must foresee a "Tea Party 2.0" effort in 2022.
1
Politicians elected to public office are tasked with regulating the same entities that contribute to their campaign funds. This is the first thing that needs to be fixed,
before everything else gets fixed.
Every tax return filed could include a fixed % surcharge on the tax due to fund two things:
The Electoral System and The National Health Care System.
Then special interests can hire all the lobbyists they want as long as their money doesn’t go to the politicians they lobby. Individuals, but not corporations, can contribute to the candidates in their district, and candidates can only raise money from their own constiuents.
This will force political campaigns to be more creative:
Example: Now in Australia,Tony Abbott, Member of Waringah, our recent Prime Minister, is up for re-election. The “Think Twice Waringah” campaign AGAINST him is very clever and very cheap: Volunteers are slapping large stickers with his face and one of his previous quotes on every single trash can in the precinct.
Google it, Very Funny, Use it!
Election campaigns do not need to be overstuffed with high cost political operatives. They just need to be clever, cheap and organic.
The present election system is ripe for Time and Cost containment and every decision made in Congress is affected by how we fund it.
2
Why is there an Obamacare Expanded Medicaid Estate Recovery program to track government health expenses and asset strip the poor over age 55, while there is NO comparable Obamacare Subsidy Estate Recovery Program to track government health expenses and asset strip higher income earners over age 55?
1
Honestly, I am not a professor or an expert on public health and services.
That said, as a rural pediatrician of over three decades some thoughts come to mind.
My family had no insurance for three years, after United Health Care cancelled our policy hours before Christmas day 2015.
The second of the one-two punch came, when I discovered that there was no affordable health care available in the United States of America. That both political powers handed over the hen house to the Health Insurance Company foxes. Any small business, rural family, with parents over 50 were brutally punished by Health Insurance Companies.
So Democrats and Republicans, in light of the fact that both of your parties have no clue whatsoever about running a now former-Supreme Court or running a functioning Department of Justice, please keep your wretched hands off medicine.
Rather, consult with the Mayo Clinic, Harvard Health Systems, Johns Hopkins University. In short, ask professionals who have devoted their lives to helping American Families, often at low wages. Stop talking to prostitutes like Health Insurance Companies or medical equipment corporations, who have inflicted worse than colonoscopies on America for decades.
5
I had a torn retina last year and under Medicaid (I was a student with no income). I was rushed to the University of Iowa and had it fixed.
In October - December I made a lot of money. I went off Medicaid and onto Obamacare / Medica (which I was told was the only Insurance I could get due to the Individual Mandate).
Due to my sudden income, I do not qualify for any government subsidies.
In January was having problems with my eye and went to the U of I hospital to have it looked at. I was told that Medica no longer worked with the University of Iowa. And that the only hospital who could fix my eye in my network was the Mayo Clinic in Minneapolis.
I called Medica up and told them I was willing to fly to a hospital or stay with relatives if they could suggest a hospital in a city that could perform the surgery in my network.
Medica found an Ophthalmologist in Iowa to look at my eye that week. That doctor took one look at my eye, ordered an ambulance and had me driven to the University of Iowa Hospital right away. He assured me that it was an absolute emergency and I needed the surgery right now to prevent permanent blindness.
I had a weird year Including a stalker and changed my address and phone number and made myself hard to find.
On Thursday I opened some mail telling me I owed $27,000 due to the surgery I had. My Obamacare refused to help pay. I meet with a lawyer next week.
I respect our past President, but Obamacare is a scam.
3
Dems need to show some real work their first several months. No mixing it up on impeachment - unless the evidence says otherwise, and the public sees it all - and getting bogged down in petty fights.
They need to build on the ACA, go after costs, present the WH an "offer they cant refuse" infrastructure plan, do something about the border children, and show some real efforts on DACA. While also showing they are ready to stand up to Trump and his nonsense.
One thing I would suggest is for the leadership, and their seconds and thirds, as well as some of the freshman - do more on-point press conferences, to show a support for the 4th estates crucial role in our democracy. Plus, tell the public the facts, dont expect them to go off and find them, like Dems tend to do. (Like HRC so failed at.)
The Dems have to make serious inroads in crafting a narrative, and not leave it all to Trump. When he lies, they need to counter. When he goes off on one of his made-up spiels, they have to counter.
The more Trump is shown to be a liar, and wearing no clothes, the smoother the road into 2020 will be. Not easy, just smoother.
2
If there were a Medicare option, healthy patients would likely flee the ACA in droves, and Obamacare might collapse. The ACA was designed to have no alternatives for insurance so all people would be forced to stay in the plan, like a "Berlin Wall" keeping everyone in.
Professor Pollack need to explain the statistic below and how the ACA failed to address America's spending on healtcare versus other nations.
"Bend the cost curve' was Obama's promise to Americans.
And I can get you a great deal on the Brooklyn Bridge...
"On average, other wealthy countries spend about half as much per person on health than the U.S. spends".
Source: Kaiser Family Foundation analysis of data from OECD (2017)
All modern societies except for the US of A use tax money to pay for services that everyone needs sometimes but few one needs all the time.
Adequate healthcare is one such service.
Healthcare therefore is necessariy an inalientable human right and unavoidable cosd,o be guaranted in any modern society.
Paying for aAdequate healthcare is not charity, or just for hose who can afford to pay . Roads, police, water supply , and the costs of other government operations and services are "costs of doing businees" for a modern society. And therefore are funded with public money =taxes.
Those who sneer at or fight against public funding of healthcare costs are saying:" if you can't pay for your own or your family's healthcare with "insurance" you will just have to stay chronically ill, or die.
Why can't all of us admit that we as indivuduals and our families and communities and our society must have adequate health care to survive? Universal healthcare coverage requires using public funds to cover those costs.
2
Having watched the healthcare debates and hearings as a retiree in 2009, and having just moved out of CT, I remember full well that it was then Senator Joe Lieberman that would not cast the 60th vote to end the Republican filibuster unless the public option was dropped.
All I can remember thinking was "Oh, no, Joe....Say it ain't so!" Had it been included then, we would not be in the state we are in now. Healthcare will continue to be the issue most of the country is concerned about. Democrats will again have to correct what the Republicans continually attempt to dismantle.
7
All true, Democrats need to get moving on real reform and expansion of the ACA, but this time let's not let a senator from Connecticut kill the public option or a senator from Montana pretend to negotiate with Republicans as nauseum. Lieberman killed the public option, Baucus kept more progressive policies from being adopted because he was involved in some sham negotiation with the GOP.
Everyone with a heartbeat knows what needs to be done, time to show the political will, and the willingness to cut the Pentagon budget, that is required to make it happen. We need to redirect our priorities in this country from enriching defense contractors and billionaires to providing healthcare and basic security for all Americans.
4
It isn't only the high costs that are a problem for so many. It is also that, with profit-driven private insurance companies, patients and their families often have to spend time and effort getting the insurance companies to pay out on claims. The ACA should have included the public option that was discussed. If people observed that the public option was working better than private insurance companies, more and more people would switch. But, Democrats (and hopefully some Republicans as well) should not only draft and enact the legislation, they must work together to sell it to the public, something they failed to do with the ACA. They should also warn the Supreme Court oligarchs to keep their hands off and stay in their lane.
2
Now is not the time to tinker with the ACA , no more half measures, we need universal healthcare and we need it now, as crazy as it sounds, with Trump as President now is the time to fix healthcare once and for all, he can get enough republicans to vote for Universal healthcare and you know the democrats will vote for it. No half measures let’s fix this once and for all.
5
This piece reflects a critical flaw in thinking about healthcare: It focuses solely on coverage and completely neglects reforms to care.
We need a system that makes care accessible to everyone for everything inherent in being a positive member of society, "your beautiful skin and all within". Mental health, addiction, dental health, glasses, hearing aids, everything essential for a kid to be prepared to learn, for an adult to be able to work, and for seniors to be fully engaged in their communities.
And we need a system that takes a no-holds-barred approach to costs, transparency to consumers, and the obscene complexity that favors insurers and vexes nearly everyone else.
Please Dems, on this issue, go big, or go home.
7
A "For Profit" health care system can never be "fixed". Cancer is a profit center, Diabetes is a profit center, Obesity is a profit center. What's the incentive to cure when the diseases are hugely profitable? Capitalism is incompatible with life.
9
@DILLON -- you are so right!
Tell me, why can’t we have nice things?
As a 64 year old man I pay $1200 per month for my health insurance. I pay for the largest military in the world and for tax breaks for the wealthy and large corporations.
As a professional and small businessman the GOP was very careful to exclude me from their enormous business tax cut.
It’s all about priorities. If the government of the richest country in human history prioritizes healthcare, education and good paying jobs for its citizens over world domination and catering to the wealthy, we can afford this.
To say that single payer is a non-starter is not just wrong, it is a willful misrepresentation of reality. Another words, it is the Big Lie that is dutifully repeated.
We can afford this, we just need to elect politicians who have a different vision for our priorities as a Nation.
This recent election was just the beginning. Democrats who do not get behind single payer are risking their political future. This will be the litmus test.
19
@Robert
Yep. I'd love to vote for Sherrod Brown in 2020, but he needs to evolve and get on board with single payer sharpish.
1
People keep saying we can't afford single-payer because it would require too high of taxes. They almost always fail to point out that we currently pay extreme premiums ($6K to 15K per person plus deductibles and co-insurance. There is nothing affordable about it.
Let employers and/or individuals, choose between buying a private plan, or having an extra 8% income tax rate (Not sure what the right rate is) and being enrolled in Medicare or it's equivalent.
Currently people with very good insurance (which most can only afford while they are healthy enough to work because the employer pays) and plenty of money, can get great care in America. Many fall through the cracks. Therefore, we have worse over-all outcomes than the rest of the developed world.
It's very clear that we can get better over-all outcomes for more people at significantly lower costs with a single payer system. The single payer system will inevitably involve some level of rationing -- it can't pay for anything and everything for everyone. But -- healthcare is already rationed to those with the most money who can afford the richest insurance and pay, deductibles, co-pays, out-of-pocket maximums and balanced billings.
Any system should retain a private insurance market for purchasing supplemental coverage for whatever the public system can't, won't provide.
We can have better overall outcomes at lower costs for everyone and still allow those with means to get whatever they want.
8
The ACA is far from perfect, I wouldn't call it a disaster, but it is far from perfect. The part nobody discusses is that if a spouse has insurance, no matter how bad it is then you can' t sign up for the ACA you have to take the spouses insurance. You have to make under a certain amount of money (combined for family) or else you won't get premium credits and will pay full price for insurance. I'm talking $9k per year per person (over age 40 or 50) if you don't get the premiums, and that is with a high deductible. I believe the income cut off is something like $35K. The rules are unclear as they welcome everyone to sign up and when you find out mid year that you messed up, they will ask you to pay back the premium credits which are usually in the amount of around $900 or so per month. When you call the help desk to ask questions, the people there are friendly but don't know much, when you call the IRS to get answers they are cold and uncaring. If you don't have the insurance you have a tax liability at the end of the year. I say no thanks. How about single payer health care, lets talk about that now please.
4
If not Medicare For All, then Medicare By Choice (that is, a public option). Come to think, a public option might be better as it would reveal how many Republican voters stick with their principles and refuse to join.
Every public plan should include dental coverage. Along with the immediate pain and suffering, many other conditions are made worse by the chronic infection of dental disease. The distinction now made between "medical" and "dental" is artificial and harmful.
7
A frequently overlooked group of people benefitting from the Affordable Care Act is those who retired before age 65 and are doing something else with their time. Before the Affordable Health Care Act people 50 - 65 would have stayed at jobs just for the health insurance.
It was estimated before the ACA that 2 million people wanted to leave their jobs if they could only get health insurance. In the last few weeks I have spoken with a banker who left the bank and now consults out of his home, a travel agent who sold her business to her son and now travels, a person who quit his job and flips houses. Each of these people is able to get insurance online because of the ACA. None are happy about the premium costs. But they are able to make life altering changes while still in their prime years.
It is not just poor people and those who receive expanded Medicaid who are benefitting. The Democratic party needs to emphasize that the middle class is benefitting as well.
4
@Karen -- I don't believe the middle class is benefitting unless they too get the subsidies. If you were insured through ACA and do not receive a subsidy but have to pay in full, I think you would change your tune.
1
It is really frustrating that single payer health care may not be politically feasible even though, as the author says, it is less expensive and much more straightforward to administer. He doesn't really say why it is not politically feasible, but presumably it is because an attempt to pass a single payer bill would be demagogued by the the insurance companies and Wall Street, similar to what was done to Hillary Clinton's attempt in the 90s.
But do we really know that it is politically infeasible? Has sensitive polling taken place to learn if the public would reject single payer healthcare, presumably because, at least in part, they would resist paying the additional taxes in place of paying insurance premiums?
3
America 'wastes' 6.0% of GDP on health care costs verus other western democracies. Germany, France and England spend about 12% of GDP on healhcare costs while we spend closer to 18.0%. Moreover, these other nations have better metrics - higher life expectancy and better child mortality.
Objectively, neither party has a good answer to this waste of money. While the Republicans embrace a private sector answer that begs for a public sector alternative; the Democrats desire health care for ALL and really are not focused on lowering health care costs.
Simple solutions to the ACA like incenting Americans to get a yearly physical (to avoid clogging Emergency rooms) and setting price ceilings on some key drugs (and not all) would both lower our overall health care costs and improve American's health.
The reality is that lobbyists in DC are pushing for higher health care costs and noone is looking after the patient or the taxpayer.
Congressman are being paid to look the other way (from both parties) as you need campaign funds to win elections and United Health Care and Big Pharma are big donors to subvert true change to our healthcare 'system'!
1
Democrats should own the healthcare issue, and that should involve a constant push to insure all, manage price, and base a whole system on care not profit.
After the blue wave of the midterms, Dems need to seize the momentum, and get the U.S. to join the rest of the developed world, and recognize that healthcare is a right. Campaign on that slogan, move to amend the Constitution to get this idea in stone.
7
Just silly. Single pay is the ticket to total, total bankruptcy.
@dick west Just getting care to remote areas is a challenge but it's done. If you are in Canad legally, you get the care...."OTTAWA — The United Nations says Canada’s health care system is “commendable” overall but vulnerable groups still face barriers to quality care.
That’s the conclusion of the UN’s special rapporteur on the right to health, Dainius Puras. He wrapped an 11-day visit to Canada Friday.
He says Canadians enjoy a good standard of care but barriers remain for Indigenous peoples, the poor, undocumented migrants and other vulnerable groups.
Why aren't premiums at $6K - $15K per person per/year and going up at 6-12% per year + deductibles and co-insurance the ticket to bankruptcy -- not to mention a ticket to an early death. I would gladly pay a higher tax to skip the premium as would many companies I think. @dick west
2
@dick west
Bankruptcy? You mean like the rest of the developed world, which has healthcare outcomes at least as good, covers everyone from conception to grave -- and yet spends half as much?
1
A little humility is in order. Harold Pollack and all the folks who pushed for Obamacare rarely acknowledge the errors in their previous analyses or the problems they've created for many Americans.
Yes, some people got health insurance for the first time, but a larger group of people were hurt in the process.
Total out of pocket costs (e.g., premiums, co-pays, and deductibles) have risen sharply since Obamacare was enacted. Folks who buy their own health insurance, without subsidies, really got screwed.
Harold Pollack's piece doesn't address Obamacare's two fundamental failures - it didn't 'bend the cost curve' and it has not lead to better health outcomes.
Every estimate I've seen says that health care spending, as a percentage of GDP, will continue to rise for the foreseeable future. Here's an April 2018 example from the Centers for Medicare and Medicaid Services:
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html
American life expectancies have fallen for two straight years:
https://www.cnn.com/2017/12/21/health/us-life-expectancy-study/index.html
To make a long story short, Obamacare did not work as advertised.
We're past the point at which the folks who foisted Obamacare on the rest of us should show a little contrition and work towards creating a new system that's good for the nation as a whole, not just a handful of special interest groups.
13
I don’t think we need to throw the baby out with the bath water. The ACA needs to be tweaked and the things that work should stay, the things that don’t work need to be revised. Now is the time because voters have said that healthcare is the number one priority.
The obsession of Trump to throw everything that occurred during Obama’s presidency is self destructive not productive in moving forward. Responsible Republicans who want to get re-elected in the next election cycle need to move forward on responsive and responsible legislation.
Absolute nonsense. It did “bend the cost curve,” as anybody who looked for five seconds at the zoom climbs in premiums and OOP costs between 1998 and 2009 knows.
I had a nail fungus. A young dermatologist saw me for 10 minutes. He clipped a piece of the nail off for testing. I left. When the bill came it was for $800. I called the office thinking it was a mistake. No. He "cut" something, and that is surgery. Seriously? Surgery. $800 for ten minutes....you do the math.
The insurance companies want a number for everything. The doctors had no choice but to label every symptom as a "thing". If you get to see a doctor for more than 10 minutes, good luck. My doctor, a young woman, who just left her practice, had over 1,000 patients. Forget trying to reach her ever. Impossible. Her response was, "Go to the emergency room." Seriously?
I am old enough to remember when the doctor still came to the house. Sounds like it was in 1850, not 1955. We have made a lot of technical progress but have gone absolutely backwards in terms of actual human caring.
The Dems will face gridlock in everything they do. Working on things is fine but in the end, it won't do any good except maybe for PR for the Dems. McConnell and Co. want to dismantle any government system we might have and give it to "for profit" companies. As it is, people die. They only care about fetuses (unborn babies, now). SAVE them at all costs. (See recent NY Times article on punishing the mothers.)
Not back to the future, forward to the past.
6
Democrats need to work immediately to lower pharmaceutical fraud which is the radical drug prices. Medicare for all no matter the age. Hospitals need to be in the business of healthcare not "big business" pushed by overpaid administrators who keep building palaces in the sky and increasing costs that no one can afford.
8
Health Care should be a priority for the Democrats; don't get involved with the vicious GOP in the process.You should start ,with an open eye , to look at some other countries ' systems.Hire the best independent and non politicely colored people to start a proess with a blank paper;you may be surprised how feasible the project will be. The main charactheritics should include : universality, inclusivity, non profit driven and simplicity.There is NO reason why the richest nation in the world cannot insure to all its citizens the scurity of an inclusive health program.Best
5
ACA was such a big advance over our non system that was a human rights violation by 20th C standards. But it’s still the world’s most expensive and profitable h/c system. It leaves out millions, and uses our taxes for insurance profits.
Corporate monopolies set US limits of health care policy. Both parties need their funding to run for office. Jimmy Carter said we veer to oligarchy since it costs so many millions to run for any office now compared to when he ran for president. The result is inevitable.
In effect, our democracy isn’t operating. Instead of elected govt regulating corporations, the corporations regulate our elected govt. Also regulate indirectly our news media through setting of norms of what’s left, right and center. This is promoted as aligned with American freedom. One of the great cons in history of democracies.
Other capitalist democracies have generations of health care for all, and they don't turn their elections over to corporate mega donors. Why not---if corporate funding of elections is such a great system, aligned with 'free speech' per our supreme court?
Don't these countries value freedom? Some would say no, since many countries ban the privately financed campaign ads that inundates our media and voters.
Countries ban these ads to protect voters from being inundated by manipulation, to prevent their politics being dominated by special interests, overwhelming the voice of average citizens.
5
@Meredith -- I have to disagree. ACA gave to some while taking it from others, all the while leaving the insurance companies in the driver's seat.
Medical care cannot be profit-driven. We need a new system.
2
@Don Juan.....reread, rewrite....where exactly do you disagree with my post that basically says same? Curious.
Open Letter to Texas Politicians: Knowing Medicaid will expand in Idaho, Nebraska and Utah and likely elsewhere, what do these states know that Texas just can't understand?
Ponder, for a moment what Republican Governor (and Catholic) John Kasich told his fellow Republicans in 2013 when discussing the expansion of Medicaid in Ohio: "Now, when you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer...."
My final thought is: WWJD
9
I am soooo tired of the self-fulfilling and defeatist meme that political realities make it impossible to enact the best policy. Medicaid for All is what we need, it is what most people want, it is what most other advanced countries have, it would cost the least and cover the most. Maybe, just maybe, if the Democrats craft THAT bill, and spend two years aggressively explaining and promoting it, they can actually give the US what it needs and deserves. The thought that after all we have been through, they will just keep meekly tinkering around the edges, and leave in place a parasitic insurance industry and an unnecessay additional layer of bureaucracy that exists solely to perpetuate that industry, is soooo depressing. I guarantee that approach will not inspire the voters, and could very well hand it all back to the Republicans again. Go bold or go home, Dems. Leadership — show it now, and you’ll have it for decades.
13
@Bruce Exactly right.
Single-payer that provides people with health care security is what the vast majority want. The Democrats -- the old guard -- are bought out by the insurance and for-profit care industries; that's why they've lost the country to a phony demagogue who lured voters with promises of "beautiful" health care for all, and cheaper than they pay now, and a Republican Party that works to enrich the top 2% of the country. Why do Dems (and "experts" like Pollack) still want to rearrange the deck chairs on the Titanic and keep us in stupid plans designed to deny us services?
I only hope the new crowd of young Dems remains bold, unsought and unbossed, and finally gives the people what we need. I hope the first thing they do is tell the public exactly what health coverage Congress members and the Pres have.
3
It’s pretty much hopeless trying to communicate any of this to Trumpists, who’ve hallucinated themselves into believing that everybody but them is a big cheater and Pappy’s gonna take care of them any day now.
But I sure do wish that more of us lefties would learn some of the basics (Kaiser Family, the Upshot here, are not that hard to Google, folks), learn a few things about the PPACA, and get some simple things through their heads.
1. You are not gonna get single-payer legislated any time soon. Period, end of story, full stop.
2. You do not need single-payer; you need universal coverage. That’s what the PPACA moves us towards.
3. It is plain nonsense to keep shouting that getting rid of private insurers would Solve All. Admin costs and profits ain’t where the money is. The money’s in our lousy, lazy lifestyles. It’s in pharmacy costs for new drugs we don’t need, but demand anyway. It’s in fancy surgeries we could forestall or avoid, but insist on anyway.
4. You can either have a system that pays for everything for a minority, or one that pays for basic needed coverage for everybody. Malcolm Gladwell was right.
5. We need to make some choices about what we will pay for and what we won’t pay for. No country on earth pays for every drug or procedure that people take it into their heads to want. No other country pays to extend the lives of the elderly past all reason, or pays to try and salvage hopeless preemies the way we do. Because it’s impossible.
2
Oops! My plea for a public-private health care system modeled on Australia is a few comments down in the next story below:
‘’Trump is starting to Loose His Grip.’’ ( About 7 comments down,
comments closed on that one.)
If Trump had just come up with a better, cheaper health care system, like he promised, we wouldn’t be having this conversation.
Australia’s system works for everyone, please research it.
2
One of the things I liked in this piece was the suggestion that Democrats take full responsibility for improving and implementing the ACA. The Republicans, unfortunately, have dishonored themselves and the country by their obstructionist behavior. They shouldn't have any part in the process unless they play by the Democrats rules. As the Republican Party slips off Trumpism it may become more trustworthy again someday in the future.
The new and improved ACA must be insurance that everyone can afford and has low or no deductables. Too many families are bankrupted by illness or other medical concerns and we are the only country where this happens. It's not right. I think most people can agree on that.
2
We cannot keep trying the same pair of socks on over and over again. We need change and if it's radical to help us (the American people) then so be it. I think everyone would give anything a try that would substancially lower premium costs and so forth.
My husband and I are looking at major surgery. Our insurance company has decided because we need to go "out of network" to get this very special procedure done that they will not pay all of the costs. We pay 100% of our premium, yet they will only pay 50% even though the surgeon we need is the only one that can do this without some dire outcome. The insurance company is not interested in our best options, only their bottom line. The "researcher" they assigned to our pre-surgery paperwork even questioned why we needed this surgery. It is outrageous. I'm considering contacting the AG after the surgery is completed and all is well. These are the types of stories that have made people furious and demand the changes. I say go for it. It has to be better.
5
I’ll bet your insurer tried to get you to look at alternatives and clinical outcomes for what you’re demanding against their advice and probably also your doc’s and you plain refuse to listen.
But looky here, folks. See this here? Sorry, but this here is a big chunk of why your costs keep rising.
I don’t mean to be unsympathetic, but there is next to zero chance that you’re right and they’re wrong, and even less chance that only one doctor can do your surgery. Almost certainly, you ignored medical advice about your health to begin with, then either “researched,” your problem on the Internet or saw a TV ad of some sort, got convinced, stalked into the office and told your doc what you had to have, and refused to listen to a darn thing.
Again aorry, but not buying it.
I don't see what the problem is. Our "health care" system works exactly as it is intended to work: 1) Squeeze every dime out of the 99%, so that their health insurance premiums cost more than their rent or mortgage; 2) when they are old and need long term care, make sure that they drain their bank accounts and sell their homes, so that they end their lives in poverty and their heirs have to start all over again from scratch; and 3) continue to enrich the 1% so they can keep purchasing the legislature and make sure the system stays in place.
All the proposed tinkering by the Professor Pollacks of this world won't change it. Single payer will.
19
Yes, get to work immediately. Nothing the House Democrats send to the Republican Senate will get through to the president's desk, but send it to them anyway. And this time make it what Democrats want, what their midterm voters want, not something they hope Republicans will vote for because none of them will. Don't negotiate or compromise on the House bill. Make it a Democratic bill. I want free of the private insurance bloodsuckers and all the middlemen. I want either a public option add-on to the ACA or a Medicare for All replacement for the ACA. It is wrong for taxpayers to subsidize the profits of private insurers when we have no control over the premiums, deductibles and co-pays they set for their plans. Medicare is a well-run government insurance program. No reason it can't be scaled up to serve working-age citizens too.
5
Underpinning most overseas national health care systems is that an education in the health care sciences is basically free. Prices across the entire health care system are posted. And governments negotiate the cost of pharmaceuticals and other imputs.
None of this happens in the US.
(For overseas travelers to the US,
the high cost of Travel Insurance,
due to the high cost of medical care there, is a serious barrier to
to visiting.)
Here in Australia, doctors don’t employ people in their offices to deal with insurance companies.
If your doctor charges the government scheduled fee, you present your Health Insurance Card, your card number is
imputed, and your bill is paid.
If your doctor charges more than the scheduled fee, you present your Health Insurance Card, you pay the full charge, and the government puts their share of your bill into your linked checking account overnight. You only pay the difference.
Doctors who charge the scheduled fee are popular.
The idea of a 3rd party system of multiple insurance companies that forces individual doctors to employ people to deal with multiple insurance companies is crazy.
5
@BBB
That's why our health care costs are so high. Health care related employment surpassed manufacturing employment in the USA many years ago. The medical industry is now the major employer in many towns. They hire people who can't get a job anywhere else. It's also why medical error is so rampant.
3
We've abided by a fallacy that leaving industries to profit oriented "market forces" is more efficient than government could ever be. Three health related industries put the lie to that assumption - medical care, pharmacy management, and elder care/assisted living.
As background, I have treatable but incurable/chronic cancer, and my wife and I are both doing with elderly mothers who cannot live independently. My "costs" for diagnosis, treatment, and ongoing management in 2017 were over $900,000. Each 2.5 day treatment cycle, including labs, immunotherapy, and chemotherapy, was $85k. My insurer reimbursed providers 50-60%. What are the real costs? If pre-existing conditions were not covered in the event of a recurrence, I'd have to choose between bankruptcy or death.
Some prophylactic drugs exceed $5k per month, yet last year it cost me $30/month through a specialty pharmacy. Where'd the $4,970 go? The US doesn't require drug companies to negotiate prices, allowing more commonly needed drugs to be arbitrarily priced regardless of "cost."
One parent lives in a facility that accepts Medicare, the other is private. Both staffef up and sold hard to get people in, then reduce skilled staffing to save money. All's well as long as the resident has no problems. Once something arises they're eager to wash their hands of it and turf the resident out to a hospital or other facility.
Cost-plus would satisfy profits without holding us hostage to the dollar.
4
"The insurance marketplaces are a godsend for 12 million people, particularly those with low incomes or chronic illnesses. Yet in many ways, the marketplaces proved disappointing. Middle-class families face high premiums and punishing out-of-pocket costs."
The ACA , Obamacare, is a reflection of the Obama's attitudes that are in effect a form of class warfare. They have this idea that once a person makes a certain level of money it is subject to taking. He showed that early when he wanted to increase the taxes of any business or person that made more than $250,000 a year. That's not much when an ordinary car cost's $40,000. So what if the middle class have to pay more for health care, like $10,000 a year for a minimal benefit policy in the bottom tier for one person.
Obamacare did nothing to contain the high prices charged for drugs that cost pennies to make, like epinephrine in Epipens or naloxone, used for opiate overdose. It did nothing to contain the third leading cause of death in America, preventable medical error. It just mandated an increase in the victim pool of people subject to industrial level malpractice.
4
How about MEDICAID for all. I'm on Medicare, and so are a lot of the people I know. All of us have an Advantage plan with Medicare. The Advantage plan insurance companies get about $950 a month from the government for each person in the plan. It seems Medicare is set up to maximize profits for the health care industry and insurance companies. My primary care doctor tries to set me up to see him as much as possible, because he gets paid every time I see him. Lets cut out all this waste with Medicaid For All.
3
@Martin Slater
Medicare Advantage is not accepted by many doctors and hospitals. Original Medicare is accepted by most doctors. Medicare Advantage has co-pays and deductibles and hospital costs should you need to stay in the hospital. Medicare covers those costs. Medicare Advantage is a rip off run by private business.
3
Years ago I was thinking Medicare for all would be a good first step. Legislators should also hold hearings soliciting ideas for laws that would reduce medical costs. I might offer a few, but it would be good if some readers start the ball rolling.
1
I am a never-trump Republican and physician.
Our current health care system is broken. It is an unsustainable strain on the middle class. Affordable health insurance policies are ridiculous with high premiums and high deductibles. Our family pays around 10-15 K (we have 4 children, some with asthma/allergies, another had an appendectomy, etc) a year towards health care, and our insurance pays a fraction of that, less than a thousand.
I favor a radical change in our health care delivery--I do not see another way. The middle class is not able to continue to pay huge amounts for their health care AND pay the increased taxes that fund medicaid. My taxes jumped significantly after the ACA passed, as did my insurance premiums and my deductible. HELP!!!
63
The PPACA increased taxes between 1-3% on incomes over $250K per year. Sorry.
10
@DocMarke with all due respect, I think you're in the wrong political party.
Have you not noticed that Republicans don't believe that the government should have any role at all in ensuring that all of America's citizens have access to affordable, high quality health care? The Republican party destroyed the last attempt to fix the health care system (yes, the ACA was flawed but it was a darn sight better than the situation that preceded it). And Republicans eviscerated the ACA with absolutely no replacement or better plan for what would happen to the tens of thousands of pole they ripped health care overage away from.
I am sorry about what has happened to your family. But you know, the last thing the Trump GOP is going to do is give a rip about any health care misfortune your family is facing.
If you keep voting for Republicans, then in essence you will be voting to continue this health care nightmare.
I would suggest that you take your concerns to the party that feels the same way you do about health care, and unlike Republicans, are actually working to do something to change it.
33
@DocMark
Doc.
You just want someone else to pay. But there is no someone else. As a Doc, you will be a big time loser—you will earn less and still pay higher taxes.
3
With dramatic losses in the House, Trump, beleaguered and anxious over the impending Mueller report, is in a rare position: negotiating from weakness. He may very well be amenable to agreeing to solidify the pre-existing conditions provisions in the ACA as well as bucking McConnell by approving a sweeping infrastructure package. This could improve Trump's position for 2020, showing the people that he can get things done despite the "witch hunt" that has dogged him. The time is now to get Trump to act. He has a history of using people and then dispatching them. Dems can pull a Trump right now and it will benefit us all.
1
Whatever happens as the ACA is revised, we have to cut overall health care costs. Simply switching to a type of single-funder plan is not going to do that by itself.
We know the sources of our biggest cost overruns: massive administration costs (consume nearly 25% of national health care spending), tests and procedures and meds that are too expensive predicated on any reasonable international analysis, and the over-sale of nearly every element of health care. These things will need to be addressed no matter a switch to Medicare for all or some variant thereof.
54
In addition to high admin costs, the US has exorbitant unit prices for all services vs. the rest of the world. US doctors are paid 2 or 3X amounts in other W countries. Ditto hospital administrators, where the multiple is even higher. While Medicare and Medicaid dictate pricing to providers, private insurers must "negotiate" with provider cartels. Why would providers have any interest in controlling costs (or innovate, or provide better customer service) when they can consolidate (absent any strong anti trust enforcement), and even acquire their "customers"--- doctors, who are the only authorized purchasers of any hospital service. Now the cartels own their customers. What a racket. Anyone see anything wrong with this picture?
18
@PV
I had mentioned the costs of tests, procedures, meds, and just about everything else used in the name of health care.
As for physician's salaries, I've heard the cartel remarks before. The late Uwe Reinhart had something to say about that subject. His point was to look at the average salaries of students coming from the same talent pool as physicians in this country. Looking at what physicians do, relative to investment bankers, corporate lawyers and Wall Street denizens, some might say physicians were underpaid (I am not trying to push that argument).
This does not even get to the average debt load ($200K+) for students coming out of med school. This also does not consider the huge income spread among various physician specialties (pediatricians and most family physicians rarely get rich).
2
Cry me a river, I yet to see a doctor who is living in poverty, and worry about food on the table. And last time I checked admission in medical schools is quite competitive. I don't buy the argument that the doctors are not overpaid in this country.
4
I have never understood why “Medicare for all” is so hard to accomplish. What, exactly, is hard about it? The other thing I can never wrap my head around is the subsidy cutoff. Why does that seemingly have to be a hard number like earning more than 150% of the poverty income. Why can’t it be a sliding scale? You pay nothing at 150%, but pay $30 (or something like that) per month if your income is between 150% and 160% of poverty, the payment goes up progressively as one earns more, where subsidies phase out at, let’s say 250% of poverty. Seems simple to me.
2
@Hans Mulders You are right; push it a little bit to avoid administration costs, make it universel and all inclusive...you maybe surprise of the effects!
Children and babies die in this country, the richest in world history, due to lack of health care. What is wrong with us?
8
@MS You have the insurance cies involved in the process and a profit driven system to provide the services...this is why you pay actually more than 30% for your hole-full system than we pay in Canada for an all inclusive & universel simple health care system.
"For better and worse, these bridge figures are almost all gone."
Good riddance to them, and especially Max Baucus (who declared single payer "off the table" from the git-go, removing a bargaining chip and thereby doomed the public option). Oh, and also the Senator who received more campaign money from health and insurance industry interests than any other member of Congress. https://www.democracynow.org/2009/6/16/report_senator_max_baucus_received_more
5
@mkc
And Obama rewarded him with an Ambassadorship to China for his trouble.
The US is the lone holdout in universal health care among modern nations as captives of big money politics. Big money is equated with 1st Amendment Free Speech by our highest court.
Contrary to what we've been taught in school, the US may be the most un-free nation among capitalist democracies. Our policy limits are set by corporate mega donors for profit.
Our 2 parties must vie for funding, cooperating with corporations instead of regulating them, while marketing to citizen majority woefully unrepresented in congress.
An rw GOP party has dominated our 3 branches of govt and most states. GOP state media Fox News, promotes fake news across the land, as a huge media monopoly, putting the other media on the defensive with charges of 'left wing, liberalism'.
Single payer or govt regulation of insurance are hardly discussed. It's advocates were once thrown out of the Max Baucus hearings. That’s censorship. UnAmerican? Or maybe too American.
The media presentation of the health care funding issue is skewed, avoiding how dozens of capitalist democracies pay for their h/c for generations --- with wide support. And fund infrastructure, transportation, and green energy for modern standards. Without this information, US voters are vulnerable to GOP propaganda. Trump swims up from the swamp depths.
Our media isn’t living up to its duty to inform the public. Where is our famous American ‘free press’? We get only a narrow spectrum of solutions in our political center.
8
@Meredith U.S. media, the “free press” as you referred to it, is dependent on its sponsors' – advertisers' and owners' - financial objectives, and is therefore sensitive to its readership, which determines, essentially, its income. Consequently, it is not as “free” as we would wish it be.
With the constraints – the ever search for sensational news, “star” reporters, biased editorialists – it must cater to a vast group of undereducated, prejudiced, misinformed readers, or else lose its means of sustenance.
Thus it’s no wonder that more thoughtful, incisive, penetrating, and more profound articles seldom appear in the “mass media”.
It seems Democrats have lost their minds. Republicans tried to fix and improve Obamacare. Republicans insisted that preexisting conditions be covered and that drug prices be reduced. Democrats however, claimed that there was nothing wrong with their masterpiece legislation and voted against any changes. They got many votes this election because of their stubbornness and now they want to admit that well yes, the ACA needs improvement? I wonder if I will get to keep my doctor.
After reading this post, I reflect on why it’s a good thing that supplementary leg to the PPACA requires mental health to be benefitted at parity.
1
You get my vote if and only if I am convinced that you support and will work for a federal single-payer system.
5
Nothing can improve healthcare in this country unless and until costs are contained. There is so much waste in the system on all levels. Obamacare, though well intended, made an already bad system worse. Mega-mergers and "almost" monopolies being formed in states and regions, quashing competition. Unnecessary testing, surgeries and treatments being ordered and done for monetary gain. Some hospitals taking advantage of laws that allow them to charge outrageous facility fees (among other things), requiring huge out-of-pocket costs for patients with high deductible plans. Mandatory medical records systems quickly imposed on practices already strained with paperwork from dealing with a myriad insurance companies and government requirements . Doctors spending less time with patients, and practices needing to hire all kinds of extenders to pick up the slack. Overall quality of care suffering.
Most articles I read about our medical system explain only bits and pieces of the problem; it is very complex and will need lots of time to correct. But Democrats can't and shouldn't do this alone. They will need resources and expert voices from all facets of the health care delivery system. And they will need the Republicans to work with them, legitimize the process and make it acceptable to all.
3
This has probably been said somewhere before, but the Democratic House should start passing health reform legislation Now. Prof. Pllack's suggestions, while good, are themselves procrastinating. Obviously, whatever the House passes will not pass the Senate, or probably even get a vote, but the Democrats must force the Republicans to take a stand against health care reform. Maybe the votes to expand Medicaid in Idaho, Nebraska and Utah indicate that the electorate has finally realized that the Republicans Do Not want them to have affordable health care, but the House Democrats need to make that clear ever day.
3
Sigh. Not only does this article say get going, but Pelosi put it top of the list for January.
Medicare for all seems to me to be a stealthy move towards single payer health care and elimination, or at least dominance of insurance companies providing this service. If this incremental step can be achieved, the health of those now unable to afford adequate health care will benefit. Who, except insurance companies and the politicians in Congress who take their contributions could oppose this?
In Europe single payer and privately paid medical insurance exist side-by-side. There’s no reason the same couldn’t be the case in the U.S. I think that in time many would see that when an effective single payer health care system kicks in the necessity and desirability of medical insurance would diminish.
6
The ACA was basically written by the health care industry and it can‘t be fixed to work to the benefit of the insured. Why are we still talking about this when we need to push for single payer?
13
Some suggestions:
Help people realise that the world did not end once ACA was implemented and help other people, who are wary of any
Government programs to understand that.
Raise the maximum income for those who receive free health care, if you think you can live on $ 31,000 a year with a family of three - you don't know what it is like to be poor.
Convince Hospitals that it is in their self-interest to be paid
quickly and automatically rather than having to wrangle with
patients and Insurance companies.
Convince employers that your reforms will save them money.
Produce a set of advertisements that present Americans
who are deeply thankful for ACA.
4
This is just another in the long list of articles from a so-called health care "expert", whom, much like corporate/establishment politicians who take money from the healthcare industry insist on continuing this "snails pace" approach to solving the issue. America has been haggling about healthcare since Harry Truman was President with little or no resolution so don't you think it is about time to REALLY do something about it?
The reality is, the rest of the western industrialized world realized decades ago that in order to solve much of the issue of cost and efficiency , the better route was to eliminate the "middleman" in the process pay for healthcare out of increased taxes which would STILL be considerably less than the premiums one has to pay to insurance companies and everyone is covered, employers would be free of the obligation and cost and employees could move about freely in their careers without worrying whether not they would have coverage.
The healthcare industry is now by dollar amount the biggest lobbyist in Washington and it is all done to maintain the "status quo" and ALL Republicans and some corporate/establishment democrats like Nancy Pelosi, Chuck Schumer, Diane Feinstein and other "wafflers" on the issue want it that way, their healthcare corporate donors told them so.
It is no accident why several newly elected democrats want to have a change at the top of the leadership of the party and the healthcare issue is one of them.
7
Yeah, except that is not what actually happens in all industrialized countries.
This is a good start. But I don't see anything to check Medicare Part D--the no negotiation costs of prescription drugs--one of the cruelest "reforms" ever enacted by Republicans. If TV ads are any indication, the future of choice remedies modern medicine is in the hands of and at the mercy of big pharma. The quality of mercy must be restrained.
1
If we want to get rolled over by a red wave, yes, let's continue to jack up the prices of health care. Pelosi sold us out to the insurance companies, and the idiots with six figure salaries keep saying that more taxes and more government intervention are making it better while everyone who works for a living realizes that they have less cash and less health care.
For 50 years, Union labor voted straight ticket Democrat. Obamacare destroyed that in 6 years, and the coastal liberals want to double down on it. Embarrassing.
2
It would be if it were even close to true, sure.
One aspect of many of these “free stuff” proposals is so insidiously untenable – the only people who can embrace it are those who make more money off the system, the more dysfunctional and inefficient it is...
How is it – in most of these schemes – the poorest get to have zero copays and deductibles...While same said copays and deductibles rise to punitive levels for those earning between $50K and $100K per year...
Aside from it being insanely bad economic and health policy – it’s one of the most morally inequitable approaches one could devise...
Further, whether by circumstance beyond their control – or very conscious life-style choices – the poor not only need a disproportionate share of care...They’re the ones – with their zero copays and deductibles – that’re most likely to go to an ER with a non-emergency need...
And run up a $10K bill that’s left for the rest of us to pay...
Unfortunately – for the rest of us – those who make more money off the system, the more dysfunctional and inefficient it is (emphatically not the physicians), are currently calling the shots...
If I OD on opioids at 3 AM on Saturday, some public-health staffer on weekend overtime at the ready with the Naloxone...
Same time and day – get a venomous wasp or spider bite...
“We’re expecting the epi-pens any day now – but there’ll be a co-pay”
You know – to discourage you from going and getting stung in the future...
1
Until the “healthcare” insurance companies--which offer nothing to healthcare, save parasitic skimming--are taken out of the loop, i.e, healthcare becomes a “single-payer system”, this is just another Congressional slam-dance to nowhere.
6
@Alice's Restaurant
Then start electing those politicians whom are both unencumbered by the influence of money from the lobbyists and have the compassion, commitment and "political will" to move forward on what 70% of Americans consistently indicate in polls that they want.
The fact remains as long as a considerable number of politicians presently in office continue to accept corporate donations from the industry, they will offer every "excuse in the book" to prohibit meaningful changes from happening while continuing to defy the wishes of their own citizens and these politicians exist in BOTH parties.
3
"There is zero chance..."
Of gays serving in the military.
Of women serving on the front lines of combat.
Of a black man being elected president.
Of recreational marijuana being legalized, state by state.
Of gays being allowed to marry.
Of Donald Trump being elected president.
We've heard all that before. Thanks. We'll take our chances with Medicare for All.
14
This is an excellent article, not least because its author knows what they’re talking about and remains hard-headedly practical about what we can and cannot get done right now.
As President Obama said all along, Medicare for All would be the way to go...if it were 1933, and we were starting from scratch. We are not. And the unrealism of declaring that everybody wants single-payer, and would give up their private employer plans, and would pay the giant whomp in taxes, and would be okay with seeing doctor and nurse pay slashed, is just...well, nuts.
Folks, it’s not that hard to learn the basics. Jump on Kaiser Family’s website, or take a look at the excellent material available through the Times’ own “Upshot,” column. Maybe then, lefties would stop muddling single-payer with unjversal, stop swearing that every other country has single-payer, and stop the right-wing blather about how eliminating overhead and those accursed insurers would fix everything.
I’m on a Board that runs a middle-sized JPA, and have been for years. I’ve SEEN THE BOOKS, okay? Admin costs are between 2-6%, depending on exactly what you’re talking about.
Where’s the money? Pharmacy, especially since we demand fancy stuff we don’t need. Beginning/end of life care; we’re nuts. Chronic conditions, often caused by our laziness. Fancy surgeries we insist upon. Oh, and an aging pop.
Sorry, but I strongly back universal coverage. And if you want costs down—figure out what you’re willing to give up.
Yes, this all sounds very good, but the devil is in the details. The important thing is that the democrats be seen to do something that clearly benefits the middle and working classes. Here's one obvious idea: Pass legislation mandating that medicare negotiate drug prices with the pharmaceutical industry. It's simple, straightforward, understandable, and it would make the republicans look very bad in opposing it. But I wonder if the democrats are themselves too deep in the pockets of the drug companies to do it.
4
@TRW
Stop wondering....they are. Before the ACA was passed, Byron Dorgan, D-ND offered an add-on (amendment) to the ACA that allowed Medicare to negotiate drug prices with big Pharma. It failed! Even though the Democratic Party controlled by a wide enough majority the Senate, the House and the Presidency. That is what being "beholden" looks like.
3
@Abbey RoadGood point, but that was then. I believe that House democrats have shifted a notch or two left since then. But I guess we'll find out.
Excellent! Thank you. Here is one of the emerging statements reflecting the reality of our current situation, especially based upon credentialed polling results that have seemingly been totally overlooked by others commenting on this subject. What a relief to read a no-holds-barred review of the recent history and support for humane policy. Bi-partisanship has been a rotting corpse of something murdered by Republicans even before Obama was first elected--leaving me flabbergasted at how someone could ignore the clear signs and try to negotiate with Republicans. Every day, week, month into Obama's first term, I was increasingly frustrated by the wasted time and power to obtain a "compromise" exactly like Pollack has stated. Now, it's indeed time for Democrats to act with determination and the support of the majority of citizens in this country!
1
Yes, Democrats don't procrastinate about America's health. Stop being the Party of our decent ex-President, Barack Obama. But save his Affordable Care Act - with improvements! Especially with current Republicans in the Senate majority and an autocrat for President. Stop in-fighting. A gavel is a gavel as long as it is in a Democrat's hand. But it only matters when it comes down in favor of American lives.
America's "for profit" healthcare system will not change for the masses until the "for profit" dialing for campaign dollars business model of the current Democratic Party leadership is destroyed. Yes, Nancy Pelosi is a skilled tactician in Congress, but she and many of her corporatists colleagues are the "gatekeepers" for the party's donor class. And as such, Medicare For All "will not see the light of day" and will never come to the floor for a vote.
3
Yes, Democrats don't procrastinate. Save American lives. Don't be like our decent ex-President Obama. At least not with the current Republicans. But save Obama's Affordable Care Act - with improvements! Don't get into a dog-fight about who has the gavel. A gavel is a gavel but Americans' health is not.
1
It's the great fear of those who voted Democrat that they will waste their opportunity to do something they haven't done in y-e-a-r-s... legislate. That they will just investigate and end up jeopardizing their opportunity and the 2020 election.
2
A resounding yes! to this opinion piece. The biggest danger Democrats face is winding up with some kind of rump party like the Freedom Carcass or the Tea Party, focused on blowing its own horn for the enchantment of its own constituency. Republicans were rendered ineffective because they were not a real party, but a squabbling coalition of factions whose main tactics were obstruction and intransigence.
1
What appears as an obvious approach is to restore taxation to previous levels (that means the wealthy and corporations will again pay their fair share), and cut the ridiculously inflated military budget by half. Doing so will provide the necessary funding for an effective medical program and concurrently enable reduction of the impossible national debt created by trump and his supporters.
3
Good. Now, as we figure out what form a single-payer system should take, let's include dental coverage from the outset.
Many (not all) European countries, including France and Germany, cover dental in their universal health care systems. Let's do that.
Why these two categories were ever separated in the first place makes no sense except for the usual motivation of private care profit. Our dental health directly impacts our overall health; it can in fact kill us. Can you imagine a health care system that separates out any other part of the human body?
And let's face it: No matter how conscientious we are about dental hygiene, our teeth will fail, and solutions abound that are constantly being improved upon with modern technology - yet the cost is prohibitive. (This is not only a quality of life issue, by the way; the complications of tooth crises put a heavy toll on the entire system, including visits to emergency rooms.)
In the end, though, it's needless pain and suffering that's the issue here, and yet another example of the great divide between rich and poor ...
5
Sigh. Dental coverage is cheap, with very stable premiums.
@Robert: Sigh. "Cheap" is relative. Our dental insurance is not "cheap" for us, and it also caps what it will cover for some of the procedures that most families need, such as wisdom teeth removal, or root canals. So we pay the premiums, pay the co-pays, pay the deductible, and also pay whatever costs go beyond the cap. Dental and vision treatment needs to be included in any new government plan that is devised. I am not holding my breath for any of this to materialize, since the whole country has apparently gone mad with greed.
4
@Allison Exactly! Thanks, Allison. I'd forgotten to mention the relative worthlessness of dental insurance. You said it all, including the reason why this won't be addressed until this country values human beings over profit, i.e., anytime soon. We've truly lost our way.
1
Democrats have no urgency on America's health. The only positive issue that gave the Democrats the majority in the house was the Affordable Health Care Act (AHCA). They have been resting on their laurels ever since it was passed. The Democrats and their supporters are in denial that there are serious flaws and as Bill Clinton has said it is the worst system in the world. Not accepting that the albatross of the Affordable Care Act on Americans who chose to buy into it would be very partisan but Harold Pollack is partially right. I would go further and say that lawmakers should develop a replacement of the ACA.
A hybrid of a private and public health care would be a way forward. Those who have private insurance and are happy with it, let them continue with their private insurance. The rest who cannot afford private insurance should be provided government managed affordable health care based on income. For this the billions that is spent on contracting private insurance to provide health care can be spent on government owned infrastructure and government paid medical personnel just like the Defense Department does to defend the nation at homer and overseas. Any replacement health care should not be conditional on not having any previous health issues or preconditions, the only part of ACHA that should be the foundation of any health insurance.
In summary every American citizen and legal resident should have optimal health care until they are eligible for medicare from age 65
2
The biggest cost driver is prescriptions. Obamacare created pharmacy benefit manager, a third-party administrator of prescription drug programs for Medicaid and Medicare in 5he hopes a larger entity could negotiate lower costs.
The opposite has happened. Three entities control 85% of the market including CVS Caremark, which is rapidly putting independents out of business, replacing with CVS stores.
It is time to think out of 5he box. Providers should be allowed to dispense many low cost meds such as Metformin which is cheaper than the co-pay, by passing the insurance big pharm distribution stranglehold. At the same time Pharmacists should be allowed tp prescribe certain low level meds competing with the stranglehold of the Docs.
The Trump Admin has moved to association group plans, build on it, and cross state lines. Individual insurance doesn’t work, groups can work.
The problem is the Dems have no plan other than Medicare for all which is unsustainable
1
Sigh. I’m on the Boards governing a medium-sized health insurance JPA. I assure you that Caremark et al ALL have programs that try to get patients shifted to cheaper drugs, and manage the administration of drugs to those with chronic conditions.
Just remember, we currently have a debt load of $21T that is not going away. We have a deficit of over $800B that is rising. So while giving away free healthcare is a nice idea, it is fiscally irresponsible.
And, if you think taxing the wealthy and corporations will solve the problem think again. According to Forbes, the billionaires in this country have an aggregate net worth of $6.4T, so taking everything they have wouldn't make a dent in the debt, no less, pay for additional spending.
1
@Rich
Agree Rich, but these folks will not understand the dire situation we are in. Nor will they understand that the 'rich' don't have the money to support them.
Frankly, why should the 'rich' support any of us.
@Rich
Then again, we could always take it from, say, the Defense budget to plug those holes. Just sayin.
4
@rtj And, we could take a more rational toward our health. Base payments to doctors on the health of their patients instead of their illness. How about paying for the number of days patients don't need to see them?
My goal is to have my health insurance completely separate from my career. I should not have to base my career on access to health insurance; I should have the flexibility to move around to accommodate the ups and downs and swings of any career arc!
I’m fine with an expanded health insurance market same as home and auto insurance (like through USAA - buy it and keep it for decades) or with some form of single payer system. But the trajectory of the current system is an unsustainable dead end. It does not serve patients nor at times it seems the health care providers.
6
Medicare for all, more than paid for by closing offshore tax havens and shell corporations. That simple, and that hard.
7
I’m sorry but it is NOT POSSIBLE to arrive at a truly universal health care system bit by bit. Doing it in one go is the ONLY way. No buts about it. The sheer complexity of the system demands that it be done in one go, because so many parts of any universal system are fundamentally reliant on other parts.
Anyone telling you otherwise is being totally dishonest, probably by people who largely aren’t affected either way, and so don’t care.
6
Then mark me down as totally dishonest, what with my being handicapped by having a fairly good isea what I’m talking about.
The facts are still the same: we spend almost twice the amount per capita for health care as most industrialized countries, and for this we have health outcomes that are almost as good. As long as health care providers have such undue influence over legislators, their "public interest " foundations are lobbying fronts and the public is unable to see through the fallacious arguments, I see little prospect for change.
This is the test for Democrats. The costs of the American system are choking off growth and improvements in other sectors. Ultimately decisions will have to be made about how much profit, how much choice, and how control can rest with private companies.
3
I've read all the comments. OK, here is what single-payer would be like if we don't cut costs:
You are currently paying 2.8% of your salary in Medicare tax, or 3.9% if your salary is over $250K. Wealthy investors are paying 3.9% on their investment income over $250K. Seniors are paying from $134 to $460 in Part B premiums, plus Part D plus supplemental insurance.
Now we have Medicare for All. Each worker will have to pay 28% of salary in a new Medicare tax, with no cap. Each insured adult would have to pay $134 a month in Part B premiums, and there would have to be family plans covering children. You'd also have to buy a Part D plan, and a Part A/B supplemental. You'd spend about $500-600 a month for a family.
According to my calculations, this scheme would raise the $3 trillion we currently spend on healthcare. But since healthcare would then be available freely, usage would probably increase dramatically. So I would suggest cutting the premiums, and having a small co-pay instead, tied to income. Even a homeless vagrant would have to pony up $2 to see a doctor.
2
@Jonathan - Behind the numbers:
The 28% payroll tax would raise about $2.25 trillion, so we'd need another $750 billion. That's about $4500 per household per year. Divide that any way you want between premiums and co-pays. Remember, there are many poor households who couldn't pay anything.
3
Actually, you currently pay 1.45% of salary, and your employer adds another 1.45%. Add them together, and you get your 2.9%.
As for your claim about costs in Valhalla, one assumes you mean 2.8, not 28%, though the latter is closer. Nor have you considered that you and your employer pre-pay for your benefits over what, about fifty years? Yank that out of the system, and yank out that young people pay without taking bennnies, and your house of cards collapses—without massive tax increases.
And you’d STILL have at least your $500/month, plus co-pays, plus Medicare pays 80% only, plus there are deductibles, plus you forgot dental and vision.
Sorry, but us lefties are kidsing ourselves, if we think everybody’s gonna cheer for anything like that.
@Robert - Total US payrolls are about $8 trillion. Therefore, a 28% tax would be required to raise $2.25 trillion.
This sounds like a megaphone full of excuses of why America can't/shouldn't develop the best medical care system in the world. Why are we working to be less than best? "Some men see things as they are, and ask why. I dream of things that never were, and ask why not." - Robert Kennedy.
7
Republicans' rallying cry for destroying the ACA -- that it's bankrupting America -- came very close to working. Yet non-partisan analyses of the proposed Republican alternatives came out *more* costly (in the longer term) than Obamacare. The "repeal/replace" fiasco revealed two important things: First, that the Democrats under Obama and Pelosi did a remarkable job of crafting bullet-proof legislation; and second, that far too many Americans can't -- or won't -- do simple economic math.
Finally, Americans want the kind of healthcare security that only a national, government-operated system can provide. But they still don't want to pay for it, and I bet they still can't tell the difference. The reality is that national, state-sponsored healthcare offers significant cost savings, and that's not a difficult reality to explain to people. If they want to succeed, Democrats should make that lesson plan a priority equal to their legislative plans.
2
"The process of writing the A.C.A. began years before it passed."
Yes, but unfortunately for the working class, ACA was written largely by the health insurer lobbyists.
"Many Americans would prefer greater bipartisanship."
Let's see, there are more registered voters identifying as "independent" than voters of either of the pro-business parties. Then there's the fact that most voting age citizens don't vote. Lastly, both parties are despised by the public, according to numerous opinion polls.
Taken together, the facts clearly indicate that bipartisanship may be the goal of the elite who desperately want to maintain the two-party illusion of democracy, but the public seeks other perspectives.
6
Somehow, I know that you cannot name any three provisions of the PPACA.
No plan will be successful for lowering the cost of Health Care without a change in Physician compensation and the conflicts that arise from Physician directed activities that encourage excess utilization of both services and products. In short, no plan will work without a change from Fee For Service Medicine. Remember it is only the MD that writes the orders that generates all the costs.
Stats from 2016:Physician and Clinical Services 20 percent share: Spending on physician and clinical
services increased 5.4 percent to $664.9 billion in 2016. Although growth for physician and
clinical services decelerated slightly in 2016 from the (5.9 percent in 2015), it outpaced the
growth in all other goods and services categories. The growth in the use and intensity of
physician and clinical services was a driving factor in the overall growth in physician and clinical
services, accounting for nearly three-quarters of the 5.4 percent increase.
1
The big failure of the ACA is that a relatively small proportion of the American public are covered by the marketplaces, but it spreads the costs for things like covering preexisting conditions onto everyone else. Employer provided plans rose in cost and provided less coverage at the same time. This was exactly contrary to what the politicians said would happen when they were trying to sell the ACA to the American public. Even those that once boasted about their good health plans don't have them anymore. That's why it was so unpopular. So, whatever the brains in Washington do, they need to ensure that everybody is in on the costs and the benefits of any proposed changes, and tell the truth about the blowback, instead of the lies that were told in order to promote Obamacare.
5
To all fairness, the growth of premiums with declining coverage started way before ACA. In 90s my part of premium of employer provided insurance went from 30$ per month to 150$ per month in 3 years, and that also with bigger co-pays and less coverage.
1
You are writing as though everybody didn’t benefit from the PPACA’s provisions, not just those in the marketplace.
1
It’s simple, Democrats, provide a public option that is an easy conversion to Medicare at retirement. The gov’t is the only entity that can negotiate lower pricing for the masses. The private market will never have the best interest of patients in mind. The government is mandated to do so and if your representation in Washington isn’t doing what’s in the best interests of their people, then fire them coming election time. And keep firing them if they say one thing but then vote in policy that is in the interest of non-person entities (business) and only the wealthy. We need ethical and moral healthcare in this country. Still waiting...
1
When it comes to health insurance, I'm Pro-Choice. I prefer systems like that in Switzerland where individuals can choose from among several different options. Keep the mandatory coverages minimal - I don't want to be forced to pay for someone's chiropractic or homeopathic treatments - but let folks add these services and vision, hearing, dental, or other services as they desire and are willing to pay for them.
It would also be nice if individuals who adopt healthy lifestyles could be rewarded for doing so through lower premiums, but I suspect there would be a huge backlash against any such plan.
5
@J. Waddell: What you may think of as superfluous may actually be necessary for others. Chiropractic treatments were the only thing that helped my son manage the pain stemming from his skeletal defects. Massage has been the only thing available that helps my 87-year-old father manage his debilitating arthritis. Although Floridians legalized medical marijuana, the state legislature has made it as difficult as possible to get, and disqualified many conditions, including arthritis. They would rather put old people on addictive opiods than allow them access to less-harmful medical marijuana. That is just one consequence of allowing institutions such as insurance companies or state legislatures to determine what medical treatments should be paid for. And how anyone can think of optical or dental as "extras" is beyond the understanding of anyone who has eye or tooth problems. When was the last time you tried to ride out the pain from a tooth that needed a root canal? One of the biggest problems we face is that of insurance companies deciding what types of treatments ought to be paid for, when it is obvious that some people respond well to some treatments, while others respond better to different treatments. None of us are exactly alike, yet we keep insisting upon uniform treatments for everyone. Look around. That approach is obviously not working.
3
And what would include the 'minimum'? One visit to doctor per year? I don't see the reason to exclude vision or dental coverage. Blindness is a disability, and tooth pain is not less painful than headache. It is ridiculous to treat vision and dental health as a luxury.
3
Beyind the fact that chiro and massage are not where the money is, no system that allows everybody to cherrypick can possibly be made affordable for all.
Insurance doesn’t work that way. Period. Oh, and nobody knows what they’re gonna need next week, let alone five years out.
1
Democrats absolutely need to avoid duck taping overly complicated policy. They certainly shouldn't talk about these considerations in public. Medicare for all is popular because it's easy to understand. You start going into wonky details on health policy and the public stops paying attention. There won't be any healthcare reform at all.
The message is Medicare for all. If people express concerns or doubts, we introduce a transition plan for doctors, patients, and insurers. If we don't have the votes, we pass as much Medicare for all as we can. It won't be hard to find tax revenue after Trump's tax bill. Passing a massive healthcare package through budget reconciliation is much easier than cutting taxes.
In other words, forget revamping Obamacare. Democrats should focus on making a Medicare for all package airtight so Republicans can't unravel it with 51 votes when power swings back the other way. Keep it simple and go find the money. That's how you fix healthcare.
5
For many, the biggest objection to a true national health system is that rich people fear they won't be privileged -- that they will have to wait for an appointment, just like the hoi polloi.
But once we incorporate a dozen government programs with non-profit health care and hospitals, once we negotiate drug prices down from the stratosphere, a universal health care program can accommodate people who want to pay for privileges.
As long as the rest of us get basic care for little cost, we will have moved the mountain.
2
This is a tack-on to my previous post.
There will never again exist in this country the political conditions that will allow for a bipartisan approach to fix the health care system (after all, we have one entire political party that doesn't even think health care should be a right for all citizens). Letting people buy into Medicare at any age wouldn't be viewed as fixing the system in the way that the ACA tried to to. But enacting a Medicare buy-in would be so much more effective.
If the ACA debacle showed us anything, it was that Americans want change more than anything. But only if everything stays exactly the same.
With Medicare, we know what we're getting. Americans of all political stripes LOVE and trust Medicare. Letting all Americans buy into it - which poll after poll shows that more and more Americans want to do - is the way to go. When more people are in that system, the likelihood is higher that we can work for the improvements that the Medicare system does, to be fair, really need.
In short, I'm in favor of just about anything that gets for-profit insurance companies OUT of our health care system. There's something really evil about those organizations. Their CEOs would gleefully let your entire family die if it would save them fifty cents. They are cruel; their policies are horrific;and absent having the living daylights regulated out of them by the government, they have no place in a civilized health care system that seeks to SAVE lives - not ruin them.
7
@Josa - Right now some people are eligible to buy into Medicare. The premiums are:
Part A: $422 a month
Part B: $134 a month ( unless your income is high, then more)
Part D: Pick a plan, $15-150 a month
Then you would normally buy a Part A/B supplemental plan at about $250 a month.
So you would typically pay $800-900 a month in premiums.
2
@Jonathan Yes Jonathan, this is what I pay every month in premiums plus the difference of the cost of my medications and the part that it is not covered for part D of my insurance and it comes to around to $1000 out of all total. Figure it out.
Why doesn't the Times publish an article that actually explains why health care is so expensive?
It's all the middle men. Today let's look at Insurance Companies. Other developed nations do not have these middle men. Their mere existence adds anywhere from 40-50% to the cost of health care for everybody. How?
Ask any hospital administrator, as I did recently, what are their costs centers?
1--Administrative costs of 15+% to deal with the paperwork Health Insurance Companies require;
2--The cost of uncompensated care--another 15%
Total? A 30% additional cost added to everybody else's medical bills
Further, studies have shown that Health Insurance Companies cost 20% off the top to cover the cost of administration and their profit.
What do you think the response of the American people would be if they truly understood these cost centers?
Could the Times do a study of all this including how well these Health Insurance Companies have done since the passage of the ACA compared to any conceivable benefit they provide?
15
@Sylvia You left out the following from 1016:
Physician and Clinical Services (20 percent share): Spending on physician and clinical
services increased 5.4 percent to $664.9 billion in 2016. Although growth for physician and
clinical services decelerated slightly in 2016 from the (5.9 percent in 2015), it outpaced the
growth in all other goods and services categories. The growth in the use and intensity of
physician and clinical services was a driving factor in the overall growth in physician and clinical
services, accounting for nearly three-quarters of the 5.4 percent increase.
1
Healthcare should come out of Central government taxes like like in does in every other developed 1st world nation. USA is the exception to the rule.
Your profits before people healthcare system probably costs the government more from over charging and fraudulent invoices and administration costs than it would, if it was a universal healthcare system. run by central government and not private businesses.
Preventative tests and free nationwide screening programmes costs the government less, than having to treat someone in hospital for a serious illness that could have been prevented if tests had been done. Free breast screening for woman over a certain age keeps families together and mum doesn't need to die unnecessarily. (That's just one example)
6
I agree with Mr. Pollack. If we could start over from scratch and build an ideal health care system for the U.S., I think there would be widespread agreement (even among most Republicans, though they would never dare publicly admit it) that a single-payer system, or some very close approximation to it, would be the way to go. I mean, look at the empirics from other countries that have done this. The evidence is overwhelmingly in support of the fact that when every single citizen is required to pay a little (relative) to get a lot (again, relative), the result is a better, happier and healthier society.
But we can't start from scratch. There are simply way too many entities that have gotten, and continue to get, so obscenely rich from the status quo that they will spend every last dime they have fighting change.
Obama understood this. Which is why he went with what he could get - the ACA - versus what he really wanted - Medicare for All.
The simplest and easiest way to "fix" the health care system is to let people buy into Medicare. Gradually start lowering the age limit until anyone who wants in to Medicare can get in. I suspect that in doing this many insurance companies will go out of business (YES!!!!). But this is the best path for the country to take. Medicare is a well-known, well-loved and well-regarded system that has long existed. It needs tweaks and improvements, including a tax increase. But it works. And it means we don't have to build a brand new system.
5
@Josa
the big question is what price do you allow people to buy into Medicare?
Do you charge them on their actuarial cost? The average cost of Medicare spending per person? Do you charge them more for pre-existing conditions?
2
It's a bit ironic for those in rural areas to be adamantly opposed to a single payer system since there are are so few, expensive, and sub-par choices now anyway in these areas, what would be the downside other than less cost? In rural America these days, there are more health care choices for animals than humans. Let's think about that for a while.
3
What is this political realism of which you speak? A lot of the Democratic base and a huge chunk of people who voted for Trump want a simple generous plan that covers everybody equally. If it is presented to them clearly and with assurance they will vote for people who advocate.
Instead we get another round of half measures and complexities. Medicare is clear and easy to understand, unlike Medicaid it is not subject to the vagaries of state frugality. People understand it, people want it, and by your own admission it will be cheaper and more effective. Why not do it?
6
The Democrats and Republicans both spend all of their time arguing about who is going to pay for health insurance. However, neither party is trying to change the underlying reasons health care is so much more expensive in this country than in any other country.
One such reason is the cost of medical malpractice insurance. If we changed medical malpractice to a program similar to workers' compensation, we would reduce the cost of every procedure, every doctor's visit and every dose of medicine.
OB/GYNs, for example, spend about 17% of their expenses on medical malpractice insurance. On top of that, all doctors perform countless unnecessary tests for fear of having to justify not performing them on the stand.
This is just one example of what would be needed to provide true relief to the American health care system. I am sure there are others - unnecessary bureaucracy comes to mind.
4
@Bill: One reason why people are so eager to sue is because we have to pay so much for care. It is a vicious circle: premiums, deductibles, co-pays, and denied claims cost patients thousands of dollars. People of modest means who have had the misfortune of experiencing a serious illness or accident know that expenses for even one incident can wipe us out. And then to have that outrageously expensive healthcare that we go into debt to pay for go wrong and cause even more trouble, pain, and expense - that's incentive for anyone to sue. If patients were not being forced into bankruptcy by major illnesses, we would not need to seek large monetary settlements. Make it less expensive up front, and you will see fewer people having to sue for botched operations, misdiagnoses, etc.
3
Actually, no, costs for a single disaster can’t do that any more. Capping out of pocket costs at around 9% of annual income was a major achievement of the PPACA.
1
@Robert For unsubsidized plans on the individual market, the annual out-of-pocket cost is not based on a % of income. For 2019, it is $7,900 for self-only and $15,800 for family. And it resets each and every year. Also, very important: An out-of-pocket maximum applies only to *in-network* expenses. Marketplace plans have very narrow networks. Don't get sick or hurt more than 30 miles from home. And there is no cap on out-of-pocket expense for out-of-network care. The sky's the limit.
1
Capitalist forces are so strong that America can only end with in-between solutions. Perse, these solutions can't last long. A few political defeats here and there is sufficient to erase them.
1
This is a disguised hit piece from Corporate America to you, circumventing what Corporate America dreads more than a large outbreak of ethics at the Justice Department: single payer / Medicare for all. This is a Corporate America welfare scam, like scam that prevented Microsoft from being broken up 20 years ago, like the one being created by entities like Facebook. Corporate America wants is for the Congress to enforce a mediocre scheme of provision for the Great Unwashed so you can hold them prisoner and milk them.
First thing to notice here is that this is addressed to "Democrats" and by that they mean the limited voting block held in place by the DNC and the corporate cons like Pelosi. When Sanders proposes a Medicare-for-all option the "Democrat" voting block with balloon and corporatists won't be making ridiculous pleas, they'll be running for their lives.
6
The first step should be letting American's import medicine from abroad.
3
I have relatives in Canada. Their taxes pay for their health care, which includes their government negotiating drug prices, and sometimes provided direct dollar subsidies for drugs, for 35 million Canadian citizens.
Why should their taxes subsidise Americans? Americans need to solve their own problem, not leech off their neighbours.
"Although a single-payer system would reduce overall health spending, it would require major tax increases "
Why?
Americans already pay more of their taxes for healthcare than almost anyone else in the world.
US healthcare is such a rip-off that the government (meaning the taxpayer) spends $4,860 per citizen per year to cover just one third of Americans (those on Medicare, Medicaid and the various military set-ups). Yet this is more than the governments of Canada, Australia, Germany, the UK, France, Japan, etc, etc spend to cover ALL their people. (In fact, Luxemburg, Switzerland and Norway are the only places on the planet that spend more tax money on healthcare than the US.)
And just to twist the knife, only America then spends as much again to buy private health insurance.
https://data.oecd.org/healthres/health-spending.htm
9
It is obvious that Prof. Pollack wants every American to have affordable health insurance, and he is correct that Medicare for All would never pass with a GOP Senate and Pres. Trump. That is why we need to elect a Democratic president, House and Senate in 2020.
Pollack is wrong is suggesting that keeping our current fragmented multi-payer health care system is a viable option.
Suppose that we had a public option for Medicare. The insurance companies would go after the healthy people leaving the sickest for the public option. This would be the worst of both possible worlds. The government would not get the tax revenue from covering everybody, and the public option would be expensive since it had the sickest patients. It would become another instance of privatized profits socialized losses.
Pollack is also not correct when he says that Medicare for All would require an increase in taxes. A recent study showed that the government covers about 65 percent of health care costs. We could implement Medicare for All without an increase in taxes. (See the link below)
https://www.sparksremarks.com/2018/01/19/medicare-for-all-requires-no-increase-in-taxes/
3
Even Sanders says that there would be large tax increases; so, this is bunk.
Why don't we see in the NY Times lots of opinion pieces and articles advocating for a Single Payer health plan. Whenever I read something it is for some reform version of the Affordable Care. It is as if the public have to advocate for universal health care in Comments sections like this. There are also lots of myths, lies and misconceptions circulating out there about the single payer option that need to be clarified and the media plays an important part in doing so. Open a forum for new discussion on this issue. Dedicate some front page articles to the issue of universal healthcare (not to some revival of Affordable Care). Cover the health insurance issue relentlessly instead of giving most of your space (front page space) to every stupid tweet and provocation coming from the man sitting in the White house. It is exhausting and vacuous reporting. This issue is #1 for most Americans.
10
My deal with the poor, wretched, under-educated portion of the American population that idealizes and worships Donald Trump is this:
Treat me decently, and I will treat you decently in return.
In practical terms that means you stop defending Trump’s persistent lying, his racism, his misogyny, his all-around crude behavior, his attacks on migrants, Mueller, Obama, Hillary, the Justice Department, the FBI and the Constitution; and I will support health measures, education and employment programs and tax reforms that will benefit you and your children.
Otherwise, the deal is off and I will sit back, do nothing and watch you and your family suffer while you ride Trump’s sinking ship to its final destination in Hell.
I’ll be quite surprised if you take me up on my offer, but the choice is yours.
2
@A. Stanton
I don't need your tax support.
One major fix that must be addressed: all physicians must accept all types of insurance. It does no good to be insured by the ACA, Medicaid, or Medicare, if not enough physicians are willing to see patients. That is a huge difference between European systems and the US. When I lived in Germany, I could see any doctor, any dentist, any specialist. Here, you have to scour insurance lists, looking for an "in-network" doctor who accepts new patients. Often there is no choice whatsoever.
This is especially important if we are going to continue to insist upon allowing private insurers to raise premiums by outrageous amounts, which forces people to change insurance policies every year. Nearly every year, premiums are raised to unaffordable heights & I have to change policies. Every year the policies are more expensive, have higher deductibles, higher out-of-pocket costs, and cover less. And every year I have to search for new providers. It takes weeks or months to get appointments with new providers. As a cancer survivor, I have had no consistent care: three oncologists in four years, two PCPs, and multiple treatment plans, some of which are simply broken off when I have to change insurance plans. My premiums went up 250 % this month, so I have to switch yet again: again, another inferior plan, less care, and higher costs. My income doesn't go up every year. I doubt most people get consistent year-to-year raises - why should insurers and physicians be allowed annual increases?
7
@Allison - The insurance companies are beating the bushes for doctors who will accept their measly rates. Usually, these are the worst doctors who can't get patients.
The top doctors are charging huge fees to wealthy people. If you are not rich, you won't be able to see them. Why is this a surprise?
1
@Jonathan: It is not a surprise. It is just another sign of the debilitating inequality we have encouraged in this country. Other countries mandate that doctors may not opt out of their systems. Other doctors in other countries do not suffer. They do very well - and in many cases, they do even better than their counterparts in the US, who may earn more up front, but who wind up spending far more on things like private schools and their own health insurance, both of which are major expenses that could be halved of we weren't clinging to the notion that every sector, from education to health, has to turn a profit. If rich people would only manage to understand that democratic socialism would benefit them in ways they never seem to contemplate (for one, wouldn't it be much nicer to live in a society where people cared about each other's welfare, instead of snarling, "why should I be forced to pay for others"?). We could do so much better for everyone, but instead, we continue to prop up a bizarre, impractical, for-profit, two-tiered system that provides everything to anyone able to pay, and almost nothing to those who are unable to pay the outrageous prices physicians and hospitals demand. That has to come to an end - one way or another. My boyfriend keeps saying, "pitchforks and torches." If we don't fix inequality, there will be worse than pitchforks and torches in store for the misguided people now in power, I'm afraid.
1
I'm a board member with Small Business California. Our survey last year showed overwhelming support for public health insurance like Medicare. Our board supports publicly funded, non-profit health insurance for California residents. The benefits of publicly funded health insurance are manifold; creating the best attainable coverage for all residents with the smallest feasible differences among individuals and groups, fairness of financial contributions, and cost reductions through increased efficiency. Publicly funded health insurance will improve California’s economic performance and health outcomes in several important ways, including:
•Health insurance becomes a public responsibility shared equally by all
•Better protect patients from premature death and financial ruin through elimination or substantial reduction in copays and deductibles
•Increase international competitive position for California business in countries that provide public health insurance
•Allows small business to compete equally with large business in hiring and retaining employees relative to benefit packages.
•Merge the medical portion of worker’s comp into the single, public health insurance system
•Uncompensated care will disappear strengthening the medical services, particularly in rural communities
Americans support publicly financed health insurance on the principles of universality, accessibility, portability, comprehensiveness, cost efficiencies and public, non-profit administration
5
Public health care is great for business and employees too. It allows small businesses to hire. It allows employees job mobility. It allows people to be entrepreneurs.
I looked at your website and your survey; thanks.
Thing is, your survey seriously loaded the dice. You asked three questions on health insurance only: do you offer it? Would you like single-payer? How do you want single-payer paid for?
About 70% offer no insurance benefits. About 60% favor single-payer. Considerable majorities want it paid for with sales taxes and employee taxes alone—and disfavor businesses kicking in at all.
So pull the other one, it’s got bells on. Sorry and appreciate what you’re trying to do, but that survey’s badly skewed.
Here we go. For 40+ year Koch brothers and other Wall Street Robber Barons put their operatives into OUR government to stop any health care and other social advances for 99.9% of us.
Now Professor Pollack says it's up to "democrats" to fix it fast. He says, " Progressive voters will be demanding a single-payer bill, and will be disappointed when they don’t get it. They are entitled to a feasible alternative they can genuinely be proud of."
It is red state voters who put democrats/independents back in control of OUR U.S. House because THEY want health care and - even if they don't know it - they want fraud and corruption purged from medicare and medicare to get costs down to a reasonable level then government-administered health care for all aka Universal Health care.
Stupidly, it is the same voters who didn't purge the Robber Baron operatives like Traitor Mitch McConnell from OUR U.S. Senate so there won't be any real reform until 2020 when they are purged as well.
I am livid that that progressives are always tasked with cleaning up the messes of the greediest people on the planet. WE THE PEOPLE must DEMAND that the wealth they have inherited/stolen be taxed at 99.9% and put back into OUR systems to provide health care, education and other social benefits to ALL American citizens.
NOW is the time to lay the groundwork and 2020 the time to do it.
8
Medicare already has costs at a reasonable level, and extremely low rates of fraud and abuse. Please stop with the nonsense.
I beg to disagree on that unilateral strategy. It is a better strategy to invite Republicans to contribute amendments. Some bi-partisan support will only make it stronger. But there should be a price: either those Republicans should support the law or they should do concessions in other areas. And under no condition should this be allowed to delay the law.
1
Americans support publicly financed health insurance on the principles of universality, accessibility, portability, comprehensiveness, cost efficiencies and public, non-profit administration. Medicare will improve health outcomes and economic performance, including:
• Health insurance becomes a public, self insurance fund
• Better protect patients from premature death and financial ruin through elimination in copays and deductibles
• Increase international competitive position for business in countries that provide public health insurance.
• Public health insurance through a single, public risk pool allows small business to compete equally with large business in hiring and retaining employees.
• Small business will obtain enhanced support for entrepreneurial startup and expansion
• Statewide pool will leverage volume discounts for drugs and medical equipment
• Strengthens communities when people are no longer required to remain paupers for MediCal, limit their income for ACA subsidies, or face financial loss through high deductibles and copays
• Merge the medical portion of worker’s comp into the single, public health insurance system at substantial reduction in premiums.
• Financial loss at emergency departments and trauma centers for uncompensated care will disappear strengthening the availability of medical services, particularly in rural communities
• Simplifies billing process for medical community that will reduce costs for residents including small business
8
America's health depends on single payer's health plan. Stop trying to argue for a patched up health care system with Affordable Care. It is too expensive. Health is not for profit. Democrats, be brave, embrace Medicare for all and not Pollack's timid proposal. I will fully embrace Democratic Party again when it advocates for a single payer's plan.
5
@tdb. France is not single payer nor is Canada or Spain. They have Universal Health Care which works very well. And pray tell how your version of “Medicare for All” is structured and paid for? Does it include Vets, social security disability beneficiaries or workers’ compensation injuries? Just a few “Brexit” questions. The “Leaves” swore it would be easy but here they are...
@Connie Canada is, the term comes from a system where all bills are submitted to a single source for payment hence the term. Private practice runs the thing it's just how the compensation is handled. Also the insurance and hospitals are not profit centres....
Let's be honest here. Medicare for all means less Medicare for seniors because the amount of money available, no matter how much you tax, is not infinite. It may be good public policy, but as one of those seniors (and not withstanding the fact that I am a physician) who is beginning to see how much medical care costs it is probably not good for me.
Also, whether or not to cover pre-existing conditions is another hot button issue. But, if insurance companies or government health plans are forced to accept patients who are already ill, what is the incentive to get insurance at all. Why not wait until you get ill, or go for a very cheap plan, and then transfer when you really need it. What will that do to the cost of care for the rest of us.
2
I guess, we as a society, should decide what we want, health care for all, or health care only for senior citizens. Let face it the senior citizens are the most expensive patients. They consume much more health care than any other group. Including the younger people in Medicare will not increase spending much more but will bring more revenue - premiums, and give more negotiating power to Medicare to slow down medical cost. Denying the insurance to people with pre-existed conditions are just unfair. Imaging person has the insurance through his/her work than he/she changed the job and now need a new insurance, but could not get it because pre-existed condition, how that's fair? Sure, it could be abused, that's why single payer is a better system, when everybody chip in all the time, depending on their income. If we can afford most expensive health care now, we should be able to afford Medicare for all that is apparently much cheaper.
3
If the author is sincere he will advocate for Pelosi to become Speaker again. She is the only Democrat in the House that has the political savvy to get the Democrats on board. And Democrats need to get off the “medicare for all” bandwagon and start talking about Universal Healthcare which allows for more flexibility and has many western european models such as France. Sanders spouted the term but no one pointed out that his state Vermont ( less than 650,000 people) was able to make a single payer plan work. Sanders tried to sell it to the country and apparently did a good job because many people bought into the term even though they have no idea what it means (because it has different meanings to different people).
5
@Connie
"Sanders spouted the term but no one pointed out that his state Vermont ( less than 650,000 people) was able to make a single payer plan work."
And neither has any other state been able to as well. Because these have been proposed at the state level, and not the federal level, which have very different budgets and systems of taxation and revenue. Can you spot the difference?
1
Yes, plan for 2020, but if I were Pelosi, my first order of business would be to pass a sweeping ban on semiautomatic weapons. That would be the first salvo in the reform of our public health system and it would be hugely popular to the 54 million people who voted for Democrats this cycle, especially young people. Let Republicans reject it. Then patch up Obamacare. Both just might get support from Trump. Then a jobs bill. Democrats have to push a practical agenda that will protect the House seats gained in red states, because you know all we’ll be hearing from the right for the next two years is socialism, socialism, socialism. If we get bogged down in investigations and pushing Medicare for All over the next two years, we’ll be right where we were in 2010.
1
She can pass what she wants in the House, but nothing will pass the Senate. So, I think on lots of fronts — guns, health care, climate — the House Dems need to spend this time creating, and then selling, good, comprehensive, compassionate, costed policies that convince the public that the Ds are the party that can be trusted to deal with America’s most pressing problems.
Then we take the Senate and the White House, and enact them.
So: no content-free slogans, no grandstanding, no purity statements or tests, no airy-fairy go-nowhere pie-in-the-sky “legislation” — hard work, on realistic and, yes, enlightened and idealistic policies and programs that reassure all Americans, from toddlers to coal miners, that, hey, we got this.
1
The ACA worked beautifully for a lot of Americans who couldn't afford insurance but it also caused serious problems for middle class Americans who saw their out-of-pocket expenses increase dramatically, sometimes by factors of 5 or more. No wonder so many people hated the plan and the Democrats who enacted it. The reason for this imbalance was that the ACA failed to address the fundamental issues with American health care; rather, it was an enormous shell game that added coverage for the uninsured by shifting the costs to the government (expanded Medicaid) and the middle class (higher premiums). It was a classic case of the law of unintended consequences.
And now Professor Pollack suggests we do more of the same, thinking maybe this time the results will be different. They won't. Democrats will once again try to find "workable" solutions, and once again the costs will shift, the Democrats will be blamed, and the Republicans, who have not added one iota toward a solution, will win at the voting booth.
The best idea in this piece is the "Public Option" that was abandoned in 2010 at the first hint of opposition by the powerful health care lobby. What makes us think the same won't happen again?
Until and unless we break the health care lobby's hold over Congress, we won't solve our health care crisis. Only when we grow weary of making our blackmail payments to the leeches in our system will we be able to see genuine change.
13
Here's the Great American Healthcare Rip-Off in simple naked dollars.
America spends roughly $1 Trillion extra each year for its unregulated 'free-market' healthcare extortion rip-off compared to the humane single-payer and true universal systems that civilized countries have.
And America's health care outcomes are quite middling, with poor outcomes in average longevity, infant mortality, and other health indicators, not to mention lousy access and equity.
America's corrupt, right-wing, for-profit healthcare system is essentially a Twice The Price For Half The Healthcare Swindle that the Republican Party has created by resisting all sensible reform in favor of humanity.
America's the only rich country where people wake up frightened of medical bankruptcy.
Healthcare expenditure in 2017
Country and % of GDP
United States 17.2%
Switzerland 12.3
France 11.5
Germany 11.3
Sweden 10.9
Japan 10.7
Canada 10.4
Norway 10.4
Austria 10.3
Denmark 10.2
Netherlands 10.1
Belgium 10.0
United Kingdom 9.6
Finland 9.2
Australia 9.1
New Zealand 9.0
Portugal 9.0
Italy 8.9
Spain 8.8
Iceland 8.5
Greece 8.4
Chile 8.1
Slovenia 8.0
Korea 7.6
Israel 7.4
Hungary 7.2
Ireland 7.1
Czech Republic 7.1
Slovak Republic 7.1
Estonia 6.7
Poland 6.7
Lithuania 6.3
Latvia 6.3
Luxembourg 6.1
Mexico 5.4
Turkey 4.2%
https://stats.oecd.org/index.aspx?DataSetCode=SHA
Time to reform this right-wing, Randian economic crime against humanity.
D to go forward; R for the Great American Republican Rip-Off.
89
@Socrates
Turkey 4.2%
Turkey is 96% Turkish. You want to live like Turkey, go there. In a few weeks, you'd be MAGA.
@Urko
Did you read the rest of the list ?
How is your reading comprehension working out ?
Sad.
9
@Socrates So true and so easy to fix....
3
Here's what I think might work:
1. Abolish Medicare, Medicaid, the VA system and all the other healthcare bureaucracies we now have
2. Replace them with a single program for all Americans, which works as follows:
A. Care is provided by the private sector
B. The government pays for all primary care—everyone has access for free, ensuring no American is unable to see a doctor
C. All Americans are required to be insured for care beyond primary care and to have an HSA to cover any deductibles or copays. That insurance can be provided by an employer, purchased privately by individuals, or maybe purchased from the government. The government specifies minimum requirements for all insurance plans—limiting the ability of insurers to restrict coverage.
D. The cost of this insurance is subsidized by the government so all can afford it.
E. The government also acts as a reinsurer (maybe placing some of the risk with private reinsurers) to provide stop-loss and catastrophic coverage. This will help hold down the cost of insurance.
This approach basically preserves the employer-funded and private health system we have now, but puts a government wrapper around it to ensure free access at the entry point (primary care), relief for catastrophic costs, and subsidies for those too poor to otherwise purchase coverage.
Single payer would be better—but given where the US is, I think an approach that preserves the private insurance system is probably more practical.
ACA also seemed practical, but in practice it turned out to have a lot of flaws. I can see how your plan could restrict insurance cost for citizens, I don't see how it will curb the medical cost. With Medicare for all, Medicare has enough power to dictate the price. With private insurances it will be not the case.
1
What you are arguing for IS a single-payer system.
The author claims to be all for Medicare for all, yet offers basically two reasons why he claims we will never see it.
First mentioned is the anticipated opposition from private insurance companies. If single payer would phase out that part of private plans that produce egregious levels of profit from illness and misfortune then, so what? I am certain that private insurance corporations would find ways to profit from a federal single payer, just like they have with supplements, Part C, and Part D.
Second, and the one the public would hear about endlessly, is the issue of increased taxes to pay for it. I have to believe that most people are not stupid. Yes, taxes would increase to pay for universal national health insurance. But, hello...have you looked at the deduction from your paycheck for employee contribution to employer sponsored plans? Add deductibles, copays, co-insurance and out of network costs, and I wager it would be a favorable trade off for most working people. And it increases annually, more deductions for less coverage.
The author says Medicare for all would be more functional, more economical and fairer. So, what's wrong with that?
7
I would like to read a health coverage reform article and leave thinking "yes, that would help solve my problems." Never happens.
I have employer-provided health insurance and won't go to the doctor even for "free" preventive care. First, it isn't free; I pay thousands for it every year. Second, why go for screenings if you can't afford treatment? Who knows what they'll ask you to pay for? It used to be that once you reached your deductible, insurance kicked in and paid everything. Now, on the best plan my company offers, insurance pays 80 percent. That could leave me paying 20 percent of thousands of dollars. I don't have that in my budget or stashed somewhere. And the out-of-pocket cap for me and my dependent is more than a third of my gross pay.
A new ACA should get rid of "in network" and "out of network" nonsense. I thought the idea was that providers would compete to provide good care efficiently. Instead, the care providers and insurers "negotiate" to fix the highest prices they can get away with.
The public option, for which Nancy Pelosi fought until President Obama asked her to stand down, was critical to reform. It was the gradualist gateway to Medicare for all. My health care should not be tied to the economic health of my company and how much of my insurance they can afford to pay. Health care is a right and should be paid for with progressive taxes. The apportioning of health care based on income is the most appalling example of inequality in this country.
222
@C Wolfe
How is healthcare a right when other people supply it to you? You do not have a right to another's time, experience, or education.
5
@C Wolfe
Your health care should not be tied to your employer at all. The majority of Americans want Single Payer Improved Medicare for All...they don't just want the "option" of it. Any reform that maintains a role for the profiteering insurance industry will fail to achieve universality, accessibility and affordability and will keep you and so many others avoiding the care you need due to fear of financial ruin. Profit has no place in health care.
56
@Driven
Heathcare is a right if the people of the United States choose to configure it that way. If other people do not want to provide their time, experience or education working for such an endeavor, they don't have to. Other countries do this, we can too.
26
Because Medicare Parts B and D come with very significant out-of-pocket costs for enrollees, they can be as great an obstacle to obtaining health care as no coverage at all. A better goal would be Medicaid For All. With minor exceptions (which could be eliminated) Medicaid offers near-total coverage and no financial obstacles for enrollees.
Paying for Medicaid enrollment could be simply a matter of granting every American a monthly stipend equal to his or her State's average monthly Medicaid expenditure for non-institutionalized enrollees and restricting the use of that stipend to medical care costs as is currently the case with Health Care Spending Accounts.
Americans could elect to enroll in their State's Medicaid program (at no new cost to the States), to buy insurance in the private sector, or to pay cash for their care. Those stipends could be taxed as ordinary income to defray some of the new costs.
22
@David C. Murray
This is a common misconception of Medicare for All. The bill in the house, HR 676, is called "Improved and Expanded Medicare for All". Medicare would be improved by eliminating Part B and D premiums and coverage would be expanded to include dental, vision, hearing (including hearing aids) and long term care. There would be no copays, in fact, no financial barriers to care at the point of service. Everyone living in the US would be automatically enrolled. This would be far better than Medicaid for All.
4
He’s a lot, lot closer to reality than you are. The costs for extending current Medicare civerage to all are already astronomical; extending a system that civered everything....not gonna happen.
Obamacare proved to be the greatest political disaster in American history. While it saved lives, prevented bankruptcies, and allowed millions to gain health insurance, it also led to a complete reversal of gov’t, from Dem majorities in Congress including a supermajority in the Senate, control of the Presidency and a majority of governorships, to what we have today.
This turn of events did not happen because of Facebook, Fox News, fake news, GOP lies, or the Russians. It happened because a majority of Americans living outside the northeast and the west coast found Obamacare intolerable, to the point where they were willing to vote for absolutely anyone who promised to repeal it. Clearly, forcing people to buy insurance they do not want, cannot afford, and then cannot afford to use once they have because of high deductibles and co-pays, is not the best election strategy.
While your column mentions several salutary proposals for fixing what is left of Obamacare, your comment that “Much of the work that produced Obamacare was done well before President Obama took office... Activists, legislators, congressional staff members and constituency groups quietly met in forums... to make difficult political and policy decisions...” does not inspire much confidence. These clever, well-meaning policy wonks were obviously clueless about the political consequences of their law, but yet there has been no acknowledgment of their role in the current catastrophe.
29
@kbaa
Your comment that the ACA forced "people to buy insurance they do not want, cannot afford, and then cannot afford to use once they have because of high deductibles and co-pays" is certainly accurate. The question is do we want to pay the higher taxes to eliminate the high premiums, co-pays and deductibles. I don't know what the necessary amount of tax increase is but I suspect that another $150 billion a year should cover most of these shortfalls. I think that it's imperative that we do raise taxes to pay for much better coverage; but I suspect that there are many Americans that don't agree.
28
@kbaa
The American public has not finally learned to love Obamacare and Nancy Pelosi. Had Trump and the GOP not repealed the Individual Mandate, the Dems would not of made any inroads in this last election either.
Everyone involved in the creation of this hated law should be banned from public life for eternity. House Speaker Nancy Pelosi my foot.
6
@kbaa
"but yet there has been no acknowledgment of their role in the current catastrophe."....
From your comment and by "their", it seems you have left the healthcare insurance companies out of the blame when, in fact, they were principal architects of much of the ACA's design. It seems, to me at least, that they deserve considerable credit for much of its failure as well. That said, please tell me how that political windfall to the GOP has translated into any positive improvement to the situation other than allowing people (many btw, not of their actual desire) to forego the security of health care. Being irate is not a substitute for coming up with good ideas for a workable solution.
12
Professor Pollack you are correct that the Democrats must not look for assistance from the Republicans but just get it done. Healthcare for all is just too important an issue that needs to be fixed for our nation now instead of procrastinating.
It would be a political suicide for the progressives if they do not try to do what they promised the nation to provide. A quality healthcare system, free from the nuances of profiteering and greed. 2020 is not far away and if the electorate feels that they did not even try to deliver on Healthcare they are toast.
Increasing the availability of Marketplaces is okay but it still doesn’t answer some basic questions on healthcare delivery.
Currently we are spending close to $3.4 trillion of which almost 20% is for the profit and overhead of the for-profit companies involved in the delivery of Healthcare. It is almost $680 Billion per year. With a single payer system and negotiated savings from the medical devices and Pharmaceutical manufacturers the system can effectuate a savings of almost $ 20 Billion bringing it to a reduction of almost $700 Billion in overall expense of Healthcare.
A two track approach would work for the Progressives which should include a short term fix of ACA with a major push for a single payer system getting the profit motive out of this basic human need just like clean drinking water.
Time to get to work now.
67
If I had a dollar for every person that said that single payer was a good idea but politically unfeasible I would be a millionaire. The problem here is our politicians and the people failing to hold them accountable. Medicare-extra for all seems like a good idea but I worry about costs - everyone with complicated expensive conditions will choose medicare-extra so over all the insurance pool will be too expensive and unsustainable, creating the same 'death spiral' that we see today.
This article notes that premiums and cost sharing would be capped at an 'affordable level for everyone' - thats what we were told with the Affordable Care Act. Medicare-extra could have some benefits, but lets set our sights higher, folks.
2
While Mr. Pollack lays out a god argument for not pursuing Medicare for All, it really is the best idea. Medicare for all would do the following:
Companies no longer will provide Health Care Insurance
Takes care of pre-existing conditions
Allows people to keep their own Doctors
It is portable, in other words if you are traveling somewhere else in the Country and get sick, Medicare will cover it.
If you take a job in another company or move, you will still have Medical Coverage where ever you are employed or moved too.
It will provide every citizen with very good Health Care.
And here is how it can be paid for:
Remove the cap on earnings to be taxed. Right now it is at $123,000. That will put more money in the Medicare Fund
Raise the tax on both Employer and Employee by 1%
Cancel Medicaid and let Medicare for All replace it.
Insurance companies have proven that they are only profit motivated, not patient motivated . They had their chance and they have blown it over and over. If people are worried that jobs will be lost, Medicare for All will need many more employees to run the program.
And last but not least:
Keep the Congress from dipping into the fund.
141
@Jean
Paying for it wouldn't be that tough--It would almost pay for itself because of the trillion dollars the US would save by switching to Medicare for all. People often forget about how much is saved, and that pays for it.
10
@Jean. There is no cap on income for Medicare tax. Income is capped for Social Security - $128,700 for 2018.
11
@Jean
I thought Medicare was taxed on all income but only at a 2% rate, which is too low.
4
My oldest son is a new physician and he and I have discussed one important change that's absolutely vital to health care reform and lowering costs--eliminating medical student debt by requiring 4-5 years of public service and a government's role in setting salaries along with regulating medical malpractice. While my son received a full-tuition scholarship to a major medical school, he still had a $150,000 debt for living expenses and gladly would have been willing to work, say at the V.A.which has a massive physician shortage, for 4-5 years to eliminate his debt. In Canada and Europe medical school is free, but this debt relief plan would allow physician access to under-served populations like the V.A. and rural America. Control of medical malpractice would lower the costs physicians pay for insurance and eliminate the practice of "defensive medicine" that costs the medical system tens of millions of dollars annually as doctors order unnecessary tests to protect against a law suit. In other words, health care reform should not be myopically focused solely on the cost of insurance, but on other major factors like physician salaries and fees that are significant part of health care costs.
97
@Paul Wortman
So your son graduates medical school, and does a residency - say surgery. So he's around 32 years old after residency. Now he does his mandatory 5 years of govt work. Now he's 37 assuming no breaks in education. At 37, he has no savings, no net worth, has sacrificed his youth learning his profession. Now, he goes into a govt regulated system becomes a govt employee with depressingly low salary, no autonomy, and maybe a goal of retiring in 20 years with a pension. His peers who did not go into medicine have satisfying careers, houses, families, money in the bank. He has a white coat and still lives in a small apt.
This will destroy medicine in the USA as we know it. Go to Britain or drive up to quebec and look at their hospitals if you want a preview.
1
I believe this country needs to move to some form of universal health coverage that includes a public option, and do so quickly. But I am concerned that many of the facile proposals for universal coverage or Medicare For All ignore the reality that healthcare accounts for upwards of 18% of GDP. Any realistic plan that won't have dire consequences for healthcare and the economy - and, for that matter, be met by strong resistance by those whose livelihoods would be threatened by these changes - will have to include clearly articulated programs for transitioning people now involved in private sector healthcare administration to roles that support improved access to and delivery of care. While doing so may not significantly decrease the percent of GDP devoted to healthcare, it will at least promote more of those resources being devoted to activities in the healthcare sector that improve quality and outcomes.
17
Agreed, but as Pollack says, “Medicare for All” is politically impossible for now. As a short-term effort to reduce system costs, Here’s one relatively easy change: simply mandate, perhaps state by state, that all insurers accept a single claims form, with a common set of diagnosis and treatment codes. That will reduce the number of insurance clerks required for all service providers.
1
@aea Why can't a medicare for all plane be implemented in clearly articulated stages so the insurance companies, employees, and individuals can prepare for it and get used to it. Kinda like for cars. Manufacturers were given a period of time to refit and adjust cars to fit the mileage mandates. They weren't happy about it at first either.
All the facts are in, and questions answered. Costs are high, and can ONLY be controlled via a single-payer plan. But the elephant in the room is the 30-40% of total healthcare costs wasted on administrative overhead, with all the pre-authorizations, denials, appeals, and other paper shuffling driven by for-profit insurance companies trying to keep a larger share of the premiums and spend less on health care. At least half of that can be saved in a single-payer system - much more than enough to pay for everything we need, covering everyone. Yes, taxes will go up, but 95% of households will pay less than they currently do in premiums, copays, deductibles, prescriptions, etc. ALL public option plans are nothing more than lifelines to these wasteful, inefficient, for-profit insurance companies. The ONLY route to a successful system is a complete move to single payer improved and expanded Medicare for All - with all the good and none of the bad. Lower costs, better care, less waste - what's not to love? I'm a neurosurgeon, and I fully support this. See info at https://newimprovedmedicareforall.org.
6
Scaling back expectations of relief from the democrats already. Apologizing for the corporate cruelty and assuring we remain slaves to the corporations. Here in lies the reason that Trump won. Democrats have a constituency and it is not the American people. The GOP is super cruel and obviously so. The democrats are just a bit more sneaky. So we will flip back and forth forever hoping that finally someone will do something for the people. Except what we will get is obvious corporate lackeys (GOP) and sneaky corporate apologists (DFL).
1
Democrats have learned from their former leader Obama that the only way to pass the healthcare t is to tell the American people naked lies. "If you like your doctor, you can keep him. If you like your health plan you can keep it. The average cost will decrease by $2500 per year" Obama told bald faced lies day after day about the "affordable" (gag) healthcare act and this paper remained mute as he personally shoved that monstrosity down the throats of the people. But for John Robert's relabeling it a tax, (Obama said it was not a tax) it would have been thrown out as unconstitutional. Now Ms. Pelosi who admitted she never even read the bill before she voted for it is back in charge. She will bring more of the same tired old big government ideas to the table. Stay tuned.
2
As bad as ACA is, is still better than what it was before, because at least it helped some, while the old system helped only insurances.
1
The Democrats should take on the extortion of Big Pharma. Nothing else they do will make any difference as long as the drug companies can raise their prices at rates several times that of inflation.
Americans who become ill are being sold into slavery. Tweaking Obamacare won't fix that.
5
Government should get out of the health care business for those of us who do not want this intervention. All I need is catastrophic health insurance, which is what I had before this fiasco of Obamacare. I am 56, healthy, take a couple of medicines, and know enough to get regular check ups, mammograms, colonoscopies, etc. I can pay for these visits myself. However, I am smart enough to know that if I develop cancer or am in an accident, I will need insurance to cover what could be astronomical bills.
But Obamacare does not allow me to do this.
What do Democrats not understand about "choice?" My body, my choice.
Get your paws off of my body. You have no business dictating to me how I should take care of my own body.
2
Well then, thank goodness you don't need the Democrats. You can just avail yourself of the Republicans' excellent healthcare plan and rest secure in their respect for your bodily autonomy. Not.
1
But that is what the ACA insurances do. With high deductible, you barely could use it for anything else other than for catastrophic events. It is true, premiums are high, but premium of catastrophic insurance were growing as well before ACA. Remember, once you got a cancer, it is long term condition, and. even if insurance covers only such catastrophic condition, they still need money. Where will they take these money? Correct, high premium or limit in spending leaving you on the hook for the rest.
1
@Jackie: You are ignoring the basic tenet of insurance: the bigger the pool of people, the more costs can be spread out. So what if you are healthy? You could become unhealthy at any given moment. Accidents and illnesses occur every second of the day to people who considered themselves "healthy" the second before their diagnosis of illness or their accident occurred. You are healthy until you are unhealthy. As a part of the insurance pool that is healthy, you are helping to share the costs borne by those who have become unhealthy. The day that you become "unhealthy" - and that day will come, because you are a human being - your costs will become shockingly astronomical, and you will be grateful that other "healthy" people are out there, helping to cut back on those costs and saving you from utter ruin. I sure that many of those people will also begrudge you their help, just as you are begrudging the help you are unwillingly giving to others.
1
Until Democrats acknowledge they manipulated the American public with ObamaCare, there can be no reconciliation. R&R is the only way to fix this mess.
Agreed....conservatives did indeed develop the healthcare model known as RomneyCare. And yes...Democrats quickly embraced it because they could steal the moral high ground by claiming ObamaCare was simply a 'conservative' idea and RomneyCare a Republican model.
The defies logic.
Romney Care was developed as a STATE model.
That's a simple one state model to be tried with one states' residents and one states' taxpayers and one states' legislature. This same state has mandates that literally force you to buy health insurance. This same state is the only state that passed a law post-ACA that still mandates people in their state buy health insurance or face a huge fine.
A state model is not a national model anymore than a tricycle is a Harley Davidson.
Dr. Gruber was right. If not for the stupidity of the American people, this never would have passed.
The answer to our current crisis is to unpack ACA and go back to RomneyCare, a state model that can be adopted and changed by each of the 50 individual states that meets the needs and budgets of each of those 50 states.
Let the states innovate. If MS or CA wants something unique, who the hell are we in MN to tell them different? Go back to the model as designed.
D's tried to sneak in Single Payer and this is dead. It's not gonna happen. So fix it. Give us RomneyCare.
@Erica Smythe. I'm genuinely curious why you think healthcare is a state model, and not a national model. Is there something specific related to health that is different for people in Minnesota that would not apply to us in Colorado?
1
The United States is the only country in world history in which a mother could tell her son that he would have to spend his entire life in exile in order to be eligible for health care. This is precisely what my mother told me fifty-two years ago, so I left. Whenever I hear American politicians say how wonderful America is with the words “only in America” I think of all those Americans who are ineligible for health care. Last year 4,800,000 Americans declared bankruptcy because they could not pay their medical bills. 45,000 other Americans died because they had no medical insurance. I have lived in eight countries that have socialized medicine. The cherry on the sundae was that none of these countries had a Second Amendment.
15
I wonder how much American violence adds to our healthcare costs. For everyone killed in our weekly massacres many more survive with terrible injuries. The cherry on that grotesque sundae is that they get to cope with the losses, pain and expense alll on their own. Even if NRA puppets wanted to help them - ha ha ha! - they couldn't afford it at current bribery rates.
3
Screw the Affordable Care Act, which is neither affordable nor offers health care (it offers "access" to health care, which is not the same thing, while leaving roughly 30,000,000 Americans uninsured). Instead, Medicare For All. Now. This is both good policy and good politics. The Democratic Party would win in a landslide if this were their actual platform; it is not, the hacks running for President in 2020 are only giving it lip service. That they do not see or cannot see Medicare For All as both good policy and good politics is a testament to the degree to which the Democratic Party has been corrupted by lobbying and campaign funding (i.e., bribes) by the Medical Industrial Complex.
4
Finally, at long last, the Democratic party is 'owning' Obamacare.
1
Universal health care for all is the only solution, eliminating the vast array of insurance companies and medical billing firms that raise costs while allowing the government to set prices for drugs, hospitalization and medical procedures. Whatever tax increase would be needed to pay for it would be miniscule compared to the private insurance premiums now paid by Americans or their employers. Australia and all the other developed countries in this world seem to manage just fine without making health care a business, without overly burdensome taxes and without running a deficit.
1
Sen. Joe Lieberman (Conn.) was single-handedly responsible for deleting the Public Option from ACA.
His actions to back the insurance industry's financial benefits vs supporting nation's future will go down as an example of leadership beholden to special interests and dereliction of his duty to the country.
www.publicintegrity.org/2015/02/16/16766/elimination-public-option-threw-consumers-insurance-wolves
14
There's no going back. Whatever the Democrats do, they will advance health care options for the American people.
Only Republicans don't care about people suffering for no reason. The GOP is toxic, unless you believe that billionaires need tax cuts.
"Similar structures work well in Western Europe. " Though oft repeated, this is just a lie. Western Europe uses taxes paid by everyone (including the poor) to pay for these broad benefits - mainly a VAT (or sales tax) which exceeds 20%. By contrast, most Americans pay little or no income tax and only pay 7.6% payroll taxes.
This basic math frustrates liberals including Prof Pollack. "Although a single-payer system would reduce overall health spending, it would require major tax increases as we moved private expenditures onto the federal tab. "
Instead, liberals inch toward single-payer in a dishonest way by expanding both the Medicaid and Medicare populations - even as the trustees for these programs recognize their pending insolvency. https://www.wsj.com/articles/social-security-medicare-trust-funds-face-insolvency-over-20-years-trustees-report-1466605893
The simple fact is there is no free lunch. Large government programs require broad taxes - which Americans mainly will not accept. If healthcare is a right, then why not housing or food or other essentials ? If we want to improve the lives of ordinary Americans, we need to encourage not just full time work (as the EITC already does and Republicans want to expand with Medicaid work requirements) but also promote marriage and education which are the cornerstones for a middle class life.
1
@Alan Backman
American's don't like their government but they like their insurance companies even less. Medicare-for-all has broad public support, including the concept of raising taxes. Its the rich that don't want to pay their fair share of taxes. I support the idea if calling it a 'premium tax' to show that it is replacing insurance premiums with a tax. Most Americans would pay less and get more.
2
@Elizabeth Frost
Why should the rich pay for you? Or anyone else pay for you for that matter?
@Alan Backman
Alan, it's perfectly straightforward. The rest of the developed world spends half as much per head on heatlhcare -- but gets outcomes at least as good and covers every citizen from cradle to grave. Who cares about their VAT?
You're right that these rich countries generally pay higher taxes than the US, but this isn't because of healthcare: it's for their more generous welfare systems. In fact, only Switzerland, Norway and Luxembourg spend more of their taxes on healthcare than the US.
https://data.oecd.org/healthres/health-spending.htm
US healthcare is outrageously inefficient and exploitative and must be reformed.
1
Churches and other so called charitable trusts should be taxed on their wealth and assets then the government could fund universal health care for all USA legal citizens. Most of these religious institutions and so called charities who run businesses and pay no tax only do the bare minimum required to qualify as a 'charity' and have a charitable trust status. There's nothing charitable about them at all and religion has no place in the law making legislature of a democratic nation. Democracies are not Religious Theocracies.
2
Indeed, health care will continue to be a hot button issue, as all of us either have a medical condition (however mild right now) or will develop one in the future. That is 'the nature of the beast'. That's why we need a system tham covers any and all of us, as you said, with quality affordable care. Who would have thought that the employee-sponsored health coverage started around the WWII period would, today, be detrimental in trying to change to a more functional system that embraces all. No one expects the necessary changes to be easy, especially when we have an ossified and rigid republican party that, hypocritically, is denying others the health coverage they take for granted for themselves. So, if we have the 'ganas', the will, we shall proceed, and the sooner the better, as it will require courage, hard work and perseverance (certainly on democrat's side, as the G.O.P. seems oblivious to change anytime soon, a shame really).
What a shame that America keeps insisting it must invent the wheel, when advanced and efficient wheels have been rolling along nicely in the rest of the developed world for nearly 50 years!
On a recent overseas trip, I was forced to visit an emergency room to seek treatment for a case of food poisoning. Cost of the emergency room visit: $16.50. Fee for the laboratory analysis of my stool sample: $2.30. Fee for the medication prescribed by the emergency room physician: $5.60.
Here at home, I cannot recall ever having visited an emergency room without being dinged for several thousand dollars.
Wake up, Democrats. Stop trying to tweak your creaky Rube Goldberg contraption in the name of "bipartisan support," and start educating the public about what has actually been proven to work.
11
I’ve been practicing emergency medicine for over 30 years and am an independent centrist Obama supporter. I also purchase my own health insurance. Here are some thoughts and suggestions.
Yes, we a need single payer system but it needs to be two tiered. Everyone gets the basic first tier but a secocond tier can be purchased separately.
A public option is the best alternative to Medicare for all.
The conservative middle class needs to realize they are being conned. They will always pay for Medicaid etc because America will never refuse to take care of the poor- so the middle class might as well get it ( “Medicare for all”) too. The conservative middle class needs to realize this is not a socialist plot but rather common sense.
Doctors and other providers should spend a minimum of 80 percent of their time doing patient care. Politicians have totally failed us because they have allowed and encouraged ridiculously inefficient computerized systems and health care bureaucracies to run amuck resulting in something closer to 20 percent patient care time.
State level congressional delegations should hold serious town hall type forums for health care professionals to allow for our input before enacting any major changes. This did not happen before Obamacare -which was a huge mistake. I’ve unsuccessfully attempted to have a conversation with my two Washington State Senators’ health care staff many times for at least 10 years. This is an example of unacceptable arrogance.
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@Doug M
Excellent well thought out ideas.
6
@Doug M A two tiered system should make room for coverage for catastrophic illnesses. Cancer, for example, is now medically survivable. It is not financially survivable without good and reliable insurance. And that insurance must be transferable across jobs. Otherwise, ruinous debt will be incurred. Currently, without good insurance, the middle class is being sold into slavery.
13
@Doug M
I think you have some very cogent points in your commentary. I have a friend who was a general practitioner for 16 years with Kaiser Permanente, a leader in computerized medical records as they like to point out. She loved being a doctor, but the upkeep needed to enter in the notes for her patients took so much time that she was working into the wee hours of the night doing her notes.
My friend ultimately left Kaiser for a multitude of reasons, but one of them was the onerous task of electronic record keeping.
I've worked in health care marketing for the last eight years for various health care (insurance) companies. They spend a lot of money each year to gain market share during open enrollment. Think about what that money could do used for actual health care.
I'm all for a public option, because no one should have their health care coverage tied to work, which is not reliable in this day and age.
13
A seldom remarked on problem with marketplace insurance plans, most of which are offered by the big commercial insurers is that physicians like me are not in nor can get in network with them, even where I am in network with every other plan the insurer sells. If I mistakenly accept and see such patients, I get paid $3.00 (yes three dollars) for a consultation and, unless the patient has agreed in writing in advance to pay the rest of the charges, I can not balance bill them either. Medicare for all in any form would presumably fix this egregious loophole in ACA marketplace insurance.
1
Medicare for all.
If Dems take White House, House ,Senate in 2020 use "nuclear option" to bypass a Senate filibuster.
If the GOP could use "nuclear option" to put two arch conservatives on the Court then surely health care is as important for Dems.
2
Well, Nancy Pelosi has been presented as some kind of liberal in her bid to be Speaker again, but she isn't, and certainly not on health care. If there isn't some effort toward at least lowering the Medicare age, voters are going to be very disillusioned. You can usually count on Democrats to go in conciliatory, like Obama, instead of fighting for the people who put them in office.
@RAC
I don't know what evidence you used to form your OPINION of Nancy Pelosi's position on access to health care.
The FACT is that when Nancy Pelosi was Speaker, with her leadership the House actually included a Public Option in the ACA.
(The idea was that people could choose to keep their private insurance or opt in to the Public plan and, those of us who believe a public plan is better than private insurance, assumed that more and more people would choose the Public Option, moving in the direction of Medicare for all. That is why the Republicans have spent so much money demonizing Pelosi)
The Public Option died due to the Senate, not Pelosi. Again, she supported it before, and has said that she supports it now.
2
@Lynn
So why does she support the so-called kneecap rule on any changes to tax policy? I plan to lobby my new member of Congress to oppose her as Speaker.
1
There are stark political realities that still keep any form of single payer healthcare system in the US a distant goal. But the ongoing battles over “ObamaCare” and its Medicaid expansion offer some degree of hope and many practical insights. The most important such insight, which should not be dramatic or a surprise, is that the GOP is not, and never was, interested in helpful compromises. The compromises must be made between progressive and corporate democrats. And such compromises are worth forging if they offer much needed relief and opportunities to long suffering citizens while also moving us closer to the ultimate goal of high quality universal healthcare.
1
So it sounds like expanding both Medicare and Medicaid to cover far more individuals seems most reasonable for the time being. But this absolutely must be paid for by reconfiguring care from sickness care to health care. Cigarettes, alcohol, and nutrient absent foods must be taxed to help pay for the programs. Vegetables must be delivered to food deserts and subsidized. Exercise must be rewarded, and screenings, well visits and vaccinations must be free for all. Our current health industry’s expensive in part because of poor health of our citizens, expensive insurance, and in part massive litigation in this country. All will need addressing collectively to get us out of the current wasteland.
I wouldn't know where to find the actual ACA law and if I did, even to understand the language in it, but if I'm not mistaken, the ACA itself already has an "unchecked box" provision that, when checked into action, provides that Medicare-like, public option.
If true, this could come about rather quickly, it seems. Congress would only have to check that box now.
(And I'd love to be corrected if my memory and assumptions are simply incorrect....)
Cost cutting has to be part of the equation. And why do we need spa like hospitals complete with valet parking, lobbies that rival 5-star hotels? Ever been to a hospital in Europe - plain, bare bones, clinical in decor. Someone has to pay for these buildings? We don't need them! If we want to move to what the rest of the world has the fluff has to go - we won't be able to pay for that stuff too!
17
@Anita - But how would we get from here to there? The hospitals have already got these fancy buildings, and have issued hundreds of billions of dollars in bonds to pay for them. They are legally obliged to make the interest and principal payments.
1
@Anita Don't kid yourself. The plain, bare-bones hospitals charge every bit as outrageously as the fancy ones. Been there, done that.
As Winston Churchill famously said, you can count on Americans to do the right thing, but only after they have exhausted every other alternative.
36
Medicare available to all would save the US up to $1 trillion per year, as Ed Eichhorn and I show in our upcoming book "Healing American Healthcare." This incidentally would not require the raising of taxes and would save US corporations $240 billion per year. Moreover, it is a blueprint for corporations who could provide gold, silver and bronze plans for their employees based on Medicare as a chargemaster. As a practicing physician I can say that you go too easy on the ACA. As part of our plan the odious Electronic Health Record would have to be drastically simplified and structured so that any record can, with the patient's permission, reach into the patient's record in other locations. There is no reason America cannot once again have health care that is the envy of the world.
27
@Michael Hutchinson - That would be a sensible reform, but having everyone pay at the Medicare rate would cut physician income drastically. How would you make up for the lost revenue? If you have high overheads, you might not be able to make any money at all.
@Jonathan - First, a system based on Medicare as a chargemaster would dramatically reduce the overhead for any physician office (or hospital for that matter). Second, most of the plans would be corporate, and corporations can offer gold, silver and bronze plans to their employees. A bronze plan would pay physicians 100% of Medicare rates, a silver plan would pay 125%, and a gold plan would pay 150% of Medicare rates, giving employees access to larger pools of physicians. Since gross physician income is less than 20% of total healthcare, even an employee with a gold plan would save the corporation money.
1
@Jonathan Though different people imagine vastly different visions of the soundbite "Medicare for All" would actually look like, any of them would probably cut down substantially on physician and hospital overhead since dealing with the same payor by the same rules would reduce the costs of employing the huge number of back office staff who are employed to deal with authorizations for tests and treatments, being sure their employers are in network, that a patient's insurance is active, coding procedures and diagnoses and submitting, following up on and appealing denials of payment by commercial insurers. The downside of course is that unemployment would rise considerably, not only on the provider side but also at the commercial insurers and pharmacy benefit managers.
1
"Millions of Americans want these public options, because they are fed up with private insurance."
Some of that discontent can be traced to the arbitrary and capricious behavior of certain insurers, who built the mistrust that now plagues them. Instructing claims reviewers, for example, to deny the legitimate claims the first time around and see what the patient does about it is something to which I can provide personal witness. The insurers, nonetheless, are likely here to stay and thus need to be part of the revamp of the ACA that the electorate is expecting. The new House has to start the ball rolling responsively and responsibly.
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@FactionOfOne
News flash. Medicare competitively selects private insurers to administer Medicare FFS. More than 1/3 of Medicare beneficiaries have chosen a private health plan alternative to Medicare FFS. The upshot: Private insurers/administrators may be part of the solution. May I suggest that you look to health system cartels as the major driver of exorbitant pricing (and poor customer service)? And BTW, the "not for profit" provider cartels pay multi million dollar bonuses to execs to consolidate, raise pricing to non governmental payers. E.g.:More than 30 Sutter Health execs received more than $1m in annual comp. Please get the facts.
3
Let's get real. The ACA, a huge marketplace and economic failure, can be easily fixed economically, not politically. Of the 10.3 M covered in the ACA "market", only 1 M are non subsidized. They pay exorbitant premiums for high deductible plans. In many major metros, like Phila, there is NO plan competition (exhibit A, market failure). As taxpayers, we subsidize monopolistic health system cartels, which are paid more than double the Medicaid payment rate from private insurers. Why should providers receive 200+% Medicaid rates for a population previously largely uninsured (i.e. "bad debt"). Solution: Abolish the ACA non functioning "marketplace" in favor of expanding Medicaid coverage (with its much lower provider payment rates). As a non-subsidized ACA member, paying > $1000 monthly (individual only) for a $6k deductible, limited network plan, I would love to purchase Medicaid coverage (much cheaper) with no copays/ deductibles, choice of 3 Managed Medicaid plans, and access to all teaching hospitals. Why should taxpayers subsidize such a dysfunctional system that rewards health system cartels? BTW, the same applies for "private" employer coverage. Why should employers/employees pay provider cartels double Medicare rates? Wake up. There IS NO effective market for health plan or providers. The only effective solution is utility-like rate review--- of hospital budgets---and "all payer" private pricing determined by a commission or Medicare pricing for all patients.
26
Lots of words about coverage and not a single one on cutting costs. Healthcare in the US is unaffordable to many due to outrageous costs. No program will succeed unless it addresses per capita costs that are double or more of others ( with generally worse outcomes).
49
Corporate provided insurance costs for a family of four averages around $20,000, of which the employee pays about $5000. We spend over $10,000 a year on healthcare for every person alive in this nation. Where does that money go? In whose pockets does it flow? If we want to reduce the costs of healthcare, these questions must be answered. A problem cannot be fixed until it is identified.
Many problems are structural. We now practice protocol medicine where any set of symptoms presented triggers the same tests and procedures regardless of the particulars of the patient/customer. This minimizes liability and drives up costs and makes the most money possible for the providers. From my perspective, if this is how medicine is practiced, then it isn't practiced. It's applied. In that case, what do we need doctors to direct and diagnose for? We only need symptom discoverers and lists of triggered procedures. That's a computer. The doctors will only implement the procedures, and as soon as the robots can do that, we can get rid of the doctors.
Policy makers do not address these issues, especially the $20,000 annual costs. If we had a government supported system (like Medicare) that costs, say $15,000 per family, each company would save $5000 per employee. Who would pass that up?
The hang up is that $20,000 goes to a private insurance company and most Americans would rather do that than pay $15,000 or less to the government for better service. Big problem to solve.
22
@Bruce Rozenblit - Most large companies pay health care costs directly, and only use the 'insurance company' to handle the administrative details. So that $20,000 goes directly to doctors and hospitals. It mostly ends up as income to high-salaried employees.
3
@Bruce Rozenblit
People have analyzed--and largely understood--the sources of our enormous costs for some time: https://www.pbs.org/newshour/economy/why-does-health-care-cost-so-m AND https://www.nytimes.com/2017/04/04/books/review/an-american-sickness-elisabeth-rosenthal.html .
The biggest impediment to beginning to address the problems is our tribal partisan warfare and our elected representatives. No doubt this is influenced by very powerful lobbyists, including (but not limited to) the major insurers and big pharma. In addition, the idea that any open market system will fix these things is fraught.
5
@Bruce Rozenblit
Here in Australia I pay for Private health Insurance to cover me and my family for optical, dental and other things that our "universal Healthcare" does not cover.
For a family of 5 with 1 smoker and one with a pre existing heart condition the annual cost is A$4000 (US$2740) there are no co-pays or any extra monies we need to pay. It is a Gold or Top Tiered private cover.
4
What we really need to do is cut costs.
We currently spent $3 trillion on health care, while total payrolls are $8 trillion. There is no conceivable scheme that can allow us to spend 3/8 of our earnings on health. Individuals can't pay, insurance can't pay, the government can't pay.
So until costs are cut, we will get nowhere. Cutting costs would be painful, and have a huge impact on the 20% of our economy that supplies health care, but we don't have much choice.
3
All good ideas. Yet, they would not stop the march towards insolvency. If we don't act to both increase tax revenue and at the same time control costs, the whole issue will be moot. Just take a look around the world and see ow other countries deliver health care. Better outcomes for about half the per capita cost. Yet most Americans ( yes, both D's and R's) are counting on magic being part of the solution. Unfortunately. unless we vanquish the lobbyists of Pharma, etc. we will still get the same horrible results. Maybe as the net great Depression unfolds, we will get an FDR like leader to transform the system. Until then, it will be just like dying. It happens slowly,.... and then all at once.
10
@Mark
"Unfortunately. unless we vanquish the lobbyists of Pharma, etc. ..."
And the politicians, both D and R, that take their money. I don't know any requirement that says that they have to.
Remember the amendment Bernie Sanders introduced to allow lower cost pharmaceuticals from Canada? The likes of Rand Paul, Charles Grassley, and Ted Cruz voted with Sanders. While Dems who took 6 figure sums from Pharma - yeah, like you, Cory Booker and Patty Murray - voted against it and killed it off. See anything wrong with this picture?
4
@rtj: Even though I am a staunch Democrat, I have to agree that there are too many Dems who have joined the Republicans in serving only wealthy donors and corporations. Booker's siding with Big Pharma will eventually come back to bite him at the polls. We need representatives who are committed to fighting for us working families.
2
I think Harold Pollack is right. We can't transition immediately to a universal healthcare plan although that is the world standard. We need to transition to that state. The most politically feasible plan I would think is the public option. Allowing all Americans to enroll as payees into the existing Medicaid and Medicare plans would bring many millions of citizens into public sector insurance. Undoubtedly, this would be build broader acceptance to the idea of universal public insurance. The next problem is to ensure that both private and public healthcare providers can survive and prosper under such a system. Medicaid is a wonderful benefit for low income people, but the program finances itself by systematically underpaying all participating providers. Medicare too, does not pay full freight. So these issues, as unpleasant as they are, need to be addressed.
4
Let’s make this perfectly clear . Making Medicare available to all rather than a planned and orderly transition to a true Single Payer Medicare For All system is nothing more than a smokescreen to aid health insurers Plan B of privatizing Medicare .
Private , for profit health insurance companies will primarily fear monger and obfuscate to maintain their death grip on America’s healthcare system but as the far superior Single Payer approach gains momentum and favorability , they’re positioning themselves to wrap their greedy tentacles around the Medicare system itself as a back up plan .
Don’t fall for it . Until these third party rent seekers are removed from the equation healthcare for people , and it’s attendant dignity and security ,will always come second to profits .
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@Paul G Knox
"Profits?" When presidents get $$$$$ book contracts, lectures on "profts" are D.O.A.
(D) just spent 10 years, lecturing about "Citizens United." Then, they out-spend non-(D), 2 to 1. Talk is often phony and useless, sir.
The enactment of the A.C.A. was the one of the last acts of political courage l can think if in the past decade. Given the price the Democrats paid for this, I wonder if they can or will do it again.
4
Your implication on how the ACA came about reeks of both-siderism. While the final votes on the ACA followed partisan line, the bill, unlike Republican attempts to repeal and replace, did have some amendments that came from the other side of the aisle.
The ACA was certainly not a unilateral bill. The Republican bill was beyond unilateral in that there were no hearings or opportunities for Democrats to introduce amendments. In fact there wasn't even enough time for most Republicans to read the bill before the vote was taken, much less the Democrats.
14
In putting together their health plan, with the fastest growing age group in the US being those 85+ and over, Democrats should consider the special needs of the elderly. Currently, many things the elderly need to remain independent as much as possible are not covered by Medicare: e.g. glasses, dentures, occasional household help (e.g. cooking, dressing), adult day care, etc. Not to mention that most elderly have to bankrupt themselves to get on Medicaid if they need long-term nursing home care. (This type of care = thousands of $$ a month.) If these points are addressed, they may attract support from elderly people who may tend to vote Republican or their family members who have to take care of them. In other countries, these issues are less of a concern. For example, my elderly Canadian relative gets home care services without any issues through their national health care system.
It is well-known that many people do not know Medicare does not cover these things and only find out when they or their family member ages or becomes chronically ill.
10
Please read the Center for American Progress’ Medicare Extra for All plan mentioned in this article. It details important ways to expand needed care for elders including hearing and vision services. It truly has something for all.
1
Classic policy wonk fantasy ignoring political, economic and health care reality. Democrats are just as beholden to the insurance, hospital, pharmaceutical and technology lobbies. Health care surpassed retail as largest part of our economy and curtailing it switching from private to public sector will have serious economic consequences. Finally many hospitals and medical practices will not survive on Medicare reimbursement. Let's get real.
6
@etchory
Well then they have to go under and disappear. Health care should not be about profit enterprises and our concern being that "medical practices and hospitals" may not survive on fair costs and prices covered by Medicare reimbursement. They do so in other countries.
@etchory So you suggest... what?
Let me suggest some things.
.
First, I like the idea of full Medicare for All. It makes sense at least to offer Medicare on ACA exchanges where there is only one, or no private insurers selling policies. And I would also suggest that all Americans with preexisting conditions should be able to buy in to Medicare as well. But we must do more. I would like to see a hybrid system with limited Medicare for all, and private insurance for those who want better coverage. Those stripped down cheap policies that Ted Cruz wants us to buy? If I had my way The Government would provide something similar to all Americans. It would have means-tested catastrophic coverage designed to prevent medical bankruptcies and act as a backstop to private insurance payouts: and it would pay for annual checkups and vaccinations to help make everyone healthier. If people want better coverage they can buy it from private insurers. But nobody would have to.
.
Second. Let’s get away from “single payer”. Not all Americans are ready to pull the plug on the Health Insurance industry in favor of government run health insurance. I’m leery of it - and I lean left! No as I see it: if single payer happens, it will be because average Americans are so fed up with the games played by health insurers that they would rather let the government take over. I get closer almost every time I call my insurer - but I’m not quite there yet and I don’t think most are.
3
@ZAW What you describe is very similar to how health care works in Australia. I lived there for 8 years as a legal resident so I was eligible for Medicare, which is single payer insurance. All I had to do was go to the Medicare office and sign up. Medicare there covers a set amount for basic health care costs and eye exams, and fully covers catastrophic injuries and illnesses. Private health insurance is required for higher income workers to supplement Medicare and remove some of the burden of hospitalization from Medicare. Since I have moved back to the US I have been struck with how much easier it was to get health coverage in Australia. Applying for and maintaining health coverage (even Medicare) here in the USA requires yearly navigation of confusing choices and rising costs. It adds to the stress of daily life. I am fed up with private insurance companies. I am fed up with having to go through complicated renewal processes every year. We need a single system in this country so that all healthcare levies, whatever form they take, are put into one pool to cover all costs and to negotiate reasonable drug prices, and to make it simple for everyone to get health care and not worry about losing coverage or going broke. I am amazed that people are more afraid of “single payer” than of being bankrupted by the insurance industry.
18
Certainly good intentions, but not enough. The alleged failure of Obamacare is entirely due to the ill will, shenanigans and general nastiness of the GOP. Period. Enough of this, they will ALWAYS be an impediment. 2020, is the time for we Democrat’s to act.
Medicare FOR ALL: 2020. If not then, when ???? I personally predict the biggest Blue Wave since FDR.
Seriously.
31
I think allowing people over fifty to buy into Medicare would be an extreme my sensible move. They are the ones who lost jobs that has medical benefits and are back in the labor force in jobs that do not have any or very few benefits.
People over fifty are very likely to develop chronic illnesses that are much easier and cheaper to treat if diagnosed early. Too many Americans limp along and enter Medicare requiring very expensive treatments and already suffering ailments that will significantly shorten their lives.
50-65 are the worst ages to be uninsured. Medicare costs long term will rise less slowly if people are more healthy at 65.
I agree that America is not ready for Medicare more all, but rolling out a buy In to Medicare would be a good step.
Another alternative is for the government allow a bit into Medicaid and have the opportunity to buy Medicaid-Plus policies, similar to Medicare Plus policies that offer higher levels of coverage.
The goal is to get basic health care available to all Americans. Trump's cheapy policies are a scam as they cover so little. People get less than they pay for.
The 2018 election results are clear. Time for Republicans to stop trying to destroy Obama care by 1000 small cuts. We deserve so much better. Our health care system, which is expensive, inefficient, and having poor outcomes is, a huge drag on national wealth.
15
Our health care system is demonstrating system failure. It is by far the most expensive in the word. We spend over 45% of what the world spends on health care. We do not have 45% of the world's population.
Our health care system is bigger than the combined GDP of both Canada and Russia. Half our polity is happy with its health care; the other half is not.
Yet, we have millions uninsured and/or underinsured.
We have some twenty million Americans who have been or still are dependent upon opioids. Our degraded medical work force is responsible for that.
We have the highest maternal mortality in the OECD.
We are even suffering from declining longevity. The collapsing USSR suffered from that problem.
It is no accident we lag behind other countries in terms of our health. Our Federal system is complicated. We are a huge country with varied constituencies and moneyed leadership.
Our health care system is a product of our political system.
We may have to reform our polity before we can even begin to address our health care system.
Transformation of our health care will be as big a transformation to our country as the end of slavery.
There is no guarantee that we will succeed.
A national dialog and mobilization are needed based upon mutual respect and attention to the ideas of others.
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The House is now controlled by Democrats and the Dems should be offering up Medicare for all. Then talk it up. Sure it won't get past the House, but Americans will hear and see it. Then run on it in 2020 .
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@Mark
LOL. They tried that in Colorado -- defeated 79% to 21%, after reality arrived.
https://www.nytimes.com/elections/2016/results/colorado-ballot-measure-69-state-healthcare-system
@Mark
Urko
The state of Colorado doesn't have a medicare plan already up and rolling, but how is it medicare can cover seniors, generally the oldest and sickest and the costliest to insure, but somehow it can't cover working people who want to buy in and the poor who could get there with subsidies? Private insurance costs about 14% more than Medicare costs to insure seniors( that's what the government gibes the Medi-choice plans to insure seniors).
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Yes, Mark. If nothing else, they'd get to put the GOP on the record—yet again—as supporting profits over health.
Democrats should propose SPMFA in the House over and over, and pass it over and over even as the Senate yells in annoyance—upon which we remind them of all the times they moved to repeal Obamacare, and that unlike those, SPMFA would be GOOD for America.
(Not that "good" ever wins over the "covfefe" GOP.)
You can't pass a law if you don't even try, just as you can't win an election if you don't even field a candidate. Try, Democrats. Try.
Likewise with the impeachment and investigations.
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If Republicans had celebrated a victory like the Democrats just did - winning back the House, flipping districts in both parts of Congress, securing the popular vote - they would say something like 'The American people have given us a mandate.' Democrats should be likewise confident. Healthcare is the top issue on which they were trusted above Republicans. This was a major reason for their strong showing this month, and can be a leading 2020 campaign topic. Go for it, Dems! Our lives depend on it.
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@NM
The (D), thanks to Boehner, gave the Gen Z $10,000,000,000,000 in debt. The (D) cannot do anything, without creating giant messes. JFK started Vietnam, with 50,000 "observers." LBJ grew it to 525,000 young Americans.
Will never be fooled again. Ever. Period.
We are the only industrialized nation that does not have healthcare for all as a right.All we need do is stury how the rest of these natons do it and form the best way for us to go.The only real obstacles are the insurance,big pharma and the doctors organizations such as the AMA.They don't want to see their profits go down.In the case of the healthcare insurance industry it would virtually put them out of business.Why don't we see how our neighbor Canada does it?They have free healthcare cradle to the grave.Higher taxes? Sure,but how much are we paying for health insurance.Other countries do it for far less than we do.Another reason is the anti free healthcare advocates use is calling universal healthcare "Socialized Medicine".We all know how anything tagged with the "socialist" label is received by congress and the "God,guns and religion"crowd.We need to see free health care as valued as Social Security and Medicare.
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@Lazarus Long
There is no such thing as "free health care". Healthcare, both good and bad, comes at a price, and the electorate needs to have a reasonably clear idea what the price is. Universal health care is an objetive much to be desired and we need to move toward that objective without delay, but we need to do so with our eyes open.
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@Lazarus Long While the AMA still have power, its power has decline quite a bit from its heyday decades ago. The public still believes the AMA represents all or most MDs but in fact, young MDs and even middle-aged MDs like myself are not or have never been members of the AMA. I took history of medicine as an undergraduate and because of the AMA's stance on Medicare partly, I never joined it after I started practicing.
There are other more worthy organizations MDs can join that do support a national health care system. For example there is Physicians for a National Health Program and then there's the org I am a member of , the American College of Physicians, which is the 2nd largest org in the US for MDs (154,000 members). ACP has advocated for a national health insurance system for over a decade.
In 2008, 60% of MDs already supported some type of national health insurance program and that number has likely gone up since then. Apart from wanting to do right by people who have no insurance at all, the other motivation is the amount of paperwork and red tape from insurance companies that clinicians have to deal with in providing care even for patients who have insurance. Getting reimbursed is also a pain. Finally, it should be noted that in some countries, primary care MDs get paid better than they do in the US.
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@Edward Baker I never said it was free.Taxes will go up to pay for it but the savings of not having to pay outrageous health insurance premiums and no deductibles will be a lot less.As I said we are the only developed country that doesn't have free health care in one form or another.It won't happen until we can end lobbyists control of congress with campaign contributions.
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