I have infinite confidence in the ability of medical capitalism to survive all challenges. Even if we have a single-payer Medicare for All system, the insurance companies will survive in one way or another. There's no need to weep for them. The great difference is that we will have far fewer Americans suffering and dying from curable medical conditions.
65
Oh Boy! I can’t wait! Imagine only having to deal with a single payer and one that isn’t trying to make a profit off your health! I hope they also get rid of the awful Supplemental plans for Medicare — you know, the profit camel’s nose under the tent. And then there’s the matter of drug prescriptions and idiotic apps like GoodRX that gobble up your private information and give you coupons for cheaper drugs that your pharmacist won’t take because he’s already discounting more than the app! Oh, and while you are up: please tell the dentists that they are going to be a part of this revolution. Revolution!? Socialism? National Single Payer Health Care? My Grampa is spinning in his grave!
118
The insurance industry workers would get better jobs with better benefits working for the government Medicare insurance system. The stock market would suffer as the vast amounts of wealth sucked out of middle class wallets would no longer enrich the investor class making money while doing nothing but "investing". The real losers of course would be insurance industry CEO's would lose their multi-multi-million dollar cushy jobs establishing policies that raise premiums, deductibles and co-pay while reducing coverage for all manner of procedures.
162
This sounds suspiciously like the opening salvo against it. Say it ain't so Times. But I bet it is.
71
I want to see all the healthcare and big Pharma contributors to all Democratic congresspeople and governors published in the New York Times.
You owe it to decency and fairness.
Do it!!
83
It would be about time. These bloodsuckers have ripped off the American people long enough. No more 200 million dollar bonuses for these thieves.
130
The insurance Mafia. Voracious parasites. There is no place in a civilized society for for-profit health care.
149
And slave labor plantations employed lots of white people and made lots of money too. Doesn’t mean it was right or good for the country as a whole just because it gave some people employment, income, and cotton!!!
92
“But we can’t separate from England! What will the investors think?”
“But we can’t end slavery! What will the investors think?”
“But we can’t implement Social Security! What will the investors think?”
“But we can’t (fill in the blank)! What will the investors think?”
228
For God's sake, they must be really scared now, if NYT is on a warpath against the single-payer system. Of course, there will be a disruption. When half the money spent on healthcare (almost 10% of the country's GDP) is wasted on various parasites, those parasites will lose when this waste is eliminated. But guess what? Everybody else wins. Stop feeding that beast already.
99
If you like your doctor, you can't keep your doctor.
Sorry about that.
28
Dems are 50% of the population. That is enough scale to start a health coop. Go ahead. Then you can provide care for all the smokers, junkies, land whales who have not exercised since high school gym, and people who did not save for their old age.
When the people not in your coop see how WONDERFUL it is you can get them to join at a bit of a premium and make some money to boot.
19
Private insurance can be taken away from you.
It’s literally what the word “private” means.
29
This has been beat to death and yet a lot of willful ignorance remains. To clear things up on the private provider vs single payer issue:
https://www.bmj.com/content/327/7426/1241
6
Not sure the premise here is true. Who is offering the many Medicare Advantage plans? Why is the NYT running poorly prefaced articles when bringing clarity to this topic would have more value.
39
Thank you for shedding light on the radicalism of the current policies being proposed by these Progressive socialist and communist Democrats.
22
Did Henry Ford Carey hat buggy whip makers would be out of business?
The millions that work at insurance companies provide value only to the insurance company.! Gone and good riddance to those jobs.
63
When the upper 1% income bracket owns 50% of all US stock and 84% of stock is owned by the upper 10% income bracket, we know that the rich could be profiting mightily from the illnesses of 90% of Americans. https://finance.yahoo.com/news/the-richest-1-own-50-of-stocks-held-by-american-households-150758595.html
Next, let's talk about health insurance company monopoly power. The notion that there is competition is poppycock! https://www.healthexec.com/topics/healthcare-economics/insurer-monopolies-cause-higher-premiums
When doctors spend 50% of their time wrangling with insurance companies instead of caring for patients, we've squandered their hard earned medical expertise.
There are many other arguments for Medicare for all, but these arguments are sufficient for me. Health insurance company CEO's earned $343 million in 2017. How do these people sleep at night? Nhttps://www.fiercehealthcare.com/payer/ceo-pay-2017-342-million-unitedhealth-molina-cigna-aetna
NO ONE should profit from another persons illness! Medicare for ALL!
110
I'm a nurse practitioner. And of course a health care consumer. With regards to the title of this piece -- who cares! Who gives a rip about any of that anymore?? We're all fed up with the status quo. Bring it on, Bernie! Come on NYT.
98
It means that the people society no longer sees as productive are going to be thrown under the bus.
My sibling is sixty-two. He walks about five miles a day now. He worked for more than a decade for a school district in Colorado as a botanist and grounds keeper using a now infamous herbicide with no safety gear.
He was dismissed from that position a year after they found Cancer in his bladder. Without medical coverage and without steady income his health declined, his teeth fell out, and glaucoma steadily encroached on his good eye. His wife left him... still he walked miles each day to mow the lawns he could mow and to help keep his daughter steering towards college.
When he came here to live with us he had 4% hemoglobin. It was easier, in his birth state of California, to get his bladder removed. Cancer free; he is now down to eight teeth and smells like death warmed over. State insurance will cover him but your private "medical" industry and brokers whose jobs you want to protect can't get him into a Dentist for dentures.
This is what will continue to happen. The jobs of those in the middle class will be protected while people die because they have no political representation. Bernie Sanders gets it, always has... Elizabeth Warren gets it... it is the insurance industry and all those brokers who work with companies who can now have a receptionist track benefits online--these people have yet to "get it".
Don't save my job if it means another suffers.
93
Let's start here
Under the ACA, the pretax profits of the 5th largest health insurers increased between 2009 and 2015 from $ 15 Billion to $ 25 Billion
See the data for yourself
https://www.economist.com/sites/default/files/imagecache/640-width/images/print-edition/20151205_FNC666_0.png
That is they almost doubled. By 2015, $ 25 Billion where not going to patients but executives and stock holders
This needs to end.
But to replace the current system with a government run insurances system is NOT the best solution.
The German system, that dates back to 1883, by trial and error, arrived at system of tightly regulated, non-profit , non -government organizations, that compete, and offer the customers options. In addition, once your income is above a government set limit, you can , if you wish, opt for insurance outside the government supervised non profit system
To learn more, read the NY Times
A Better Path to Universal Health Care
The United States should look to Germany, not Canada, for the best model.
By Jamie Daw
Dr. Daw teaches health policy and management at Columbia University.
Feb. 20, 2019
41
New York Times has run some version of “Medicare for All” can’t or shouldn’t be passed for the last week—maybe more stories as Fox News. The basis is “well, it would be a major change and as history shows us nothing changes so let’s just continue doing the same thing.” Where are these people that love their employer based coverage? Do these employees not realize that their insurance changes on a earlier basis and has been true for me, been subject to less coverage and more cost shifting. Why should private insurance exist? It simply profits from denying coverage and making consumers pay. This anti-Medicare for All bias in the Times coverage is similar to the articles about the Green New Deal, arguing “we’ll that too disruptive and costly, so maybe let’s work with CEOs or something like that and give them subsidies.” This coverage denies lives realities of people. O recently had a relative commit suicide because of a medical diagnosis because he was worried about the financial cost of treatment. Just about everyone I know can’t afford medication and their insurance companies deny everything using various methods that require hours on the phone only to realize the person on the other end doesn’t have the power to make decisions. Although, the Times has mostly dedicated the last two years to documenting Russiagate, so I should not be surprised by anything. The Times is now just coasting off its brand. It’s totally detached from anything resembling the world.
44
These Dems are so totally stupid I cannot believe it.
Here we as a party have a no-brainer opportunity to knock Trump out of the White House in 2020, and the lamebrains touting a complete socialization of medicine are going to leave him in office with a nonsensical pipedream.
Makes me sick to see it.
Then add in the something for everybody wish lists of Harris, Sanders and Warren, who apparently believe money grows on trees, and I may get pushed into voting for GOP senate candidates just to ensure that somebody puts the brakes on all this madness.
And I'll sit out the presidential vote unless the party nominates a candidate who understands reality.
20
Can't happen soon enough.
40
Unless Medicare itself is totally revamped, it is not the "one-payer" system everyone touts it to be. IT DOES NOT PAY ALL MEDICAL EXPENSES AT 100%!!!!
See this page at medicare.gov:
https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
for the truth about Medicare! Note that outpatient services fall under Part B and many of them are very expensive!
So, currently, you either purchase a Medigap private insurance plan to cover expenses Medicare doesn't or opt for a Medicare Advantage Plan which is still private insurance that administers Medicare and can have very large out of pocket expenses. Also, you also need to buy a Part D plan for prescriptions, also private insurance.
Bottom line, if current Medicare is simply extended, private insurance will still be in business.
33
Poppycock! There would still be health insurance to cover those services not covered by the single payer system. That's the way it works in Canada and around the world.
44
My husband's genius oncologist's reply when we recently asked him about "Medicare for all"? He rolled his eyes and said, "of course", acting like it was such a dumb question and obvious answer. Yes, we were hoping this would be his answer.
13
A little while back, some people wanted to abolish Slavery. And of course, many people were up in arms; "Our economy!? Our profits!? Our way of life?!" But it was wrong and it was abolished. And yes, there was a war over it - because those who were profiting on the blood, sweat and tears of the enchained, didn't want to abandon their plantation lifestyles. Regardless, we all know what was the right thing to do.
Healthcare for all is a human right. Like freedom is a human right. And contrary to what the fear mongers and profit-makers would have you think - universal healthcare has nothing to do with socialism. And should have nothing to do with politics.
Health and sickness is NOT something that a third party should be profiting from. Get rid of the middle man and sleep better at night knowing that you never again have to associate sickness with bankruptcy.
23
If anything were to catalyze the formation of a viable third party, it’d be this. I bleed blue. I hate the GOP. I’m also chronically ill. You’d have to pry my private insurance out of my cold, dead hands.
This is hilariously bad policy. Progressives who believe they’ll attract votes by eliminating the private insurance industry are more deluded than Trump’s base.
11
Just imagine all the OTHER industries all
that money could be supporting! All
the NON-healthcare jobs that would be created by freeing up that money!
Not to mention the economic growth resulting from a healthier population! The reduction in personal bankruptcies once the leading cause - illness - is removed! The innovation that would result from people being freer to experiment with new jobs and starting their own companies without the health insurance tether of the current insane system!!
Also - there would still be private insurance - just less of it!
Yes! This deserves all the exclamation points!!!
(And sheesh - what a crazily misguided article. This sort of limited thinking, my friends, is why we can’t have nice things.)
18
In the years before America entered the Civil War, Reed Abelson and Margot Sanger-Katz would no doubt have been trying to convince us that it would be "unreasonable" to end slavery because of the undue hardships this would impose upon those poor, beleaguered plantation owners. Won't somebody think of the plantation owners!!
The moral obtuseness here is breathtaking. The defense of the indefensible is unconscionable. And yet they persist.
27
"We cannot afford to close down private insurance companies and cause the layoff of thousands of workers. Do the Democrats want us to be like Finland and Venezuela?" - DJT
3
I realized there was problem twenty years ago when I heard a Wall Streeter say, "Hey! Cancer is good for business!" It has stuck with me to this day. Especially since my father was in the end stages of pancreatic cancer when I heard that person say that.
It told me everything I needed to know about America and health insurance. It's nonsense.
There's also a racial component to healthcare reform and the resistance to it that I won't get in to in depth here, but there was an interesting segment on WNYC Radio yesterday.
It's an interesting perspective and I highly recommend listening to it. Mind blowing as to how people vote against their own self interest and the reasons why. Even when they need medical care and insurance to cover that care.
https://www.wnyc.org/story/racial-resentment-and-public-health
11
Why should someone’s stock portfolio be a consideration?? Those profits are paid from my overinflated healthcare cost. Stockholders drive up healthcare costs as do wealthy middlemen, Dr’s abusing the system, and big pharma. (while lying to us about research cost and all else in their purview with no supporting facts) Intelligent reasonable people, even those that profit, can see the obvious...their profits are unethical in the bigger picture. It’s time for the profiteers that call this “CAPITALISM” and not a rigged greedy system to give back the huge amount we overpayed the last 30 years while being told no to many claims.
Re employing the thousands of insurance workers into regional districts would be efficient. They all work the same billing and medical coding system nationwide. Those individuals would still be necessary however they set up the system, and needed to justify the payments to Drs and hospitals, etc
Redoing that “beast” is done every day by all Americans. Why characterize it as a large uncharacteristically nearly impossible task? We figure things out all the time with our best and brightest.
Those of you suffering from the exorbitant med cost see the Share Programs of Liberty Care, and Christian Ministries on the web. Took us from $1200-$300 a month and fulfills the govt’s health coverage mandate. Saved my husband and I $900 a month since AHC inception.
6
Oh so the gigantic reshuffle that cuts out funnelling billions and billions of dollars into the ultra-wealthy folks' bank accounts is such a frightening thought that we have to be careful?
Hmmm.... if I don't need to worry about extortionate health care costs maybe I don't need an almost-infinite retirement fund.
Get real folks, many prosperous countries do this. This article sounds like propaganda - 'Oh how scary it will be to change...'
15
Many European countries have insurance coverage for all yet they have private insurance companies that thrive? Why can't the US?
I think this article is a Republican scare tactic. e.g a BIG LIE.
13
Medicare for All Would Abolish Private Insurance. ‘There’s No Precedent in American History.’
Balderdash. The article is based upon myth, lack of 'facts', and hyperbole. The title, al alone, was captioned just to get attention.
I, and a large number of folks in the medical profession, could design a 'medicare for all' type of system, which would work for citizens . . .
and NOT for insurance companies. Insurance companies are arcane.
Get with the times, and back U.S. citizens, some form of 'medicare for all' would work well, and just by getting rid of insurance companies, would 'trip' 23-28% off current costs.
14
We Nationalized the defense industry. They are subcontractors to American Citizens.
Buy pills like bullets saving trillions.
Not hard.
4
We live in an immoral country. The rule of law means nothing, the love of money everything. Party on.
7
In Australia and Britain, there is Medicare For All AND private insurance.
This headline is wrong.
11
This what needs to happen in all of the hospitals, clinics and doctors where people go for help:
And Jesus went into the temple of God, and cast out all them that sold and bought in the temple, and overthrew the tables of the money changers, and the seats of them that sold doves, And said unto them, It is written, My house shall be called the house of prayer; but ye have made it a den of thieves.
3
This is not the first time that the Times has been extremely misleading concerning public support for “Medicare for all.”
Would you ever write that the concept of “free newspapers” or “free cars” appeals to a large number of people — and then say in the next sentence that the appeal goes down when people are told that their taxes will go up,etc.?
Why not simply say that few people support this because of the consequences?
4
The current mess of a system is the nightmare Republicans have saddled us with: the playground of fraudsters bilking us, drowning us in “choices” and endless paperwork to disguise the cheat.
7
France, Germany, Switzerland, Norway, on and on, have mixed systems. Other than hardcore socialist ideology, why in the world would we impose this disaster on the US?
8
As long as a single shot of Lupron, taking 15 seconds to inject, costs $9000 I have little sympathy for any medical insurer's reduction in revenue.
15
Hey America, we love making fun of you guys from up here in Canada. Here is a Canadian "sorry" for you, but we do care about you. How dumb can you be to turn your backs on universal health care? The right feeds you a line about how much it will cost the national economy but never mentions how it will benefit your personal economy. You will be paying far less out of your own pocket. Whatever tax you'll be hit with is far less than you would have to pay for real comprehensive private insurance coverage. We still have insurance companies here in Canada and they are still making a fortune. Former clerks will still have work as long as there are forms that need to be filled out. The higher ups in the game will probably find that they are happier not having to deal with vagaries of the health insurance game.
23
I would like to relay my experience dealing with Medicare and refute a couple pithy comments I saw about the inefficiency of government (oh my gosh you want them handling your insurance?)-
in the many years of taking care of a senior- I'd make an appointment (without need of a referral), bring them to the appointment, hand over the card, the card is copied, scanned, whatever, handed back. Eventually a large envelope shows up in the mail. it's all medical services partaken of, neatly laid out and showing what was paid. Any medical provider who wasn't an idiot about their billing would submit to Medicare and get paid in a timely fashion.
This person also had secondary (not gap, secondary) insurance, private, that covered most of the 20% that medicare didn't. In the many years of helping this person, and at times when I've offered to help others, I never had to call Medicare about any billing problems. Ever. I repeatedly had to call the private insurance. They repeatedly didn't pay, underpaid, ended up sending checks after to the fact to cover mistakes. Had to be repeatedly argued with to cover stuff they were supposed to be covering.
There's no comparison.
55
It is getting a stale example. But look towards the Netherlands. We have universal healthcare for all, through fully private insurance companies. And any other flavour you can find in other countries like the UK, Canada, France or Germany. There is no more need to hypothesise what will happen if....
I know we represent a threat to the US, because of the steel sanctions (wink). But rest assured we are still friends. We will share all you need to know to stop dilly dallying on this topic, take a decision and get moving. There is very little you need to discuss if you know what you want.
11
Stop scaring people. These writers know perfectly well there's a lot of ways this could go. Private insurers already administer Medicare and Medicaid govt programs. We could adopt a German or Swiss model that uses private companies. You are purposely framing this as an NHS style system. Of course we have to be careful when revamping one sixth of the US economy. But your scare tactics could set back universal coverage another generation and people will die for lack of coverage. Use your bully pulpit power for good, please.
21
Incredibly tone deaf article. To talk about Medicare for all in only financial terms and not mention the 10s do 1000s of people that die every year in the because they do not have access to healthcare is journalistic malpractice.
22
As many other commenters have noted, this article reads like an editorial in the WSJ, not a news article providing fair, balanced reporting.
You really want us worry about all those "lost" insurance jobs (1% of workforce) when WaPo reports that 71% of Americans are currently looking to change jobs and many change jobs 7 times in 12 years? Further, MFA will end employee job-lock: many of these job-seekers will be delighted to look for more satisfying jobs in start-ups because HEALTHCARE will be GUARANTEED.
Worse, what value do these jobs offer our economy? They do not benefit our health — in fact, they harm it by siphoning up money that could be more productively used into the accounts of the 1% (who don’t spend it and don’t help the economy) — and, worse, by routinely denying access to care that insurance customers have paid for.
Worry about investors in the health sector? The sector could drop by 75% and investors who have been in it for ten years would still be ahead (even those who have been in it 12 years). In any case, few of the health insurance co's are SOLELY in health insurance. And disruption has happened before (think medallion cap value before and after Uber/Lift, think retail stores before Amazon, and mom&pop stores before Walmart ... disasters on Main Street all over the country).
I'm very disappointed in the NYTimes — and I very much hope this pattern of article isn't a function of corporate board influence infecting the news desk.
23
So the choice is:
Save many jobs?
Or save many lives??
Save morally-bankrupt corporations?
Or save cancer patients from going bankrupt??
Save them from socialism?
Or save us from capitalism??
My Fellow Americans, the choice is clear.
18
Preventative vs Emergency medicine is the end game that provides minimal “no frills” coverage - it is the polar opposite of the Hippocratic oath
The only way they can take my private insurance from me is from my cold dead hands. I will fight this all the way.
1
Well, let's give the Democrats credit for honesty. Instead of promising voters that "If you like your doctor and your insurance plan, you can keep them," now they are telling us, "Tough luck. Wait in line at the clinic with everyone else."
5
The ACA, ("ObamaCare"), stinks.
The non-existent Republican plan stinks.
Here is MikeCare. It almost doesn't stink:
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is covered. Just like with the other services medical services should be paid for using the taxes which we pay.
You go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere. In any event you get the best possible care which is what we all deserve. What is the argument in favor of letting people get sick and die just because they are financially distressed?
And that's the end of it. Welcome to the 21st Century!
If it makes the prez feel any better call it "TrumpCare".
5
Even Republicans are squeamish at the notion of seeing folk dying in the the streets. So, if you are unwell, go to a hospital clinic. Thank them, and pay them if you choose. Their accountants may wish to sue you, but since you live in a rental dwelling and drive a 10yr old car, or bicycle, they'll see nothing to grab. Their only recourse is to garnishee your wages. You may have to live with this one, unless you have a work-around. Also, pay your dentist, because you prolly want a sustained relationship. Don't pile money in banks, find other places.
You may blow your dough good food, or World travel, my choices. Education is "free."
3
Some things we own work best after they have been “broken in.” Other things we have owned worked best when they were new. Socialized medicine, even in “the nice countries,” is fairly new. Doctors behaving economically like farmers, tradesmen, shopkeepers and pretty much everyone else in society is an older arrangement. This is not a cynical warning to turn back. It is an earnest recommendation to proceed thoughtfully. Abelson and Sanger-Katz bring to the project an attitude of realism that will improve its chance for success.
1
Said Paul Starr, a sociology professor at Princeton University: “We’re talking about changing flows of money on just a huge scale,” “There’s no precedent in American history that compares to this."
Does this man remember that we (a bit before my time) abolished slavery?
Having said that the politically safer route is the incremental one regarding health care, but thank God the A. Lincoln didn'y wait any longer than he did ....
1
The thought that the elimination of private insurance because of Medicare for All, is ludicrous. Every last one of those insurance companies has their fingers in many pies -- they will not go out of business -- they'll just go on with the other insurance policies they now offer -- home, auto, business, you name it.
What they are now crying is chicken little. No, the sky is not falling -- and never will on the industry that profits from people's fears.
7
The funny thing is that when people get sick, they come to the US. If they live in Canada or the UK for example, they can’t afford to wait weeks for what could be a life saving test. Remember when Natasha Richardson had an accident skiing in Canada? She was immediately flown to NY. I wonder what Vanessa Redgrave, her socialist mother, thinks of all this now.
5
"But doing away with an entire industry would also be profoundly disruptive. The private health insurance business employs at least a half a million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues. Its companies’ stocks are a staple of the mutual funds that make up millions of Americans’ retirement savings."
The author of this article should have thought a bit more before writing this. If there were ever a better example of "shooting yourself in the foot" I don't know what it could be.
His argument is that the grossly expensive health care system in the USA that involves insurance companies while delivering mediocre results to the people who need better (or even some) healthcare, so that the fortunate few who make money off of it can prosper, is immoral.
8
My new Senator got where he is by making multimillions while heading up the company that committed the biggest Medicare fraud in history. He will vote against it, I am sure.
5
Of the 33 "developed" countries, 32 have universal healthcare. Many have had it for a lifetime -- and the results are indisputable. Their healthcare is:
a) half the price
b) just as good
c) universal, no questions asked, no medical bankruptcies, no lifetime caps, no "out of network", no "pre-existing conditions" -- and losing your medical coverage is as impossible as losing your police, fire department, or military coverage.
And, contrary to the thrust of this article, NOT ONE OF THEM bans private health insurance. Indeed, such a ban is so outlandish that I wonder about this article's motivation.
12
Private insurance companies are just Money changers with sticky fingers. They add nothing valuable to the process.
5
Of the 35 countries with the largest economies, only the US has private insurance.
Three important elements of a nation's healthcare would be access, costs, and efficacy.
The US has at least 30 million uninsured There's about 40,000 preventable deaths per year due to under-coverage. There 's over 500,000 bankruptcies per year including many with health insurance.
According to healthsytemtracker.org, per capita health care costs ranged from $4,246 in the UK to $10,224 in the US, with an average of $5,280 among OECD countries.
According to an article in Reuters, comparing the US from 2013 to 2016 among ten other countries (UK, Can, Germ, Aus, Jap, etc) , the US was middling to bottom in measures such as infant mortality, life expectancy, etc.
Highest cost, lowest access, middling results (at best)....the trifecta of bad; yet this article chooses to emphasize that the current system is awesome because it employs a half million, generates investment returns, and allow insurance and pharmaceutical CEOs to make tens of millions per year?
Wow. Seems to me to be emphasizing the wrong thing. Everyone gets sick or gets old or could be in an accident.
Healthcare should be a human right. Single payment is just much more effective at delivering it.
The basic economic problem is that healthcare is not a market because the need for wellness is inelastic - it does not diminish with cost. Also, consumers have zero idea of prices, which hospitals don't bother to publish.
9
The article states:
"There are few international analogues to the Medicare for all proposals, but Canada, which provides similar doctor and hospital benefits for its residents, probably comes closest. Even there, people buy private insurance for benefits that are not covered by the government program, like prescription drugs and dental care."
"People," with rare exceptions, don't buy supplemental insurance as individuals but get it through their employers, who pay part of the relatively low cost.
The article states:
"Most other countries with single-payer systems allow a more expansive, competing role for private coverage."
So WHY does the headline say "Medicare for All Would Abolish Private Insurance."?
WHY does the article say: "At the heart of the 'Medicare for all' proposals ... is a revolutionary idea: Abolish private health insurance."?
This sort of statement is at once an ignorant or stupid oversimplification from those who advocate universal nonprofit basic health insurance and an alarmist lie from those who oppose it. Yet again, as in the run-up to Obamacare, the US and its media seem incapable of having a fact-based, reasoned discussion of this topic.
10
You are wrong in so many ways it would take too long a reply, so I will keep it simple. In France the largest country in Europe we have a medical system that single payer from the State ala a "medicare for all," and private insurance exists side by side that most people have for differences in coverage. It works quite well. Unlike the negative propaganda put out by Fox and others, we have choice of doctor, where we go for treatment, etc., everybody is covered and nobody can go broke over medical costs. We have the latest technology and drugs. This idea perpetrated by those with a vested interest in keeping Americans hostage to the insurance industry are simply covering their wallets. Sad that the richest country in the world is "owned" by the large insurance and healthcare industry.
11
It would mean no-one would make a profit off anyone's state of health.
5
Once again the authors miss several very important points. The first being, everyone has the same coverage. You have the same as your members of congress, their children, the judge in court and the CEO of every company in the USA. This is what makes it work. Second, private insurance is illegal, no supplemental plans, no private pay. The only medical you would be able to buy is for cosmetic. Third, HR 676 call for the hiring of displaced insurance works by the new program. The notion of a disruption of an segment of our economy is a real and valid concern, but what if we used this approach to smoking? To unsafe cars? Nobody thinks our current system is fair or viable and the use of the argument that investors are jittery is beyond repugnant when there are people who suffer without treatment because the investors need comfort.
3
Really do not people need auto insurance and other types of insurance?
I suggest they could clean up financially with a gun owners insurance.
1
Americans can not afford to tolerate such inefficiencies any longer. Maybe we never could. As for fears that a US government program would be worse, I guess that’s possible.
So why reinvent the wheel? Canada gets it mostly right. How about we ask nicely and pay our northern neighbors to expand their system southward?
4
They would need to re-tool and re-train for a new era—just like other businesses and industries and endeavors as things advance and change.
5
As we transition to much-needed single payer universal coverage—
Our massive private health insurance apparatus and its workers—
Like any other business or industry, would need to re-tool and re-train as things advance and change.
3
"Believers in markets argue that consumer choice and competition among private health plans improve the quality of care." They argue that and they are wrong.
First, there is no aggressive competition even when there is more than one insurer in a "marketplace".
Second, consumer "choice" is further constrained when the provider they want to work with is on only one plan or not the plan they would otherwise choose.
Third, it's not the quality of plans that get improved from a coverage/consumer standpoint, it's the Profitability of the plans that are edged up. That's done by cutting corners on coverage and putting more cost on the consumer. Before the ACA there were "cheap" plans that were outright fraud. Trump and Libertarians naturally want to restore to the insurance companies the "liberty" to scam consumers .
The competition-improves-health-care argument has to tossed in the dumpster once and for all! The whole reason health care is an issue is precisely Because that statement is a lie.
2
The end for these corrupt, usurious companies will breath new life into the economy at every level from personal and family finances to local and national government. As much as 80% of the premiums collected goes to paying the sales team's commissions. Claims are routinely denied and the cost of fighting their arbitrary decisions is beyond the ability of most customers. An unprecedented redistribution of wealth is long overdue.
56
I’m on Medicare. As insurance, it works fairly well, though it is not inexpensive even if less expensive than private insurance. The problem is not with the insurance part but with the healthcare part.
1. They pay less for medical services. This has three consequences.
a. Fewer doctors will work for such fees and hence do not accept Medicare patients.
b. Doctors that do treat Medicare patients try to see more patients per day to compensate for the loss of income, resulting in less time with patients and poorer care.
c. More doctors are leaving practices and fewer people are choosing medicine as a career path making it near impossible to find doctors accepting new patients.
2. Medicare requires massive amounts of physician office time entering data into computers. Doctors wind up looking at computer screens, asking questions required by a computer program, not even making eye contact with the patient. Less personal interaction, less doctoring. The equivalent of being treated by a human controlled by a robot.
3. Patients must do a whole lot more work coordinating their own healthcare. Unless a patient is aware enough of their own medical conditions and the reasons for treatments and medications prescribed, they are at the mercy of the data entry skills of office staff. Small mistakes or omissions can result in poor care or even death.
Medicare for all is less care for all.
14
While the authors seem to try and present a balanced view, (their bias is apparent however) the intent here is clear, scare people into believing Medicare for all is not what they need or want. The private insurance industry would not be forcefully eliminated, nor would people be required to have medicare. No proponent of the plan has said that. There are literally a world full of models for the US to look at for guidance on implementing a medicare for all system or some type of hybrid that covers everyone. And lastly, when discussing increases in taxes to pay for the system, it should be mentioned and would be journalistically responsible to also point out that one's insurance premiums would disappear and would therefore offset the higher tax rate.
39
Americans will never accept an entirely government-run system without private supplementation. That's a dead issue. It's time we move on to more realistic options.
Let's start with the fact that rationing is the method all systems use to control costs, and Americans are used to receiving services on demand. In other words, let's face facts.
If we cannot have an honest conversation, we will never fix this problem. Demanding utopian solutions just kills the process. Time for more rational heads to intervene.
17
There’s no precedent? A century ago the Federal Government combined all the local phone companies because they did not “serve the public interest.” They refused to interconnect, the War Department couldn’t even talk to itself in its various buildings around Washington. Fire department had to subscribe to 3, 4, 5 different phone services just to be able to get phone calls from the areas they served. The result (eventually) was AT&T, a monopoly which created the best phone system the world had ever seen. Eventually, as technology changed, it too became outdated (and broken up) but do not say “there’s no precedent.” There’s plenty.
34
I have been arguing for a long time about what should and should not be included in a Medicare for all system. When I was a child and had to go to the doctor, my parents wrote a check. We had major medical insurance (which btw, is what insurance is for - spreading risk). Insurance carriers convinced municipalities and large companies to offer insurance to employees in lieu of raises that would cover regular doctor visits (things not covered by major medical). They took the bait. Then everyone wanted insurance to pay for regular office visits.
Everyone should get regular checkups - there is no risk to spread. All pregnant women should have regular visits - again, no risk to spread. Everyone will need flu shots or flu or cold visits - no risk to spread. These are things that Medicare for all should cover, leaving real insurance to spread the risk of an accident, cancer or other major medical treatment, etc., which is best left to the private market.
People who work within the industry will only have to move from a private insurance job to a job with Medicare (we will still need a lot of people to push the paper). As noted, the only people who stand to lose will be upper management of insurance companies - and their loss will only be in the number of zeros after their paycheck.
21
Stop looking at how disruptive a single payer or Medicare for all would mean for our healthcare system. Let's look at the alternative.......Oh, yeah, the alternative is to keep doing what we are doing. The only things Republicans offer to reduce cost is to reduce access. Block grants for Medicaid and elimination of the mandate serve to cut costs by getting rid of beneficiaries or making them pay more. The Republicans have NEVER offered any solutions to the reasons why Medicare for all is being proposed in the first place. Oh they are going to tackle the cost of pharmaceuticals. But they never seem to. They never actually come out and say they want universal coverage. And they say they love mandating coverage of pre-existing conditions, but when you read the fine print, you discover they allow higher premiums for people with them. And what has the industry done to address the problems that led to government take over? Made sure the share price for the stocks went up. The bottom line is the Republicans and their industry bedfellows have known for decades about the concerns of the American people with our healthcare system. And the only solution they offer is to yell SOCIALISM in front of the cameras and go back to their luncheon with the health care lobbyists. They had their chance and they showed us what they have for solutions. NOTHING. Fear mongering will do what for our healthcare system?
36
@Walking Man Agree, but you forget many of those at the luncheons are also Dems.
Of course there will be enormous resistance by those profiting from the 3.5 trillion dollar “medical-industrial complex.” But the actuarial reality is that insurance functions as intended only when everyone is in the same “pool”, the well and low risk in with the sick and high risk. This allows cost/risk to be spread out....it’s the magic of large numbers, it’s fundamental. Both “for profit” and “not for profit” insurance companies behave similarly...they try to avoid risk and maximize revenue over expenses. They all measure what’s called the “medical/loss ratio,” the dollars they must pay our for medical care/premium revenue and reward the lowest number possible. They lower that ratio by keeping premiums high, avoiding risk and denying services. The bureaucracy required to do this is so expensive and redundant across the industry and for all providers that when added to the profit motive it is estimated to cost nearly one third of the total healthcare cost for Americans. So no, “Medicare For All” will not be easy, but it would be more efficient. A responsible, incremental approach is feasible, but will require strong leadership and an educated electorate.
44
It is essential, of course, to model Medicare for all while designing and before implementing such a plan. One logical starting point is the current Medicare system, which covers most but not all medical procedures, and uses private insurance plans ("F" and "G") to supplement Medicare's basic coverage. These private plans typically cover only residual costs but their monthly premiums are nearly as high as the core Medicare premium—which suggests that they are probably very profitable products for the private insurers perhaps even more profitable than the employer-sponsored plans they write. Still, some contraction of the private health insurance industry is inevitable under Medicare-for-all.
Private insurance aside, it's difficult to see how opening up Medicare to all ages could "bankrupt" the country as its critics charge. Medicare currently covers the oldest and sickest; opening up the pool of premium payers to younger, healthier cohorts would improve Medicare's solvency, not impair it. Such a system would extend basic health coverage to everyone; it would also very likely create new jobs in health care, as people currently denied access to health services would now have to be served; and "basic" Medicare coverage would still leave open a market for all types of policies to be offered by private insurers, including gap coverage as well as "gold" plans for elective or cosmetic procedures.
10
@Civres It would bankrupt the country unless you accept a lower standard of care, ie. rationing and waitlists. Here in Canada we have much lower rates for many procedures like dialysis, almost no robotics. Procedures that cost too much aren't offered. I'm reading one blog where the 78 year old American lady is saying her Medicare cost for terminal pancreatic cancer is over 1 million. Canada would not be giving you 1 million in care at age 78. It's called the "common good", a concept Americans do not have.
12
@Detalumis
Rationing is the elephant in the room here. Proponents of something-for-all never mention it and, instead, pivot to criticizing private health insurers' version of it.
Health care is certainly important enough for honesty. It's not an issue that belongs to any single group. We all get to have a say. Democrats should recognize this after that midterm shellacking they received after Obamacare was rolled out.
It's not those who shout the loudest. We all have a say.
9
A healthcare system that puts investors first, by definition, puts patients second. More importantly, it contorts the purpose of healthcare.
Big Pharma seeks to make expensive drugs that require long-term treatment; there is less emphasis on possible cures. The rational - someone taking medicine for life makes more money for the company that some one who is healthy.
What about the cost in insulin? The price is pushed to new heights, while the actual cost to manufacture is low.
What about medical bankruptcies? People who are seriously injured or require extensive treatment for disease being fleeced by a system designed to make money, instead of delivering affordable health care.
It comes down to the fundamentals. A system run by the GOP, who have underfunded the VA hospitals to the detriment of those who have served, is a national shame. Republicans favor profit over people, they always have. A system that works to prevent illness, reduce costs, and establishes a high standard of health benefits every one. Better national health is less expensive than costly care.
A fair system of healthcare will be difficult, but keeping a system based on generating profits is not the best way to maintain the health of the nation. Put the profits back into the system. That’s where they belong.
24
Let us NOT read "Medicare for All" as "medical care for all" but rather health care insurance for everyone, and, we all know that health care insurance is NOT free.
And truly, can never be "non-profit" as all entities (profit or non) must run "in the black" not in the red" or go out of business or get more taxpayer subsidies.
Sticking drug companies into a "non-profit" bucket simply remove 99 percent of the incentive (profit? of course) to engage in that industry and the investors (think profit motive 99 pct of the time) who support drug companies will simply put their money elsewhere.
Government regulation of any sector of the economy forces persons even thinking about entering that industry -- medical school students, for example -- to seriously consider alternative careers.
9
@Pete in SA
You are correct Pete. If there is no profit, there is no mission. I think many people are under the impression that the entire medical industry will just work for whatever the government (taxpayers) are willing to pay them. They are mistaken.
Health care is not a right as you are depending on other people to treat you.
It would be best if taxpayers started their own, entirely separate, health care system. Complete with their own doctors, hospitals, medical schools, nursing schools, etc.....
6
Not without tort reform. If one eliminates private insurance, and lower reimbursements, then one must take away the over-litiginous incentives so that MD's can practice actual medicine instead of metrics.
Aside from that: reminds me of when I was a resident in a large public hospital. Wait time for an MRI of the knee: 1 year. Wait time for CT or IVP to look for kidney stones: 1 month.
7
Medicare for all is as bad as no Medicare. We should look to the German system of health care. It is a combination of Medicare and Private insurance and appears to be working to the satisfaction of those using the system. Why isn't anyone suggesting that approach?
15
Not quite true. Medicare unlike VA is embedded into the private marketplace. Actually, the system would benefit because more people would see doctors (we'll need more of them) an few people wol lan in ER's for primary care.
2
If I'm not mistaken, those workers in the private insurance field could likely find similar work processing claims (instead of denying benefits) for Medicare (for All)...and the industry execs who have been gouging us for decades can simply go away.
Sorry (not) if this "shakes" the health-denial industry. And please stop calling it the health care industry. That's not what insurance companies are.
21
@westvillage exactly! The 'education' and job training the article references may be the first that these deniers have had in their career.
Let's be honest, Medicare is a part of our private healthcare system and as such benefits from the private systems makeup. The only stand-alone government run single payer system in our country is the VA System. So the more proper analogy is not Medicare for all but " VA for all".
7
@gjv
Er, no.
The VA is thoroughly socialist, like the UK's NHS; it employs the staff and owns the buildings and equipment. (It's also pretty good, according to studies by both the American Legion and the Rand Corp: http://www.military.com/daily-news/2017/09/20/va-wait-times-good-better-private-sector-report.html)
Medicare uses private providers and public insurance; so would M4A.
1
Well, how has the federal government done in the areas of health care where it is the sole administrator?
1. Veterans Administration - does anyone really thing the VA is run well?
2. Medicare - this program is a walking time bomb of unfunded entitlements. It can't make its payments now, why would it be better on a larger scale?
3. Medicaid - see number 2 above.
The government run health care we have now is terribly managed, so let's give government even more authority and power.
7
@David Ricardo
I think the VA could do better, Medicade is administered
by states and subject to politics, Medicare is wildly popular. 3% of every health dollar spent by the government goes to overhead: 13% overhead for private insurance.
Private insurance companies are in the business of collecting premiums,not making payments. We are all just a diagnosis away from bankruptcy.
17
@David Ricardo
New York State has some of the highest Medicaid costs and worst outcomes. Our governor is now cutting costs. People mistakenly believe only private insurance produces poor results and cuts costs.
People have a magical view of government health insurance.
8
@David Ricardo
“VA health care is as good or in some cases better than that offered by the private sector on key measures including wait times, according to a study commissioned by the American Legion.”
http://www.military.com/daily-news/2017/09/20/va-wait-times-good-better-private-sector-report.html
“The Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients, according to a new RAND Corporation study.”
https://www.rand.org/news/press/2016/07/18.html
1
The horse-and-buggy industry ended. More recently, the video-rental industry ended, as did the encyclopedia publishing industry. The internet ended many, many, many industries and jobs and is continuing to do so as we speak. Do we make OTHER policy decisions based on preserving particular industries and particular jobs? Why do the insurance companies have some unique magical (im)moral hold on us that obligates us to preserve them, and only them?
25
@tsl
Those industries went under because the marketplace (the profit motive) produced superior products and business models. They didn't go under because of power-hungry politicians.
3
Millions of dollars in people’s retirement funds did not include encyclopedia publishing or video rental companies.
Every for-profit health insurance company has an imperative: Deny coverage! How else could they exist? The business of providing health services is called medical care not insurance. The "costs" of the former is the product of the latter. That we have mixed these two conflicting business models is perverse and ultimately unsustainable. Eventually this will sort out as it has for other countries. However, the problem of climate change is far more urgent and challenging. So far Jay Inslee seems to be the only candidate who understands this.
3
@Philip Richman
Almost all systems worldwide manage their health care costs through rationing. Time for an honest conversation about it.
2
If 80% of Americans get their healthcare through work, wouldn't a government program free up all that money to pay for a more efficient healthcare system through a combination of higher corporate taxes and higher wages/ higher tax receipts?
6
@Pragmatist In CT Unless you have private insurance in the UK you can wait months to see a specialist. Countless people in Canada cross the border into the US for that same reason.
6
@Tom LaCamera
Remember that Canadians cross the border because they can. Having the American for-profit system a few miles away is a strong draw for wealthy hypocondriacs and the critically ill. I now live in the Toronto area and spent my first 30 years in Montreal. I've never waited more than a month to see a specialist, and that included the discovery of a congenital kidney issue a few years ago. During that episode I was sent to hospital emergency the day of discovery and given a CT scan to establish priority of treatment. I now undergo scans on a regular frequency to monitor any degradation, in which case surgical repair will be considered. As fate would have it, the event happened 2 years after I had lost my job and gone freelance, losing employer health benefits. With my creator's blessing, I am now 53 and remain affluent. If I was in the USA I would likely be destitute.
14
This article confuses me. The existing US medicare program does not offer 100% coverage does it? Isn't this why people have medicare "gap" insurance. And wouldn't this just continue under a single payer system?
And if there is significant job loss in the healthcare insurance industry, doesn't this just mean that there was a lot of fat in the existing system which contributed to making US healthcare one of the most inefficent abd expensive on the planet?
In France, per capita cost of healthcare is about one-half that of the US for a healthcare system that maintains a higher level of public health than exists in the US. The system is mainly self supporting through payroll deductions and provides good basic healthcare, but many people also have a type of "gap" coverage as well to cover discretionary costs (e.g., having a tooth crowned rather than extracted).
France spends far less of its healthcare dollars on administration (as opposed to actual care-giving) than the US. But the french system is largely self-policing. Is that possible in the US or would it be a blank check for fraud? Also, the french system has cost controls that are necessary to make it work, but might be difficult to impose in the US. And pharmacists play a much bigger role in french care delivery.
At bottom, the debate should be about not only extending basic healthcare to everyone, but also how to increase the overall health of the American people cost-effectively.
13
Eliminating the most expensive and complex health care system in the world is worth the effort. Providing health care for all Americans without this indefensible level of complexity and over pricing must be the future of the USA, if the nation is to survive. It's that straight forward!
22
The suggestion to do it incrementally by lowering the age for medicare by one a year is a good one. But the warning that when only the young and healthy were left, the insurance companies would pull a fast one is also very possible. Make it so all newborns go on medicare AND the age for medicare drops one a year. This would prevent any funny business by the insurance companies since the young as well as the elderly get taken out of the pool.
That way the insurance companies would have time to adapt their business model to selling supplemental policies to the well off.
6
One of the root causes of problems with health care in America is that private insurance companies are in the business of providing health care and making a profit. Indeed this is a conflict. The profit end of things does nothing to provide healthcare. A healthcare system should exist only to provide healthcare.
14
@Rawiri So, your reckoning suggests that the capitalist system is a flop. Without the promise of profit, nothing would get built, business would not exist.
2
"doing away with an entire industry would also be profoundly disruptive"
Health insurance companies have disrupted far more lives than would be disrupted by eliminating the industry.
In essence the health insurance industry runs medicine; even physicians are unaware of how deeply affected their patients are by
"not covered", "not necessary", "not in network", "deductible", "percentage covered", "co-pay", "co-insurance", "pre-authorization", "pre-authorization denied", "tiered drug coverage", "charged amount covered", "insufficient evidence of efficacy per our guidelines" (private healthcare insurance protocols vs medical protocols), "costs not covered by plan", "one physician visit only covered per day of hospital stay"....
On one's best day those are terms requiring multiple phone calls to health insurance companies, physician's offices, researching your health plan, and speaking to the health care institution's financial office, if necessary.
Should one be ill...those terms go unchallenged and medical debt accumulates.
Health insurance companies increasingly direct your medical care not your doctor.
The health insurance company also directs your financial future, if you have any money left.
Health care should be between the patient and their physician, who can focus on health.
Health care should be a right.
It's time to eliminate the health insurance industry.
49
This reminds me of Spencer Tracy's pitch to Myrna Loy in Libeled Lady. To apply Loy's response to Tracy to the instant question, the employees would be taken are of. Medicare would need a lot more employees with insurance backgrounds if it applied to everyone, there would be a need for more medigap policies, and there are all other kinds of insurance jobs, and other jobs, for these employees to transfer to.
Medicare does some good things and some bad things; has influenced health care in many ways detrimental to patients; and is projected to exhaust its "trust fund" in several years, so I am no big fan of "simply" extending it as is to all of us. Come up with a better health care system. But I wouldn't worry about health insurance employees.
5
@Benjamin Ochshorn The laid-off insurance employees still have their hands and feet. They just may have to use them.
1
Enemies of Universal Health Care should heed what Winston Churchill said about Democracy (having changed Government and Democracy for Health Care and Universal Health Care): Many forms of Health Care have been tried and will be tried in this world of sin and woe. No one pretends that Universal Health Care is perfect or all-wise. Indeed, it has been said that UHC’s the worst form of health care except all those other forms that have been tried from time to time.
4
The "two tier" or supplemental insurance business would still go strong - the Canadians had that for quite a while. Plus, before getting too concerned about supposed insurance company finances, we should get access to their Schedule D reports showing their investments. It might be enlightwbingt.
4
We shouldn't even talk about making changes to the current system because it "makes investors jittery"? In other words, the richest 1% shouldn't have to worry about possibly losing a tiny fraction of their wealth so that the rest of us can have affordable, comprehensive health care coverage.
11
@Liz Gilliam Investors are anyone who owns shares of stock in a company. Including every single employee based retirement fund which means millions of people who are not in the 1%.
3
@Liz Gilliam Once we have established robbing the rich, we can come back for bigger bites from time to time.
2
I think the left’s insistence on single-payer is driven more by anti-corporate animus than by practical considerations. The problem is that insisting on that model, to the exclusion of others, will mean achieving universal healthcare in this country will take much longer and cost a lot more to implement than, say, a German-style multipayer model.
7
@AJD
You have it backwards. The animus towards profit-driven healthcare is driving the animus towards corporations. Q.E.D.
Even from a business perspective, Blue Cross et al. keep 20% of their revenue for administration (and profits). That's pretty high overhead when compared with Medicare's CMS, which requires a mere 3%. That's a big savings right there.
10
@AJD
Yes, it often seem as thought their proposals are vendetta-driven and anti-capitalistic. They clearly hate private insurers. The problem is doctors aren't far behind. Hospitals next.
Private insurance is not going away. Is there one honest progressive candidate willing to say this to the left?
3
Remaking 1/5 or more of the economy isn't unprecedented. The antebellum slavery economy accounted for more than a fifth of the US economy. Ending the slave economy was neither instant nor without significant upheaval. Yet, our nation survived and was made better for it.
10
Whether you call it Medicare for all or another name, what people want is simple: Health insurance that pays when you need it, doesn't let disease get you to the brink of financial ruin, and is affordable because it is pegged one way or the other to your ability to pay. That can be done as in Canada (Single Payer) or in Germany (multiple non-profit payers) or somewhere in between. Additional insurances for creature comforts (single rooms, etc.) are extra and paid by those who can.
That this would upend a big industry is no secret. We have just upended common sense by instituting a 1 trillion dollar tax cut with no benefit whatsoever to people who needed the money. Medicare for all will do something similar, however, the money will trickle down to the people who need it. You still pay, likely somewhat higher taxes, but no, or little, useless insurance companies who will wiggle wherever they can not to pay you when you need them. How is that for trickle-down. the money can be spent (higher demand, higher profits, higher stock prices of other industries) or invested (higher stock prices of other industries).The effect on retirement accounts will be negligible.
11
@TT --> What a distorted view of the world you weave.
"pegged to your ability to pay" meaning others pay more. Free stuff bankrupts, spending other people's money as a way of life; but you don't think they really need it.
We need to get out of private insurance altogether. Private companies exist to make a profit. Caring for people is not profitable. The government has the natural incentive to keep people alive and healthy, it needs citizens. Private companies have the incentive to drop you as soon as you become unprofitable.
11
The US will never have health care for all, no matter what you call it, as long as CEOs running big insurance companies continue to make multi-million-dollar salaries. Why would they ever want to lose their gravy trains, just so that people at the low end of the spectrum should get health insurance? After all, they never have to worry about going bankrupt due to a health emergency. Their multi-million-dollar salaries enable them to lobby legislators and ensure the continue to earn the big bucks.
14
It will never happen. I would like it to. Care would be better and cheaper, but it’s a thin dream. The biggest part of the economy co proses of the pharmaceutical industry complex, the doctor industrial complex, the insurance cartels, the non-profit hospital profiteers, the health care machinery makers: all unconscious and consciously conspiring together for nice salaries, long learning curves, and respected positions they will all suddenly abandon drastically lower costs for some ideal? Some election year sloganeering? Massive lobbies will be easily and readily defeated to crash the economy so we could become more like the French of the British? No. Batter to extend Medicare-like Obama coverage to those who don’t have any then change 60-80 percent of people who like or live with what they have.
When Medicare was being considered by Congress, the right wing, including Ronald Reagan in his first major opportunity to sell himself as a politician and the American Medical Assn claimed it would destroy the American healthcare system and throw us into socialism.
What was that about the more things change, the more they stay the same.
4
When our country was founded, in revolution against British monarchy, many Americans (British subjects) were very afraid of such big change. Many, called "loyalists," preferred the system they knew, had lived under and benefited from in some ways. But those we call "patriots" today had a vision of something better. They took a stand on principles of human rights long before they knew the details of the new government "of, by and for the people." Articles like this can scare Americans today to give up on the principle of healthcare for all as a human right, to accept the status quo they are familiar with whether it works well or not, and remain loyalists to the profitable insurance corporations and employers who control their access to medical care. It comes down to, are you brave enough for big change and do you believe something better is possible? Once upon a time, Americans were visionary and brave.
10
@abigail49 Many of those “loyalists” moved to what would become Canada. Their descendants would develop the single payer health care system in place today. Who was visionary?
You say that private insurance would be eliminated with Medicare-for-all plans, but nowhere explain how that prohibition would be necessary or achieved. Will providing any type of health insurance or privately funded health-related services be illegal? Most of us Medicare consumers would object to that greatly. Especially until any alternative national health care is up and running well.
And I don't understand how everyone is so sure that the coverage and government employees will be so responsive and accommodating when they handle coverage decisions and slowly pay the medical providers. Let's ask the folks needing housing assistance about their experience.
5
It's always what's left out; currently our health care system is the third cause of death and this is really really important here it's also the number one cause of bankruptcy. So why would we protect that kind business whose model is basically to do the opposite of what it's supposed to do and where are numbers of unemployed this health insurance industry has caused? I agree to handle things in a manner that is not so disruptive as to be devastating but we don't need to be forced to have it.
12
In country with national heath care systems a large percentage of the population still have private health insurance. The insurance allows them to step out of line to get prompt attention for their complain. The insurance may also cover elective procedures.
7
Yes, plus those workers can get government jobs (in theory) evaluating claims etc. The need for assessing which medical costs should be paid for will not disappear.
2
Those profits are your money spent on coverage, above what they paid out. I pay $370 a month for my family, my employer pays $1200 a month. Every year I spend 40-50 hours trying to get them to pay for things they are supposed to pay for, more than $2000 in copays (for 6 people but still no one here is particularly sick). And I count myself lucky. If the insurance industry wants to survive it's time they come up with a counter offer that doesn't involve scare tactics. I am open to ideas but they better be quick. I have been dealing with this my whole life and I am half century old. My patience is wearing thin.
12
@Duncan
I suspect under a government-run system, Americans would spend an equal amount of time trying to get those services in a timely manner.
2
For my taste this article as well as most politicians are too much neglecting the European model as a valid blueprint for a well functioning health care system. The European model is: private insurers, but they are only allowed to operate under extremely tight regulations. What’s wrong with that approach? As an immigrant of one of those European countries I have first hand comparison but while I find the current system here an absolute abomination I’m also vary of zero competition and a complete government takeover. A big problem however is that compared to Europe many US regulators such as FDA and F.A.A. are way to cozy and dangerously interlinked (corrupt?) with the private industry and that would have to change dramatically should the US ever become serious about “very tight regulations” and by that about getting an entirely new, better working and fair healthcare system.
10
Chicago Guy says it best -
"The power the health-insurance industry has over people's lives is so extreme, it can end up determining if someone lives or dies - based on profit. Is there anything more antithetical to the idea of a "civilized society" than this?"
25
While I can acknowledge that those who work in the industry are at risk of losing their jobs, that doesn’t mean that we shouldn’t move in this direction. Yes, taxes would have to go up, but in exchange we can say goodbye to premiums, deductibles, and copayments. That works for me.
10
"Believers in markets argue that consumer choice and competition among private health plans improve the quality of care. Others laud private industry’s relative nimbleness compared with Medicare, which can be bureaucratic and prone to political influence."
If one receives one's health care through an employer, the "choice" among plans usually amounts to: Silver (80/20) or Bronz (70/30), or "High Deductible." The premiums are substantial, moderate, and low, respectively. One must stay in network, so choice is limited. And judged by how quickly Medicare (my primary insurance) processes my claims, I can say for sure that they're far more efficient than my private secondary.
That said, people should read the other notes here. Almost every developed country I know combines public and private plans. Either a public plan covers some level of care that individuals augment with private insurance, or private insurers all mean certain standards and premium rates.
There's no such thing as pure "Medicare for All," and I don't think most Americans want it. They want some choice, with a public plan as a backstop. Most people won't read to the end of this, because it's too complicated an argument. But, as Obama and Trump both discovered, health care is a highly complicated and very individual issue.
7
"But doing away with an entire industry would also be profoundly disruptive."
So was ending slavery.
The power the health-insurance industry has over people's lives is so extreme, it can end up determining if someone lives or dies - based on profit. Is there anything more antithetical to the idea of a "civilized society" than this?
The other thing to consider is that, without exception, the happiest people on the planet all have single-payer healthcare systems.
There is one group, however, which has been fighting ceaselessly for decades in order to make sure that your health and welfare continue to be determined by profit motives. And they have fought tooth and nail to make sure the citizens of this country never achieve the kind of happiness the vast majority of people in so many other industrialized nations enjoy.
And that group is the GOP.
They are, and have for some time, been a group determined to rain down as much misery as possible on the people they are supposed to represent. Just look at the misery machine currently inhabiting the White House. The one they helped get elected and have criminally and treasonously abetted at every single turn.
Republicans? They are the embodiment and personification of "death for profit". If, and when, the day comes that their supporters finally realize the truth about who they've been enabling, the GOP as a political party, will ceases to exist.
And that will be the beginning of a much brighter future for us all...
22
@Chicago Guy Will you let us know when that happens?
The headline is patently false. Medicare right now allows extra coverage, and so would any Medicare for all plan. I can't believe that the Times let this go through unchallenged as it is pure pro-insurance propaganda. It does illustrate the problem of talking about changes to our health care system because some shrill voice will predict doom and gloom for any change. The insurance industry has deep pockets to spread falsehoods.
19
The trouble is Obamacare really ratcheted up the private insurance industry with plans such as Medicare Advantage and other subsidized health insurance programs. Many of us warned that the medical bureaucracy would grow exponentially quickly. We were scoffed at as conservative nutcakes but this is what happened making unwinding much more difficult.
This will have to be done in phases and take decades. Perhaps starting with Medicare for over 50 to get older people out of the pool. Private insurance for under fifty should drastically reduce making it affordable. At that point we might find that's all that needs to be done.
The utopian idea that we tear down an entire system and "start from scratch" is pragmatically foolish.
4
Your idea would put all of the folks over 50, who are more likely to need medical care, on the public hook, while those under 50 would stick with private insurance. That gives the insurance companies the high profits they seek by collecting premiums, while being on the hook for relatively little care.
Yep - that does sound like a conservative idea - letting a few profit while the rest of us carry the burden.
7
@Bill Seng No. A conservative idea is to abolish Medicare.
Trump promised in his campaign for the 2016 presidential election that he will not tinker with social security and he won. If he promises not to mess with medicare in 2020 he will win reelection for a second term. The Republicans tried to repeal and replace Obamacare and they lost the house. The Republicans along with the tax cuts took away the draconian penalty on those who were not free to choose not to carry any health insurance and the Republicans held on to the senate. Elections have consequences..... Barack Obama.
Abolishing private health to covert to medicare care for all as some extremists lefties have suggested will ensure reelection of Trump by a landslide electoral college win and with popular vote win.
I just spoke to a relative of mine in Canada and she said the Canadian socialist healthcare system similar to the proposed medicare for all system works very well for coughs and colds but if there is sophisticated treatment or a cutting edge diagnostic MRI imaging is required for a life threatening illness due to a tumor then there is a long waiting list and for the urgent needs Canadians just cross the border into the USA or go overseas. The infrastructure of the medical system in Canada is inferior to the system in the USA. The single most important reason why the Canadian health care system remains financially viable is because Canadians take better care of themselves and cause much less self inflicted illnesses. So average Canadians make their system work
3
@Girish Kotwal have you asked your cousin if she would trade the Canadian System for the American System? Would she be fine with paying tens of thousands of dollars a year in premiums, copays and deductibles, only to have some paper pusher at an insurance company deny her coverage? Would she be okay with going bankrupt because even if she has insurance, the cost of pharmaceuticals, tests and procedures won’t be covered by insurance? Our for profit health insurance system is unaffordable, unsustainable and cruel.
16
@Susan F. Wrong question. I'm sure the person is fine with the Canadian system for pedestrian needs. Many large academic systems in the US have a presence in large Canadian cities to provide an off ramp for complex care to their major US facilities.
2
Coughs and colds. Ludicrous. Health care in Canada does focus on prevention, which is less costly of course. Maybe for more elective, less critical health issues, you are on a waiting list. An MRI is available privately if that list is too long for you. The 1000 dollar cost for an MRI is what? a couple of months of co-pay and premiums for the insured American.
However if you have a serious problem, you move to the front of the line and get everything you need. Everyone I know here who has been diagnosed with cancer has been treated very quickly. The difference is that when I say EVERYONE, that’s what it means. Not just the people who have insurance. Illness brings enough worries without having to worry about cost too.
2
Here in Australia we have free health care for all, we also have a booming health insurance sector, the UK is similar, the health insurance sector booms despite it raising premiums way above inflation year in, year out. Just because you have a bad health system in the US, the worlds most expensive by the way, that's no defense of the system as a whole. Its as simple as this, do you put peoples health above company profits, id assume the answer to that question, especially if it involved one of your children would be of course not, well there is my argument for free health care for all, beat that. As for health insurance, some people are always going to want more, so let them pay their insurance premiums for that 'extra' if they choose.
11
@Bob Tonnor You don't have FREE health care for all - no one does. You just have a different way of paying for it. We don't have a bad health system; we have one with a lot of problems. But the quality of our government is the much bigger problem.
1
Obama tried to work within the system, yet the ACA still turned into a partisan lightning rod and was decried as a hostile takeover of medicine by the government. It seems that if you are in for a penny, you are in for a pound, so better to go all in on Medicare for All, that will likely garner more outward support, than try to sludge through incremental changes that are challenged at every turn.
3
@Conor
Don't blame everyone else for Obamacare's failures. Whoever thought it was a good idea to disrupt the entire private health insurance industry in order to move people onto Medicaid, which is where 80% of Obamacare's enrollees were placed?
2
Obama said one had to be careful what one decided to do in government, that anything more than a small change would probably ultimately be rejected. And as we saw with his signature health care initiative, that turned out to be prescient. If this country couldn't even stomach Obamacare -- a Republican invention -- who can reasonably imagine that it would stomach the federal government wiping out an entire industry and placing it in the hands of bureaucrats? Oh, yes -- so-called progressives, who love to talk revolution without providing any details about how. Obviously, if this is an existential threat for the health insurance industry, the health insurance industry and many related interests will probably do everything they can to defeat the Democratic challenger, very likely leading to the re-election of one of the worst people this country has ever produced, as Commander in chief, yet again. Do please remember that "corporatist" Hillary trounced Bernie 2 to 1 when the two of them went head-to-head in this blue fortress of a state. We *did not want* what Bernie offered then, okay? And he hasn't gotten a clue since. He has not changed one bit.
@Joe
I’m not opining on implementation of health care changes. However, you’re a bit off in your political analysis. It really doesn’t matter how California, New York, and most southern states voted in primary contests. We know how those states are likely to vote in a general election. Sanders won Wisconsin and Michigan in the 2016 Democratic Primary, though, two of three swing states important in the general. While I’m not stating that people in those states want Medicare for all, they clearly support a more economic populist candidate.
2
There is a simple way to transition to Medicare for All over time, simply by slowly lowering the age at which an American is eligible. For example the age could drop by one year each year. Then the insurance industry ( which as noted already contracts to provide Medicare and Medicaid to many Americans) has plenty of time to slowly downsize. We need to stop screaming with outrage and hammer out logical, reasonable compromises.
10
@4Katydid as someone else warned, when only the young and healthy were left, the insurance companies would pull a fast one and get the program stopped. Now if all newborns go on medicare AND the age for medicare drops one a year. This would allow incremental change AND prevent any funny business by the insurance companies since the young as well as the elderly will get gradually taken out of the pool.
1
@4Katydid
Most Americans are rational and would support a phased approach to expanded Medicare, provided it included an option for supplementation with private insurance.
The howling today is mostly from the left, which wants private insurance obliterated and all health insurance to be controlled exclusively by the government. Never going to happen.
2
Allowing the private, commercial business culture to take over our healthcare system has been a basic and disastrous error. Commercial insurance does not exist to provide the population with necessary medical attention - only to provide the insurance company, its executives and its investors with maximum profit. Some healthcare for most of the people some of the time is an unavoidable byproduct, the cost of which the company seeks to minimize through multiple strategies that obstruct and limit actual care. The mere fact that we have gone many miles down the wrong road already does not in any way justify continuing in that direction because correcting the error would be "disruptive".
5
My husband and I are covered by Medicare and
United Healthcare supplementary policies. In other words, Medicare did not mean excluding private insurance. The two can easily coexist.
I also have health coverage through my employer. My employer’s PPO has hefty deductibles and copayments if I go out of network. If I stay in network, I still pay a co-payment. In contrast, with Medicare and my supplemental policy, I have no deductibles and no copayments. Also, the Medicare network is wider than the PPO’s.
Medicare and my supplemental policy provide me with much better insurance coverage than I ever had under any employer’s plan, and do so while not eliminating private insurance. Yes, under Medicare for all, private insurers would not be able to obtain high premiums while providing more limited coverage. Who says they should have that right? Not me, and not the majority of Americans.
The insurance industry’s business model is the same as that of any other corporation- deliver as little as you need to deliver to maintain and grow profits. Capitalism benefits shareholders, and in many cases that may be OK. Healthcare is not one of those cases, because with healthcare, the product is the public’s health. Private profit should not be a determining factor in creating and delivering that
product.
Medicare for all is our best chance of achieving universal healthcare that is high quality and affordable, and I will support the candidates who support Medicare for all.
12
Medicare for all with no private options takes egalitarianism to a level beyond anything seen in other walks of life. Everyone deserves decent housing, healthful food, and adequate medical care. But believing this does not rule out having a spacious house and buying organic foods if you can afford it. It shouldn't rule out paying for extra medical benefits or having employer-sponsored supplementary health plans either. In Ontario, the government plan basically covers all necessities, However, in my case a university supplementary plan (administered by a not-for-profit insurance company) not only provides better hospital accommodations but, for instance, travel health insurance, which for people of a certain age becomes prohibitively expensive in the private market. These are benefits available to a privileged class, no question, but I do not find any of our social justice warriors demanding that they be given up.
Do the supplementary benefits make a difference in health and longevity? Quite possibly. But having a better house and eating higher quality food probably makes more difference. Press for equality can only go so far before it creates a massive backlash. I hope the Democrats eager to wipe out the private health insurance industry are aware of this and back off from their extreme position. Otherwise they will kill what could be a giant step forward in health care for all.
7
Medicare for all can’t come soon enough.
6
Australia has medicare for all as well as private health insurance. Why can't USA adopt a similar hrbrid system?
8
@virginia Main reason: we don't have Australia's government.
@virginia - sorry - that should be hybrid.
Healthcare costs are highest in our country because of entrenched profiteering, fraud and waste. Many health insurance workers could continue work handling Medicare services.
Why's it OK to disrupt other industries - coal, manufacturing, etc - but not the health care insurance industry that siphons off billions meant for health care? A shake up is needed to dislodge entrenched profiteers that add no value to our healthcare and spur real innovation. Hospitals, doctors, the pharma industry, supplemental insurance will all still be around and gainfully employed.
The real problem is the shear madness of businesses providing health insurance to employees. If you get sick and can't work, your out of luck, a job and health coverage. My former boss had pancreatic cancer and worked until his death to preserve his job and thereby his health insurance. What a cruel health care system!
Allowing private interests, your boss, to decide what health insurance you get, and what religious flavor of health care coverage they decide you will get, especially for women, is insane.
Instead, employers should pay employees the amount they would have paid into the company's insurance plan - paid into a health insurance plan the employee selects - like 401k plans. That way the employee decides the coverage, not the employer, and if you're fired, you take it with you - essentially 'roll-over' to another plan if you change jobs, or laid-off and unemployed for a while, get continuity through the ACA.
3
So what? Get rid of the insurance leaches and move on into the 21st century!
7
@Bjdj...If we were to expel the "leaches" from their workplaces our economy would collapse. Careful what you wish for. Please bear in mind that economics is counter-intuitive, as with almost everything else in our 21st century.
1
I just became eligible for Medicare and have been flabbergasted at how incredibly complicated it is! One has to find the right Plan B, C, D, E, F, G and H (the government takes care of Plan A). One has to choose a separate insurance company for each of these tiers, and each insurance company has multiple plans for each tier, including some plans that bundle some, but not all, of the tiers. The only people to help you sort out the complications are employees of one insurance company or another, paid to push their employer's plans. It is almost impossible to figure out what is the most suitable combination of plans for one's stage of life. On top of it all, my medicare coverage costs me several hundred dollars a month -- not exactly "affordable." Medicare is available but still not affordable, and you can bet that the insurance companies will keep it that way, or worse, if it is expanded "for all" without the protection of a single payer plan.
6
The only ones who will take a cut in the single payer system are the physician. You can bet the Medicare for all plan will still be administrated by private companies whose executives will provide zero care but still make billions. Sounds good to me.
@cb Might I suggest a visit to a Mental Health Spa like Las Vegas, or New Orleans. Take your mind off "Plan B,C D, etc.
1
When concerns are raised about taxes going up, it needs to be pointed out that there will be a larger savings elsewhere. Thus, if insurance is a perk of employment, the cost of that insurance should be paid to the worker as a salary increase to offset the tax, or the company will pay that tax for the employee. For those who are self-employed, as I am, it means not having to pay exorbitant insurance premiums in return for those higher taxes. Meanwhile, there are multiple savings to the patient and the provider, which will further offset the costs. Understood this way, it may meet less resistance. (Also, insider secret, people wait for care now.)
3
We already have a good prototype for supplemental private insurance in the plans offered by many major insurers to supplement Medicare, the so-called Medigap plans. They offer a limited range of coverages, identical among purchasers, and with tightly limited restrictions, tied mainly to failures to sign up in a timely way. They may not be as profitable as the market for employer - based health insurance, but it would be relatively easy to adapt them to a much larger Medicare - eligible population.
2
As a small business owner in HCA-resistant Texas, health insurance premiums for my husband and myself (both healthy, no claims other than one mammogram, one pap, colonoscopies and one yearly checkup each) costs more than $35,000/ year, and that is before we hit the $10,000 deductible.
That’s with no dental, no optical, and no coverage in our own County; in order to use our insurance, we have to take at least a half day off work to go to doctors located one hour from our home because there is no ACA covered option where we live.
I am not asking for the elimination of private insurance, I am asking that those of us who do not have employer based insurance be offered the OPTION of affordable, not for profit coverage like Medicare, including EQUAL coverage costs even for red states like Texas.
If you have employer based insurance, good for you, but please try to consider this in a less binary way - I don’t want to take away anybody’s private, employer funded insurance, but, in the interest of fairness, those of you already covered (especially those already on Medicare!) shouldn’t vote against or even weigh in on my having an equally affordable option.
13
Why are we concerned for the insurance companies whose main goal is to make it as difficult for patients and doctors to get paid for minimum care?
What do large companies think about single payer system? I would think it would help with their costs too.
Single payer would free up employees to make career changes based on opportunities and not on benefits like health insurance.
We are all going bankrupt from health care including many state and federal pension obligations. The current system is not sustainable.
8
This precedent-shattering event is 5 decades overdue. In the immortal words of Nike: Just Do It. The American people have waited far too long for the humane, universal healthcare that is our human right.
9
@Carla I prefer self-treatment. There are loads of information on-line.
I believe the adoption of Medicare-for-All will not be as traumatic as its critics proclaim and will in fact be beneficial to the US economy. Medicare itself caused very little disruption after dire warnings and the same will be true for its expansion. People working now in the insurance industry will find jobs that put their considerable skills to use benefiting us all rather than the opposite and the population at large, not having to worry about medical costs, will be happier, healthier and more productive.
5
We must fix the current Health Care mess that was the Affordable Care Act—and refuse to call it “ObamaCare” because of all the pejorative baggage that cognomen has accumulated. The ACA was a giant step in the right direction with significant bi-partisan input and support, despite the current administration’s efforts to dismantle it.
While there are excellent national examples of well-established healthcare systems today that could serve as blueprints for what could work in American society, we must be careful not to simply implement one of them verbatim into our society. Whatever plan we deem best for the needs of the majority of Americans must be thoughtfully and strategically phased in to minimize social and economic upheaval.
If a single-payer system is deemed to afford the greatest benefits to the largest majority of Americans, then it would need to be carefully phased in to our social-economic system over a period of several generations, deliberately and well-considered, rather than ad hoc and in the emotional delirium of do-gooders.
Personally, I believe that we should reconsider, rethink, and reimplement a thoughtful and well-conceived version of the ACA. It was beginning to work, until radical Trumpism threw a monkey wrench through it.
2
As other commenters have noted, the simplest approach would be to incrementally lower the age of Medicare eligibility. By increasing the Medicare pool to include younger, healthier people, that would reduce Medicare costs quickly, and also increase the clout Medicare has to negotiate prices. (The legislation would preferably do away with the restriction on negotiating prescription drug prices that Republicans put in place at the request of their Big Pharma donors.)
But Medicare expansion would not eliminate either private insurers or the jobs of their numerous employees. Some of them would administer Medicare, as they currently do. Others would sell medigap policies that pay the Medicare deductible and coinsurance as they currently do, but to an increasing customer base. The expanded Medicare could also include expanded medigap, standardized policies that cover dental, vision, and hearing. As in other countries that currently have real health care systems, a private or "concierge" care system outside Medicare might be available for the wealthy.
Under Medicare-for-all, private insurance companies would still have a role. There would thus still be an opportunity for private insurance companies to make a profit. Similarly, regulating Big Pharma's pricing as other countries do would still allow them a decent profit, as they make in other countries. The difference would be that they would no longer enjoy their current astronomical profits. I consider that perfectly fine.
7
People should know that Medicare doesn’t cover everything, and isn’t free. Retirees can pay up to $400. a month for Medicare and Medicare Rx. But you also need private insurance to cover the 20% not covered by Medicare.
The point is, it’s not as simple as just snapping your fingers and saying ‘Medicare for all’.
11
@JSR Insurance protects your assets, not your health. Without assets, you're on top of the World
1
I lived in Canada and was able to buy into the system -- it was great I made an appointment, saw the doctor and left. Just left. No co pays, no surprise bills, no arguments will billing specialists.
I'm one of the people who are supposed to be thankful for the ACA but I hate it. I can just barely make the monthly payment and I can't afford the co pay without going into debt. True, I'll be thankful if I get hit by a car but in my day to living -- I have the hassle or enrollment periods, monthly bills, more complicated tax forms and I'm no more able to see the doctor than I was previously.
4
I hope that when they look at all the jobs lost when the inefficient private corporations go out of business, that they consider that the Medicare program would be expanded quite a bit. Medicare is efficient, but not so efficient that it will be able to handle all those new clients without hiring any new workers, especially workers with experience in the healthcare field. Presumably those high level executives who focus on minimizing pay-outs and maximizing profits will be left out in the cold.
5
Medicare is efficient? That’s laughable. Medicare also isn’t free. People still pay premiums to cover the stuff Medicare doesn’t cover. Covering everyone with Medicare and then paying for everyone to have things that Medicare doesn’t even cover know should be astronomically expensive. But I guess that doesn’t matter to all the democrats most of who don’t pay federal income tax in the first place.
5
@John Bergstrom Those "high level executives" will not be out-left in the cold. He/she will grab a backpack and head For the antipodes. Lesser folk cannot even find antipodes with a map.
1
There may be nothing like medicare for all in U.S. history. But the world is a big place. Several places that have built civil societies for centuries longer than we have manage to provide universal health care with the state bearing all of the risk of insurance, and negotiating prices with providers. Private "insurance companies" administer payments, etc. Switzerland is a good example. Taiwan is too.
That is also how some U.S. companies provide insurance for their executives. They contract with an insurer to negotiate prices with providers and to handle payments, etc. But all of the risk bearing is with the company. Every time a member is treated, their doctor bills the insurance company, the insurance companies pays the doctor, and then it bills the company for the cost of care plus a small administrative fee.
These arrangements would shrink the size of insurance companies and they would have drastically lower revenue. But they would also cease interfering in the operation of the health care economy.
2
@DJR A lot of places have better managed health care, but they lack modern conveniences like F22 Fighter jets.
3
This is America where big money rules the roost, supported election cycle after cycle by benighted rural voters.
Universal single healcare will NEVER become a reality in this country, and literally millions of lives will be lost as a result.
1
It would be very disruptive. But it is needed. Get it done sooner instead of later.
3
What it would mean to workers, the stock market and the cost of care? Like with all other major shifts, money and jobs get redistributed and some win and some lose. Some frankly deserve to lose. The only thing I care about is, lower health care costs for people, and higher incomes for people. Because if employers no longer have to pay for health insurance premiums, that money should go to employees to offset higher taxes. I highly doubt that will happen though.
What is guaranteed to happen? Nothing of the scale that's needed. Because of corporate greed and the voters who are brainwashed by disguised corporate propaganda.
3
Spoken and rationalized like to a true centrist. You cannot think out side the box. 17% of our GDP goes to the health Care machine while other countries range between 7% and 12% AND do a better job at it. Anyone that defends our current system must be very comfortable while the rest of us live in constant fear of a severe illness causing compete economic devastation. Our system is brole and needs universal health care now. Don't vote in Republican or centrist Democrats
4
@jazzme2 The current system is OK.
Sporting folk can slither through without paying. Subversion is the key to our survival as a civilization.
1
I genuinely wish there was more explanation of the supposed benefits and feasibility of a single payer system. The idea of improving "efficiency and equity by streamlining the health care system and weakening profit motives" is extremely vague and does not map to reality. I would love it if the Times would do the work of validating whether this convoluted and industry-destroying proposal has any chance of resulting in better outcomes for citizens, or if it's just the wild dream of our new socialist twitter influencers like Bernie and AOC.
3
People on Medicare and Medicaid which are the 2 government systems don’t have better outcomes than private insured patients, I’m not sure how giving everyone Medicare is gonna make care so much better. The problem in America is the heterogeneous population. Hard to compare is to Sweden where they have a very homogeneous population.
3
Hallelujah if we could abolish private health insurance. I for one would welcome the change, long overdue in a country as rich as the US. Let's just for one minute think about ALL the money floating around the world in offshore accounts. Money the uber rich do not want taxed. Think about what a difference in society life would be if those hoarding untaxed money was therefore taxed. Healthcare, education, standard of living....ALL changed drastically. Instead we have heads of states, countries, all manner of individuals instead hiding their money. Think Panama Papers! None of this constant, CONSTANT wrangling of how to pay for universal healthcare, education, housing. No, instead, a society exists with vast inequalities. Our current healthcare system is an abomination. But none of this will ever change unless we recognize the VAST sums of money floating around this planet, being hidden, so that we as a society remain stagnant and impoverished.
2
@Margaret melville I like inequality. There are so many people I would not wish to be equal with.
2
Nonsense. In France and the UK there is universal healthcare, but there are also private insurance plans (BUPA, for instance) for those who want "gold-plated" care. Private insurance can, for example, avoid waiting times for routine interventions. The two are not mutually exclusive.
9
@Kirsty Mills Here we just hire otherwise useless people to wait in line for us
1
Surprisingly, the NYtimes presented an article that basically puts the nail to the coffin for"medicare for all," a frivolous and half-brained "idea - if you can all it that " that is also supported by large fraction of the democratic base, their congressman and candidates running for president. Hopefully responsible and informed voters become informed with the content aligning with this article, and take note and do not vote democrat in 2020. However, many will be influenced by democratic politicians, MSNBC and fake facebook posts and think"medicare for all" is good policy.
3
The premise is simply not true. Sen. Sanders has said that if people want to supplement "Medicare for all" with private plans, they can do so. His opinion was that most people would not need to do so.
I am on Medicare and also pay (far too much) for some supplemental coverage. In Canada, I would not need that coverage.
But what a ridiculous idea that we should keep funneling money into a system that lets people die so that the stock market (the financial industry) won't be discommoded.
Are the authors really concerned about the retirement funds that are invested in insurance company stocks? I really don't think so. It is the large and hugely parasitic owners and executives of these greedy companies they are trying to protect.
9
Study it and alternatives and report to the American voter to decide which course is the best. What we have now ain't that hot.
1
First, let me say if that were the case, they deserve it as a class. They have single handedly crippled the practice of medicine in the US. They wrested control from doctors by drowning them in paperwork, by denying their orders, making the practice of medicine a grueling, unhappy profession. They have had their pencil pushers play doctor with OUR lives and determine different (cheaper) courses. How many people have they killed? Certainly, some. This is a class I would be happy to see hit the dust. On the other hand Medicare, although generally better, also has its own paperwork problems.
4
Democrats Medicare for All position is political suicide. The slogan needs to be "Healthcare for all." Access to healthcare and health insurance should be guaranteed.
Connecticut leans Democratic but Health Insurance is a core industry. Most Democrats I have spoken with who work in insurance have been scared away from the Democratic message with Medicare for All.
Beating Trump is most important and Democrats are losing site of the big picture!
1
The title and gist of this piece are wildly misleading. “Medicare for all” doesn’t necessarily mean a single payer, single provider system that excludes private insurance. I dont think many people would actually support going that far. “Medicare for all” could also very reasonably mean: a) everyone has the option to buy Medicare insurance out of their own pocket, regardless of their age; or b) or everyone would gets free Medicare, paid for by taxes and efficiencies in the system, but everyone has the option to supplement that with private insurance, if they so desire. It’s very disappointing to see the Times mischaracterize this discussion so woefully
2
I support Medicare for all. This is a program that works, and if we extend it everybody, our country will see the benefits. People will received needed medical care. Also, we will prevent bankruptcies and homelessness caused by medical bills. It will be a boon for small businesses and people who want to be entrepreneurs.
It's time to check our values. What is more important, people's health or profits for private companies? Our country needs to address the needs of the 99%. I vote for a system that takes care of our citizen's health needs.
4
There is a vast difference between Health Care and Health Insurance. The American consumer has had these two concepts intermixed since GE and similar companies became corporations and employer provided health care became no longer the norm. When I was a child a person paid the doctor bill to the doctor, and those bills were always reasonable - until a patient had to go the hospital.
It was Hospital Bills that became burdensome, not Doctor costs. Our family doctor came to the house, no matter the time or day. Only the very wealthy have physicians on demand now, doctors available whenever called.
The only place the average person can find such health care is through Emergency Room intake, now one of the most expensive aspects of Health Care. No one wants to have to pay Emergency medical bills out of their own pocket. Hence - Health Insurance. The patient still pays a nominal fee, but insurance pays the largest balance of the Emergency bills.
The Health System has been rigged for decades to require insurance. Medicaid has become health insurance, ditto Medicare.
However if there is any hope for a universal health care system it will have to be modeled after Medicare, as soon as all the damage done to the system by the GOP over the past 20 or so years has been repaired.
4
I calculated that with 155 million people currently covered by employer provided health insurance which costs employers and workers, factoring in premiums, employee contributions, and out of pocket deductibles somewhere in the neighborhood of $25,000 annually, based on my situation as a public school teacher, which I would bet is about the middle of the road. That is a price tag of $3,875,000,000,000 spent providing health insurance that still leaves millions uninsured. Yes that is almost 4 trillion dollars per year.
If the federal government can do it for less and figures out a way to make employers return the difference to their workers, since employers see health insurance as part of a compensation package, we will all get a raise even with higher taxes. To top it off, everyone living in the United States will have health insurance.
Sounds like a good idea.
6
There are currently two major issues with medical care in the US that a simple proposal will not resolve:
1) Fee based medicine - an incentive system to complexity.
At a minimum we need a different approach that does not reward more service billings to reward billing madness
2) Anything that is free will be over used.
We need to learn from national health care programs in other countries: clearly total coverage for every medical care item people want will break the system. It is naive to expect people will not be incentivized to overuse a free system. But many Americans want more than "Basic Health Care", they want more for less. Who pays???
Note that currently few doctors and medical systems accept Medicare. It doesn't pay enough for them to live the fancy high life that the medical world desires.
Finally, complex problems require complex solutions. Simple solutions are for simpletons!
1
Economists and business consultants love to go on about necessary disruptive technologies or movements. They point out the inevitability of displacing workers. For example, I hear a lot of praise recently for Amazon because it "disrupted" retail. Yes, it has, and a lot of people whose bills got paid doing retail work are now looking for something else to do. I know this sounds cruel, but what's the difference if hundreds of thousands (more perhaps) of insurance employees loose their livelihoods because things change?
3
I am stunned by the timidity of so many comments here, in particular those from people who suggest we lower the Medicare age incrementally: lower it five years at a time, lower it two years at a time, lower it one year at a time. At those rates it would take up to 13, 20, or even 65 years before everyone is covered. How many Americans will have to suffer from lack of care, die, or go bankrupt, so that we can protect the profits of the insurance and pharmaceutical companies?
As for the employees in those industries who actually live paycheck to paycheck (not the CEOs), with the money saved we can set up a retraining program and put them to work doing something that actually helps people.
7
@Martha Shelley
Yes, most of the people that work in private hospitals here in NY are Black or Hispanics...nurses, technicians etc.
They could be retrained to buikd solar oanels in Kansas, right?
1
Before expressing concern about the loss of the private insurance industry, it is crucial to understand the single payer model of Medicare for All. It truly reduces administrative waste by hundreds of billions of dollars while using public policies to finally price our health care services appropriately. The funds recovered are more than enough to fill in the voids in coverage for the uninsured and underinsured. The Affordable Care Act with the public option Medicare buy-in models forgo that efficiency and still leave tens of millions uninsured or underinsured.
The insurance industry is very expensive, yet it interferes with care through restrictive provider networks, financial barriers to care, and prior authorization requirements, while providing no direct health care for the hundreds of billions of dollars it consumes. Reform models include job retraining and transitional compensation for displaced workers, so they can engage in more productive occupations of greater benefit to our economy.
In any other industry, accolades are awarded for disruption of a system with very high costs and poor value, when it is replaced by products and services of greater value. Our sympathy for the insurance industry will evaporate once we finally experience affordable health care for all.
12
Private health insurance companies aren't going anywhere. If the government enacts universal health care they'll need someone to run it. That's what the private insurance companies will be doing.
It's like FEMA. FEMA does the indemnification but the private companies run it.
6
@MIKEinNYC
Maybe. Right now the government does not outsource Medicare except for the HMO version.
1
@MIKEinNYC Yes; some of the private sector workers would transfer to the govt. the excess would go to the ‘disrupted’ workers category so touted by economists.
1
MEDICARE FOR ALL & THE BENEFITS - THE HUMANE ANSWER
1. It eliminates the big multi-million dollar salaries and bonuses of the CEOs and Senior executives and demands for higher dividends to the stock holders.
2. It eliminates the current practice of drug company plying Medical Providers with bonuses and other various incitements to buy their products.
3. It will allow the government to negotiate all the prices for drugs, medical equipment and services across the country.
4. When the Government takes on the responsibility for all health care, it can hire the current private health insurance employees who will be needed to handle the claims and the local facilities of the current private health carriers also can be purchased and utilized across the country.
5. It will simplify the parameters of coverage under one system thus easing the burden of reducing medical care providers in processing claims.
6. It is the most humanitarian way to protect the country as a whole by controlling diseases and providing care in the early stages of medical problems before they get out of hand.
7. There is nothing wrong with having a reasonable system of co-pays just like we currently have now for those folks who are collecting Medicare but it should be based on an income sliding scale.
In the long run, this is the most effective care for all and demonstrably will reduce the current runaway medical costs and skyrocketing increases in the price of drugs.
4
@Gillian Your might have a case if we had a government that was efficient, competent, and trustworthy. But we don't. I'll be happy to offer a good price for a D.C. monument to those who think otherwise.
America in aggregate spends nearly $3 Trillion each year on healthcare. We spend that much and fail to cover millions of people. We can do better. Private, for-profit health providers, and health insurance companies have perverse incentives acting, in both cases, against more economic, universal health care. Private providers make more when they 'sell' more - more tests, more expensive pills, more fancy treatments. The system incentivizes 'fixing sick people' instead of 'keeping people healthy', a fundamental misalignment. Private health insurance companies are incentivized to maximize profits by minimizing expenditures for actual health care, while increasing marketing, overhead, and (of course) profit as much as they can. In both cases actual health of the population often takes second place to these perverse incentives. We need a system that emphasizes keeping people healthy, instead of 'fixing' them after they get sick. We need a system that spends it's revenue on health services, not advertising, overhead, executive bonuses, and investor profits instead. We can do better. Other countries spend lesser percentages of GDP on health care, AND get better health outcomes. Our system costs us more, and gives us an inferior result. We CAN do better - and we should.
5
I wish everyone would reread the excellent NYTimes article on how Germany manages to have universal health care, while preserving and regulating health insurance companies that compete for patients.
https://www.nytimes.com/2019/02/20/opinion/health-care-germany.html
The worst thing about "Medicare for all" would be the fact that there might not be any competition nor incentives to improve service. Without competition, governmental rudeness can become the norm. I fear that just as some DMV employees are famously rude, likewise so would be some of the people who would regulate "Medicare for all."
5
@Larry Under a healthcare system run by the government, rudeness would be the least of our problems.
1
@Larry I have NEVER experienced rudeness at the DMV or any govt agency. Only when you seek and rudely insist on something not allowed under the rules might you get a behavior that may ‘appear’ rude.
Medical insurers don’t make life and death decisions; clinical care providers do. The Doctor can prescribe care and the patient elect to undergo the treatment, even if it’s not covered by insurance. The insurers are declining to pay the claim, but not disallowing treatment. If your auto insurer refuses to pay fix your car, what do you do? You still fix it.
Why don’t we ask hospitals to lower What they charge? Because they can’t tell you what they charge, it’s a secret. Why is the cost of medical care a secret? Why do you think?
The real issue is why US medical care so expensive to begin with.
1
@Kcoombz
Denial of coverage is denial of care for most Americans.
There will always be a private health care option for people who want better quality medical care. This is true in England, Canada and Europe. Canada has less of a population than California: not a good example. Do politicians really have research and studies for their proposals or do they just say what people like to hear?
7
When I see concern for the stock market or the stock values, I get nauseated.
The stock market is effectively nothing more than Las Vegas East. Beyond IPOs and dividends, it is just a gambling game dependent on perceptions of value.
That most people don't "get" this results in yet another "too big to fail" enterprise - and a non-productive enterprise at that.
The stock market is the heart of the "phantom financial economy" ( check out the work of economist and historian David Korten.)
6
Health care is a right? Well, I don't know. I've grown to believe "natural" rights don't exist for human beings any more than they exist for any other animal. "Rights" are simply what we decide are "rights". So if a politician or philosopher wants to say "health care is a right", then I suppose it can become a "right" if a plurality agrees.
2
@Kevin: Well, not exactly "if a plurality agrees", but you're close. It's most useful not to think of rights as something mystical or philosophical, but as something pragmatic that varies from society to society. In practice we already agree that healthcare is a right, sort of: people aren't supposed to get turned away from emergency rooms. It's felt as a scandal if someone is refused medical treatment. But then, the person may well go bankrupt from the bills, and certainly won't get some of the attention and treatments that the wealthy can afford. It's sort of like having the right to travel freely: you don't need a permit from the state, but you might not be able to afford to go where you want.
So whether it's a "right" or not isn't the most interesting question. It's whether we want the general public to have decent health care.
1
@John Bergstrom Yes, that's essentially my sense of it. But I do think it is an interesting question, as I feel I don't myself "have the right to healthcare." I work for it, and pay for it. Another question is whether such a national system can work at scale. People always trot out places like New Zealand. But New Zealand has fewer people than Houston. Also, are we willing to devote a significant part of what we spend on the military and spend it on healthcare instead?
4
@John Bergstrom Yes, that's essentially my sense of it. The Founders certainly believed that "rights" were natural; instituted Divinely. But I do think it is an interesting question, as I feel I don't myself "have the right to healthcare." I work for it, and pay for it. Another question is whether such a national system can work at scale. People always trot out places like New Zealand. But New Zealand has fewer people than Houston. Also, are we willing to devote a significant part of what we spend on the military and spend it on healthcare instead?
2
No one has yet been able to demonstrate how "Medicare for All" would provide better coverage than Medicare PLUS coverage by current or former employer -- especially for the retired. I have a feeling that a lot would be lost.
4
@Dot: Medicare could be improved considerably, along with the major expansion people are talking about. Presumably a "Medicare for all" that was intended to replace the private insurance industry, would be modified so no supplemental private plans were needed. But that would have to be carefully designed into the new plan.
2
It's my understanding from a Kiwi friend that NZ's system is a basic universal coverage that can be supplemented with additional, private insurance. I'm all for anything that brings this nonsense under control, takes it out of the mouths of the wolves and allows us to get affordable healthcare.
9
Expanding medicare to everyone doesn't need to be tremendously disruptive or complicated. First you immediately lower the medicare eligibility age to 60. Then you lower the eligibility age by 2 years every year for the next ten years. Then you lower the eligibility age by 4 years every year for another 10 years. In 20 years, everyone is covered and the system has had time to adapt.
4
Medicare for all would not abolish health insurance, but would render it largely obsolete. Medicare for all, would supply basic healthcare to everyone without premiums, deductibles or co-pays. All paid for by taxes that would be significantly less than the premiums individuals and employers are now paying.
But it would most likely not cover dental care except in case of accidents, eye glasses and guaranteed private rooms which would require private insurance for those who want and can afford them. and .
6
Cost of care would collapse over five years and medical procedures would be decentralized so that specific areas would be in a main location. The wealthy would still be able to hire private doctors who don’t take Medicare. Insurance companies would be significantly weakened. Imagine a main hospital for just child birth instead of having ten hospitals have birth care in each unit. The system would change but with the right planning could be more efficient. Build a major hospital right in Central Park with easy access for just new born babies. Hospital costs would be turned upside down.
2
How would you do something like this in rural areas? One birthing hospital—how many miles would people have to drive to get to it? Might work in cities, not in the rest of the country.
2
the idea of free college, or at least greatly reduced tuition fees might go a long way to producing more physicians and medical professionals. let's take the debt load off people so they can better themselves and our society. we need to open the doors to knowledge, let people return to schooling at all points of their lives. freeing people from employer based healthcare is a step in the right direction to a more adaptable and flexible population. empower the individual to improve their own lives and the lives around them and maybe we won't need so much socialism and quasi ineffective goverment programs
OK, I just signed up for Medicare in advance of my 65th birthday. And, guess what? I also signed up for a Medicare Advantage plan offered by my current private-sector non-profit HMO health insurer/provider. Medicare very often, but not always, and usually as a matter of choice, does co-exist and is mutually supportive with private-sector health insurance. These plans can and should be encouraged and considered by all candidates. I will pay about $135 to Medicare and about $100 to my private insurer per month, and will receive better coverage than I have now for far less. No up-front deductibles, moderate co-pays, less than $5,000 maximum per-year out-of-pocket. All in all, quite reasonable.
8
For government run insurance look to the VA. Having received care from VA in multiple ares of the country, my experience says this is a bad idea. It all may be run by the Federal government but the care varies tremendously from place to place. Bad idea.
7
@Larry
Perhaps a better comparison is Medicare. BTW People I now with employer provided health insurance must wait weeks or more than months to see many doctors even in big cities like Houston. Health care education is rationed in America to protect the bank accounts of doctors.
@Larry you confuse government run health insurance with govt run healthcare system. VA is the latter. Medicare is not.
Medicare for all won’t sweep away private health insurance in the US, any more than it has in the UK or Canada. Those who can afford it in those countries purchase supplemental insurance to the national healthcare plans, and they will here, too. Reporting that posits otherwise is irresponsible, and plays into the hands of the insurance and pharma lobbies.
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@Katherine Patton It’s not the reporting that’s to blame. That’s what the Democrats are proposing! Did you not hear Kamala Harris? Abolish all insurance. Don’t blame the messenger.
Is there any reason why Medicare for all could not resemble public education? Everyone pays for public education, but some also pay for private education. Likewise, Medicare for all not would provide coverage for all, but some could also pay for additional services or even buy private health care coverage.
8
Considering the state of many our children’s educations around the country that sounds like a terrible analogy. Critics of reform would love that.
3
@Just Julien, I am not rendering judgments, only asking about the feasibility of similar structures.
BTW, the "not" soon after "Likewise" is a mistake.
3
@Just Julien
Compared to when public education didn't exist? I don't know that you're framing that appropriately.
1
The companies reaping vast profits from the system the way it is now will NEVER let it be taken away from them.
They have many politicians in their pockets and plenty to spend on campaigns that will call Medicare for All, Socialism.
Many who would benefit from Medicare for All will vote against it. We've seen the effects of a lot of misinformed voters.
Major shareholders wont want to see their investments lose value.
There's too much money in our political system to allow for vast power-challenging changes.
4
The writer should clarify the Urban Institute
estimate of 7 trilllion dollar increase. That's
what government will spend, but the savings in private insurance premiums will more than offset that.
12
@Thaggs Thank you. I just cannot sit still for a $7trillion charge, on top of everything else
1
We mobilized to win a war. We sent a man to the moon in record time. We've met all kinds of challenges, accomplished all sorts of wondrous things. We can figure out how to care for the sick without the insurance companies. Yes, there will be disruption at the outset. We've had other disruptions. But those losing jobs in the insurance industry will find work elsewhere. Thus has it always been. Don't let the scaremongers destroy our will to rid our society of this scourge of outrageously expenive health care (so-called).
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@farhorizons
'But those losing jobs in the insurance industry will find work elsewhere.'
Says the guy who won't be losing HIS job. That's half a million jobs you're so glibly discounting.
1
@farhorizons Perhaps you should make a comparable list of what we haven't accomplished before jumping to conclusions. Do you really think there's any chance that a government that can't take care of our infrastructure, our public schools, our criminal justice system, etc. will do even a half-decent job with our health care?
@farhorizons in your examples, war and moon, private business made additional profits anew. Changing the healthcare would shift/ take away profits from existing leeches. They will fight.
I would very much like to see some analysis on the impacts of single payer to business big and small. My sense is that they should be all for getting out of the business of packaging and managing health care of its employees, retirees, and their families. Yes, they have incentive to offer “good” plans to attract and keep employees, and the current system of work provided care discourages employees from change jobs, especially across state lines. But the upside is a whole line of “non-core business” effort and expense is eliminated. Obviously some of those cost savings could/should be redirected to the government as taxes. If a thorough analysis showed a break even or significant cost savings for business, it would go a long way to getting broader, and more powerful support for single payer.
6
Reminders: 1) We are the only developed country in the world with a for-profit, non-"socialized" health insurance industry; and 2) Compared to health outcomes of all of those many developed countries with "socialized" health, America pays far more but we are not as healthy.
On the other hand, I am delighted for UnitedHealthcare's longstanding common stock holders insofar as they have 15-year capital gains exceeding 700%.
6
As has been pointed out by the group physicians for a national health program at www.pnhp.org the employees of insurance companies can easily transfer their skills to the public sector and at the same time eliminate the for-profit health insurance business. The single-payer plan advocates for a plan which makes sense and doesn’t bankrupt the public.
6
@Jordan Davies So adding a half-million new government bureaucrats will be a great boon to the taxpayers? Which math system are you using?
This is precisely how the Democratic Party is going to lose the next election. I will vote Democrat unless the candidate supports this cockamamie idea, in which case I won't waste my time at the polls. I don't care to have government insurance just as I don't want food stamps to buy my groceries, thank you very much. Universal healthcare is great, but this idea is not the path forward. Trump must be chomping at the bit to see the opposition self-immolate, as we often tend to do.
13
Hardly not an either or,just a proposal. Like any sane discussion, this will form a basis for reforming the current untenable system.
Why not wait and see instead?
1
@AdamStoler Because unfortunately the 2020 elections are now on a lot of people's minds, and a lot of potential Democratic candidates are foolishly committing themselves to various cockamamie ideas.
@John Muir Well, you're a very independent person. If you utilize the public highways, would you send me my share of the expense for maintenence? I dislike freeloaders, thank you very much.
Just blend the large groups, small groups and individual markets; then community rate them all and let the insurers, managed care companies and PPOs compete. Include the self-insured plans within these regions and you'll get about the best rates possible without socializing the entire medical pool. Rochester, NY had this model about 25 years ago and their overall rates were lower while the coverage extended to anyone who wanted (and could afford) it. "Medicare for all" makes everyone in the medial field essentially equivalent to state employees, so say goodbye to centers of excellence such as Sloan Kettering, Mayo Clinic, etc. This doesn't even consider the single payer plan paying military prices for ordinary medications where there is no incentive for economy and your local congressperson intervening on behalf of demanding constituents.
If we could have started from scratch single payer might have been the way to go but the horse is out of the barn so the answer ts to improve on what we already have.
3
just about 32 years ago i had a million-dollar-wrap-around-plus policy from blue cross/blue shield. post-craniotomy i had to be driven to new haven when they rejected an already discounted $10k bill from my surgeon. it was paid by them then, in full.
a number of years ago i signed up for a policy by united healthcare through aarp. a few years later i split the policy, still through united, to save money and keep the cost under $650. + medicare.
two years ago i called down to medicare in dc to ask if there were another backup TO medicare that would give more for less buck.
they gave me a number....for united healthcare. i am now still paying $76/month, and that includes basic dental - which i never had at all, aarp or no.
just don't get sick.
The article did a nice job.
The ACA is not single payor and expanded health care coverage but through an inefficient system of middlemen.
As a physician it’s very hard to watch how medical care is sporadically under and often over applied. There is little oversight and no brakes on profit taking.
Sit in a room with a patient and family and try to envision a perfect care delivery. No one can agree what that looks like. Make a diagnosis? Great. Find an efficient and safe plan of follow-up care? Very tough. The norm is to fall through giant cracks.
I want to cheer for single payor because the focus on profits should diminish, but the same bozos will try to subvert a free market human right based system unless it’s very free market, ie, less regulation of care delivery and therein lies the problem many editorials already identified, the Devil is in the details.
There’s certainly some pain in transition, the government will need to draw a line on services since not everyone can get everything, and that will be hard for the wealthy to swallow and they/we will work to stay privileged. Changing the funding source is only part, getting people to agree to accept similar levels of care is step two. I’ve worked in Australia and it’s a different world. True, private insurance allows faster access to surgeons and specialists, but there’s a marvelous spirit that we’re all in this together.
4
In Australia, the country has Medicare for all AND the option for people to have private health insurance. In Australia, you have the option to have private medical insurance so you can chose to get better quality care from 'better quality hospitals' and 'better doctors'; otherwise, you can receive the necessities in the public system through medicare. Yes, private medical insurance premiums are paid directly out of pocket in most instances (unless your employer pays for it for you). The medicare system seems to work there for emergencies and life-threatening situations and vaccinations. Keep in mind too that if you would like to get elective surgery through medicare in Australia (for example, surgery to fix a deviated septum), the wait times at most hospitals in the public system through medicare are months and in some cases years long. The personal income tax rates are much higher in Australia than the USA, which is supposed to cover its many social programs, including medicare. Oh, and Australia also has a medicare levy, an extra 2% tax on top of taxpayers' marginal personal income taxes to partly fund the cost of medicare.
2
@Mitch C The Democrats think this is all going to be free. For all the people in this country who don’t pay any taxes, the rest of us are going to pay for it. And no one talks about the level of care.
4
Single payer is a poor substitute for our current system. There must be a blending of current options and universal healthcare as a single payer system. The Germans have working model that we can study.
5
The NHS was set up in the UK 70 years ago to provide healthcare free at point of delivery and funded from taxes. However, private pracrtice still thrives for non-essential operations and queue jumping. Australia has Medicare with co-payments and a wide range of Insurance options. This a scare story, nothing more.
7
@a j kerron. I totally agree. The US can have the same system: a public insurance for everyone with private insurance for those who want more.
1
From a patient's perspective there is no question that a single payer system will be such a relief. No-one in a medical crisis can effectively fight their insurance company's well-greased legal cattle chutes, and no-one needs to receive daily stacks of medical bills and EOB's explaining how much they are in the hole.
In the name of shareholder value your treatment is not covered beyond the limit stated in the policy, but sometimes the company overreaches and if you have really good lawyers you can sock them for all long term care expenses you incur for the rest of your life.
Long term care is the elephant in the closet here that catches up eventually, and then we find out what that will mean in the face of budget cuts...In the big picture however, everyone needs to be covered for proper treatment in all cases. Single payer universal is the only rational and humane solution. Compassion must become the basis for our treatment of one another; the alternative is this ongoing, silent barbarity.
5
@Danny B Beautifully stated :)
"Medicare for All", assuming it's meant fairly literally, is probably the second-worst public policy change now being widely discussed (the worst being self-driving vehicles). I'm about to turn 72, and one of the best things about that is that there's no chance whatever of this happening during my lifetime.
4
I'd like to hear where we're going to obtain the doctors, nurses, nurse practitioners, etc. to staff what (I assume) would be a substantially expanded healthcare system. I live in a decent-sized metropolitan region, one where it currently takes 6-8 months to get in to see a new doctor for the initial examination.
5
Mayor Pete Buttigieg is proposing that we allow people to buy into Medicare as an option, while at the same time keeping our current private insurance companies. This seems like a reasonable idea to me. I'm currently covered by my employer in a PPO plan, which I am very happy with, but if I were to lose my job, or wanted to start my own business, it would be nice to know that I could buy into Medicare. I would also think that Medicare would welcome the additional revenue from those who want to take part in the plan prior to their 65th birthday.
10
Ending legal slavery and property rights in slaves was profoundly "disruptive," with practical consequences, resistances and impediments that continue to this day. Should emancipation have been done more slowly, more incrementally? Should the 13th and 14th Amendments have been phased in? Would near-universal abolition have been an acceptable, practical compromise to prevent too much disruption of slave owners' convenience and profits?
38
@RRI And this has what to do with health insurance?
2
It sounds like single-payer is coming for better or worse—I dare say it will be worse. I am on Medicare and have been for three years. I pay more than the basic amount because, apparently, I earn too much. I am happy with Medicare so far.
What I will be interested to see is how the lefties will convince the majority of workers who are covered by employer plans that they will be better off under a plan that will generally pay providers less than their current plans. I also want to see government employees who have platinum plans will welcome joining the ranks of the unwashed in the "guvmunt" plan.
There is no question that we will wait longer for service and may not have the option of paying out-of-pocket for better service. (Hillary's plan years ago forbade such concierge plans).
I cringe annually when my wife's renewal letter arrives with the usual $100.00 per month increase for Horizon Blue Cross, but the plan is good and we are satisfied. I just hope when the dems get done with their usual fiddling we are just as satisfied.
8
I was on Medicaid under PRESIDENT OBAMA and it was good. Now I am on Medicare under trump
Now they cut my hours and I have no help on meals and shopping for groceries
I guess trump's cuts are no longer providing the same level than Obamacare used to provide 🤕😖😱.
And this, of course, is why it will never happen.
Political decisions are about who has the money
Not about what is best for average people
How can we be so naive?
4
During her CNN forum last week, Ms. Warren said she was open to various ways to get to universal coverage. “When we talk about Medicare for all, there are a lot of different pathways,” she said. “What we’re all looking for is the lowest cost way to make sure that everybody gets covered.”
We're not very far along in the race for the Presidency in 2020, but so far Elizabeth Warren is the only candidate I've heard who seems to have actually thought things through before adopting a position that just "sounds" good to voters. I'm impressed, and I didn't think I'd ever start leaning her way.
20
@Big Guy
Talking a good game means nothing. Obama spoke with absolute authority and knew little. Said all the right things but couldn't deliver.
You can have a baseline Medicare that covers basic medical care and RX. Then have health insurance following a classical risk model. For those 55 andolder is a full Medicare system with the doughnut hole fixed.
The insurance will have regulations and closely watched.
Employers patty a tax per employee per work hour that funds the Medicare.
Having Medicare not tied to employer will allow more peop,e to become entrepreneurs.
4
@DJP They will also be healthier. Don't let the money interests wrestle your good health away from you. The money is in the system to pay for it.
@Ed Kearney How do you know? What is the level of care? Who decides who gets hip and knee transplant? And hearts and kidney transplants? The greatest medical care in the world is right here. And the Democrats want to destroy it. Let’s see what kind of treatment they want for themselves.
2
@DJP I would someone wouldn’t define the buzz word “basic care.” The latest state of the art cancer treatment? The latest state of the art fertility treatments? The latest state of the art gender reassignment surgery? Unlimited treatment for opioid addiction, inpatient? Cradle to grave first class treatment for all disorders and diseases?
It is not a stretch to say that medicare for all is a bit extreme. The British system is not the best performing system by a long shot. Surveys and studies have consistently found that the French or Dutch systems deliver much greater satisfaction and all make great use of private insurance as a supplement to a wide ranging public system. Medicare for all and related systems all tend to get everyone vaccinated and are good at things like lowering infant mortality -- i.e. at delivering excellent public health. Single payer systems generally are lousy at dealing with diseases of maturity. As bureaucracies they push to buy years of productive life. It is just built in. They don't do well at treating and curing diseases of maturity. Fixing diseases in those above say fifty doesn't buy a lot of productive life. That is why single payer underperforms our wretched uncontrolled system in cancer and heart disease.
8
@Bill H You make an interesting point, but I disagree with your hypothesis. I have been on Medicare for 18 years and I'm healthier now than I was when I enrolled. My care is excellent and I recommend Medicare for all.
7
As a mental health professional in private practice, most of my income is from clients' insurance. I accept the low Medicare reimbursements because it is a system that will soon take care of me, and it is a good thing I do for my fellow citizens---no third party is profiting off m work. However---I do very little managed care treatment, because when I accept the very reduced fee, that is because a third party--the insurance company--is profiting off my services, providing no useful service themselves, by keeping some of the premium paid by the subscribers. I think insurance is a valuable thing for some aspects of life, like home insurance, life insurance, disability insurance, etc. But I do not think insurance companies should be profiting from the transaction between health care providers and their clients. I do think that if there was government health insurance for all, there could still be a for-profit insurance market for supplemental coverage.
14
@Laurie It works just fine like that in Australia.
Will anyone have tears to shed for the healthcare industry stock holders and management? We will find jobs for the workers there. It is a big country. We have achieved harder things.
14
Millennials have no clue how Medicare works. It needs to be supplemented by private insurance and oh, you just have to pay into it your whole working life until age 65.
7
@Asher
I'm not so sure this current crop of progressive candidates understand it any better. Obama got things shockingly wrong, failing to understand how the system's players interacted and competed with each other.
Perhaps this kind of ignorance is a prerequisite for believing in [fill-in-the-blank]-for-all.
3
@Asher
And after 65 you still have to PAY PREMIUMS for Medicare Part B (Dr. visits) AND Part D (Rx costs). Only Part A (hospital coverage) is "free".
@Asher Yes, in Australia we pay between 1 and 2 percent of our income for guaranteed care. Not a single person here wants anything even remotely resembling the shambolic, costly and unjust US 'system'.
Providers and suppliers in the medical industry have become incredibly fat under the custom system. Many of the salaires, benefits and profits are unheard of in other occupations.
Sorry that they got accustomed to the good life, but ...
To everything (turn, turn, turn)
There is a season (turn, turn, turn)
And a time to every purpose, under heaven
A time to build up, a time to break down
A time to dance, a time to mourn
A time to cast away stones, a time to gather stones together
5
@Ken
Good luck on your MCAT! And on matching to a residency program that will pay you a meager salary for 4 to 8 years!
I agree this is a good idea, BUT.
To provide Medicare for all, a multi-prong strategy is required; and the elephant in the room is the cost of care, which is currently not subject to market pricing pressure.
Without price transparency within the medical industry and an incentive by patients to keep the cost down, Medicare would truly be bankrupt.
Patients have absolutely no idea of the cost, and the reality is that providers (for example, MRI labs) are quite different from one another.
There's also need to ensure this doesn't involve a race to the bottom. It would be disastrous to have doctors outsourced to a cheaper country and (on paper) overseeing patients remotely, with actual procedures performed by physician's assistants.
2
Socialist countries like England have private health clinics , and the private insurance companies are doing well.
3
The UK is NOT a Socialist country. A country with a social welfare system, including government-run healthcare for all does not necessarily make it a socialist country. Americans have no idea what real socialism is or means and use the word socialist interchangeably with the liberal.
1
@Moe
England is socialist? Try telling it toTheresa May! Or Winston Churchill if you have access to a good medium. Not to mention the Briton Adam Smith :-)
1
"Believers in markets argue that consumer choice and competition among private health plans improve the quality of care" despite the lack of credible evidence for that position. "Others laud private industry’s relative nimbleness compared with Medicare, which can be bureaucratic and prone to political influence," another unproven assertion.
There, fixed if for you.
I suppose the conversation has to start somewhere but as a reader with an interest in whatever insightful reporting the Times' crack team can provide, this round-up approach to what will be perhaps the hottest debate topic during the presidential election is hardly worth our time.
2
Private insurance had its chance with the ACA.
1
This article was fatally flawed, and so disappointing. It gave no evidence (apart from some knee jerk opinion which was not backed by discernible fact) that private insurance would fail in a medicare for all scenario.
Medicare NOW contracts with private insurance to provide care for its enrollees. It is disappointing, not to mention a rip off to me to read a headline which fails to deliver on its promise to inform me.
5
Haven’t you noticed the $$$ spent on the plethora of supplemental insurance ads during Medicare open enrollment?!Insurance companies have a huge involvement in the Medicare supplemental market in addition to their roles identified in the article. Maintaining all these roles while transitioning should have a significant impact in buffering the impact to the insurance industry when changing to a universal system.
And, I’m not going to lose too much sleep over the demise of businesses that profit from the confusion their complicated ‘plans’ and invoicing cause the average American.
4
There has been a lot of precedent already. Where are all the Buggy makers today? What has happened to all those Hat makers from yesterday? Hey its called evolution, and changing times. Wake up America and quit accepting this phony argument.
6
Jobs in the insurance or any industry are never sufficient justification for allowing companies to profit off services or products that are demonstrably detrimental to the general public's well-being. We can reasonably plan for disruption and and provide help for workers' transition to other employment, but more cancer deaths, more pollution, more war are never an acceptable price for maintaining jobs or investments in tobacco picking, coal mining, or weapons system manufacture. There continue to be profound inequities in the distribution of health care -- a matter of life and death, a basic human right. This needs to change. If that change is "disruptive," so be it. Injustice demands disruption. That's a moral imperative, whatever the practical challenges.
21
"Government Efficiency" is an oxymoron.
9
@Connecticut Yankee
Hardly.
Social Security and Medicare are extremely efficient.
8
@Connecticut Yankee
So is "business acumen" with respect to public well-being.
So is “market solutions”...
"ABOLISH"? I dunno, but I see a whole lot of private insurance offering supplemental policies to Medicare. They are hardly going to vanish with the gummint taking the biggest risks and leaving them with the "extras" and "luxury" add ons.
6
@Irene
Well said. Apparently, many of the writers and commenters don't understand the nuances of Medicare as it currently exists. In addition to the supplemental market, most Medicare A and B programs are managed by private insurers (usually the Blues).
6
"Both proposals are clear that a single, government-run insurer would replace the private sector, ...' This could not possibly be true. The Democrats can be fools but are not this foolish. Instead, this sounds like a hit piece to frighten health consumers about Medicare for all. Private insurance companies have taken over decision making for doctors, they instruct physicians to see a patient every 15 minutes, they load medical practices down with paperwork,they delay payment of most claims before an appeal, they forbid inclusion in their network if they don't go along with their puny payments, they deny patients the use of medications preferred by both patients and their doctors. They have infiltrated beyond repair our health care in America and now can't be removed because it would be a big blow to the economy?? That's like saying "We can't repair the hole in this fence, because the foxes depend on it being there to get to the chickens so they won't starve." There is a place for private insurance companies to work alongside Medicare for all. And I hope those remaining companies are properly humbled, should this happen.
18
@Drew. You have written the best comment I’ve read on this post. Thank you.
3
In Australia we have both systems - Medicare (for all) and the private health insurance system. Participation in the private health system offers more choices and reduces waiting times (on non-life threatening procedures). Our dual systems have been in place since 1975 and was brought in by a Labor government on the premise that all deserve decent health care - not just the well heeled.
When younger and having limited financial resources I relied on Medicare for many years. At the time it worked well for me.
Once I got on my feet I took out private health insurance. Participation in the private health system brings you a good benefit at tax time. Every Australian pays a Medicare basic levy. If you're wealthy and you choose not to take out private insurance you pay a higher levy.
We have a wide range of private health insurers and you choose what range of coverage you require. Pushing the argument that medicare for all would ruin private health insurance is incorrect. You guys are smarter than that.
20
So we need to support criminals, since without them, think of all the police and prosecutors who's be unemployed.
13
If you are concerned about all these people's jobs, why not keep them. Just revert to the Blue Cross model of the 1950's. Make all insurance companies Non-Profit. If they did not have to worry about profit, maybe they could take care of sick people.
12
Take a lesson from the simplistic/fantasy of "leave" and get to the details of exactly what is going to happen before voting or promoting this. What hubris there is to assume such a large change could not end up causing more harm than good. After you have your best guess on proceeding, roll out limited pilots first to see how far off your theory is from reality.
1
Indeed, health care has not always been for profit.
4
The current system is essentially unsustainable and ridiculously expensive on a per capita basis. Nowhere in the world outside the US are medical and drug prices so high and this is to sustain the profit margins of the hospitals and pharma companies. Go Medicare and negotiated prices for drugs. It’s time to put this ridiculously overpriced industry on a diet.
7
Simply said, our system is about profit. Four players. Insurance companies , Drug companies, for profit Hospital corporations, and the AMA. As well as well as, for profit players somewhere in the system.Major % of US GDP.
5
First, there are many tests and procedures that are not covered by Medicare, that are covered by commercial insurances.
As someone who does insurance work in a major medical center, I can say the problem lies less with the insurance industry than with medical providers. The fact that one hospital can charge several thousand dollars for a MRI, and a comprible hospital less than ten miles away will charge less than a thousand dollars for the same MRI borders on the criminal. It is not just Big Pharm that is destroying medical care, take hard look at all your providers.
Secondly, we are probably the only people in the world who scream about not having enough internet providers to choose from, how it stiffles our chices, but we think one health care option is a good idea. More choices are always better.
Third, Medicare doesn’t pay for everything it covers, and without supplemental coverage, people would end up more in debt than they would if they had commercial insurance. Medicare is not the first choice if you can afford better commercial insurance.
Fourth, look at how the government handles Medicare....do you really want to turn your health care over to them?
7
@Doug R
The government handles Medicare just fine.
I've had Medicare for ten years and had a number of serious treatments with less hassle than I previously had with a private insurer.
4
@Doug R Choice in medical care is a red herring. If you need an ambulance do you call around for the best price? Do you even have a way of finding out what the price is to begin with? Even having a procedure (say, cataract surgery) where you can know the listed price ahead of time, there's always that random bill from the anesthesiologist that comes weeks later and totally unexpected. How do you comparison shop for that?
3
@Doug R “More choices are always better”.. Really?? Then let’s have multiple police forces, multiple fire departments, multiple air traffic control systems, etc. etc. I believe the idea of multiple fire fighting companies was tried in the early days - didn’t work so well.
2
The devil is in the details. I personally have Medicare + Medicare Advantage which covers some of the Medicare Gaps plus prescription drugs which are not covered by medicare The role for private insurance under a Federal System is much reduced but not zero. There are many possible systems to choose from. We can simply be unexceptional, choose for example the UK or the Australian or the German Systems. This is what Taiwan did and we would be wise to follow
6
Come now — surely the invisible hand of the market disapproves of such a wasteful and inefficient industry. These are middleman profits extracted by subtracting value from the system — good riddance!
9
There are models the USA could well look to which address alternate approaches to providing universal health care. By way of example, private health care has been successfully integrated with Government funded cover in Australia. The cost of pharmaceuticals in the USA together with inflated hospital, insurance, legal and procedural charges represent a profit base possible only through the cartel structure of health care which rivals that of the Sinaloa drug cartel. (Manufacture, distribution and sales) Band-aid approaches, such as taking on opioid addiction, are virtually meaningless as the addiction itself is a by-product or a symptom of a health care system that is out-of-control. 'Profit or die' would appear to be the mantra of the American health care industry. Access to affordable medicine and health care should be a right and not a privilege for all citizens of the wealthiest nation on Earth.
3
Whatever one's wildest health care dreams entail, it is certain a patient must bear the burden of some of the cost or everyone will be going to expensive emergency rooms with headaches.
Unfortunately, the spell of idealism failed to see the results of Obamacare, no matter how divinely inspired it was.
This nation has a stark question ahead of it; will we care for each other? In the current politically inflamed atmosphere mostly because of malcontents like Trump and Congressional Republicans, the answer is we will not be able to and will likely lose more positions in Congress and lose the Presidential election. The sad fact is that the carefully cultivated Republican base is inflamed through hatred and anger rendering them incapable of even recognizing that their leaders are denying them health care. That is the power of psychological messaging.
Get real about health care. As people are so entirely brainwashed against their own well being, it just isn't going to be a winning issue.
After nine years of Republican leaders convincing their followers that "Obamacare" was so bad, it's time for Democrats to get to the point about health care. Don't just tell the public you will provide health care. Tell them they need health care. That was the single biggest failure of the 2010 program. People need to be told it will make them healthier, happier, and living longer.
1
I don't feel bad for the Catholic Church nor the defrocked priests out there. They brought this on themselves - through years and years of choosing money and power over what is right. Wonder why I'm thinking about this now?
2
The reason so many wealthy Republicans fight Medicare for All is because our current system creates treatments that only the wealthy can afford. Dick Cheney would not be walking around with a new heart if he wasn't rich and connected. The dollars that everyone pays ultimately results in treatment only the wealthy can access. Canada has the fairest healthcare system. It is illegal to see a doctor outside the healthcare system. Everyone, rich or poor receives the same care. Money cannot corrupt the system because any attempt to do so means prison.
2
@Indrid Cold
Sorry, but your assertion is incorrect.
A doctor in Canada cannot receive compensation from both a public plan and a private one.
But there is no restriction on a doctor having a private practice if he chooses to opt out of the public plan.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/
2
Whatever one's wildest health care dreams entail, it is certain a patient must bear the burden of some of the cost or everyone will be going to expensive emergency rooms with headaches.
Unfortunately, the spell of idealism failed to see the results of Obamacare, no matter how divinely inspired it was.
This nation has a stark question ahead of it; will we care for each other? In the current politically inflamed atmosphere mostly because of malcontents like Trump and Congressional Republicans, the answer is we will not be able to and will likely lose more positions in Congress and lose the Presidential election.
The sad fact is that the carefully cultivated Republican base is inflamed through hatred and anger rendering them incapable of even recognizing that their leaders have been denying them better health care. That is the power of psychological messaging.
After nine years of Republican leaders convincing their followers that "Obamacare" was so bad, it's time for Democrats to get to the point about health care. Don't just tell the public you will provide health care. Tell them they need health care. That was the single biggest failure of the 2010 program. People need to be told it will make them healthier, happier, and living longer.
2
@PATRICK
Headaches can be a sign of serious injury or stroke.
But I get your point, though I disagree with it.
There is no evidence that countries with a universal health system experience a flood of trivial complaints.
There is, however, a flood of evidence that the population of the US is less healthy than that of those countries, thanks to a lack of preventive care and people delaying seeing a doctor until a disease has progressed too far, because of the high cost of copays and deductibles.
2
Whatever one's wildest health care dreams entail, it is certain a patient must bear the burden of some of the cost or everyone will be going to expensive emergency rooms with headaches.
Unfortunately, the spell of idealism failed to see the results of Obamacare, no matter how divinely inspired it was.
This nation has a stark question ahead of it; will we care for each other? In the current politically inflamed atmosphere mostly because of malcontents like Trump and Congressional Republicans, the answer is we will not be able to and will likely lose more positions in Congress and lose the Presidential election.
The sad fact is that the carefully cultivated Republican base is inflamed through hatred and anger rendering them incapable of even recognizing that their leaders have been denying them better health care. That is the power of psychological messaging.
After nine years of Republican leaders convincing their followers that "Obamacare" was so bad, it's time for Democrats to get to the point about health care. Don't just tell the public you will provide health care. Tell them they need health care. That was the single biggest failure of the 2010 program. People need to be told it will make them healthier, happier, and living longer.
A few days ago, I got a call from the office of Dr XYZ setting an appointment for June. I was puzzled and asked what this was about. Dermatology, the caller said, your family doctor asked for an urgent visit. When was that? July 2018.
Seeing this was urgent I found a different solution.... driving to upstate NY.
This is medicare in Canada, a completely broken system that foolish leftist Canadians think is the best in the world.
3
@Georges
Because progressives' is a fantasy system. In it, services are all provided for "free". The best care is available to all on demand. One sees a doctor and walks out without a concern. Evil insurers don't exist. Doctors are happy to work for salaries dictated by fiat.
Of course, their system doesn't and will never exist. The last thing any sane American should do is abandon our current system for a fantasy.
1
@Georges
Why didn't you follow through in July 2018 if you needed urgent care?
I don't take your rather suspect anecdotal story as evidence that the Canadian system has failed.
@AACNY
Your hyperbole is so obvious that it makes your post a joke.
The people who live in countries with universal health care are happier and healthier than Americans, and they don't go bankrupt struggling to pay medical bills.
Clinging to the current system in the US is like going down with the Titanic.
1
scare tactics, distractions, disturbance and noise.
medicare for all: anyone who wants it can have it
private insurance: pay absurd premiums for denial of care and high copays, go right ahead and continue to offer it and see if anyone signs up for it
8
Boo Hoo. We shouldn't all suffer for those few. Just like we tell factory workers - times change and you need to adapt. We're wasting vast amounts of medical care dollars on profits and shareholders instead of providing medical care. Oops - my bad - I forgot medical care is an aspirational luxury you are supposed to earn.
11
Australia has a mix of private and public health insurance. May work better for us.
4
Single payer systems in other countries pay all. But Medicare pays 80% leaving another 20% out of pocket or to be picked up by private insurance. With everybody covered under a new system (putting back in place the mandate--everybody has healthcare costs), that 20% would be a huge market for private insurers--they would do just fine. But under a single payer type system, the insurer would have tremendous leverage to bring prices down--we now pay twice as much in most instances for the same overseas, and much more for many prescription drugs.
Does the system benefit the patient first, or the provider? If there is a balance, the American system is way out of whack. Notice all the lobbying by the highest cost providers--they are looking at their bottom line, not the well being of their customers. Another problem in itself, as the Supreme Court has ruled that money rules (and secret money at that, be it the Russians or the Saudis or Right Wing hate groups) in American elections, and not necessarily the General Welfare of the voters.
We should be looking at what basic human rights are not mentioned in the Constitution, instead of limiting the human rights that are. On one public health concern, guns, the right to be subjected to violence has over-ridden the right to be secure from gun violence. If 33% of the population supports this, then we can assume they don't see the right to have healthcare as a basic human right. In the U.S. 1/3 controls the rights of the 2/3.
4
Come on America try putting the health of your citizens before worrying about profit levels. Insurance companies are one of the major banes of our existence. Their web stretches across the entire spectrum of modern life. You can't own a home, drive a car, tow a trailer, form a partnership, put your kids into sports without insurance.
9
We have many precedents for loss of major economic segment- slavery - railroads - industry - and all these arguments against doing the same with our ridiculous medical system sound the same. What was the economic cost of ending Slavery - in human lives and national treasure? I'll bet it dwarves this change. Comparable? How much our lives are in hock to our HMO's and so-called insurance companies? How many people must declare bankruptcy after some catastrophic illness?
6
Bernie make this happen I will love ypu forever and make sure anyone I have any say with does the same.
Best of luck. You are our hero!
6
The millions and billions the industry will spend desperately staving off single payer is also money they’ve taken out of the system that could have been put to more productive use.
We in this country are extorted by insurers, hospitals and Pharmas so they can use their ill-gotten gains to corrupt legislators into perpetuating this obscene system that forces patients into bankruptcy.
8
A Canadian working in hospital management and now retired in China and Thailand (total 25 years) recommends Thailand model. Canada is good but it has no private care system to compliment it so people can’t get better vip type care if richer. China has free universal coverage but that means huge line ups and poor care as billions seek treatment and doctors overrun, seeing 1 patient per minute, unnecessary surgeries for Greedy doctors/hospitals, and lots of hidden extra costs... Private care, where I worked, is better, but hospitals and doctors routinely cheat patients, greedy cheating system. My experience was I had good international insurance until I got heart issues and kidney stones and my insurer refused to insurer anything related to these problems and raised the price to crazy level. Thus, I gave up on insurance and pay out of pocket to Chinese hospitals, which is ok since I know enough medicine to avoid being treated. However, by far the best system is Thailand, both their public and private systems are excellent and very inexpensive. Doctors are top quality and are trained cheaply in government run programs that trains them in specialty areas in 4 years instead of the 12 years we do in USA. Doctors can opt for further training. Costs are set and doctors give good care and mostly don’t cheat the patient due to their culture ways. They follow USA standards and speak English.
2
Too bad Medicare-for-all didn't get done in the 1960's, when Medicare for the elderly was started. Would have been so much less chaotic... Not sure myself why that didn't happen as I wasn't living in the US at that time... And would have been a bit young to wonder about it anyway then. I think Medicare for all plus some private plans for those who wanted them would be a good idea... Be interesting to see what happens. Ultimately I am certain Single Payer will the the solution. (even if there is extra private coverage for those who have the resources to pay for it.) And will there be enough medical care professionals to cover everyone?
5
Medicare for All would make the controversy and public resistance towards the ACA look like a Thanksgiving celebration. Those who like their private health care will come out screaming if our government threatens to take it away. Medicare should instead be proposed as a public option for those are unable to otherwise secure affordable health care and are willing to pay the required premiums. Those who can't should be able to enlist in Medicaid. Why ruin a decent idea by insisting that it apply to every American?
4
@stu freeman
Has anyone considered whether our current Medicare system can handle millions more enrollees? Our government couldn't even build a front end to insurers' systems (the "exchange"). It was a nightmare.
Let government prove it can handle the change. Let's see a phased plan, some proof of concept projects, etc. Tossing away our system for something that's based on purely wishful thinking is not the way to go. It's reckless.
2
@AACNY
The ACA was a complicated, bureaucratic mess. Medicare is far, far simpler.
And there will be plenty of new government employees to handle the increased load: experienced workers from the reduced private health insurance industry.
1
@AACNY: How has Medicare been able to handle all the enrollees it presently has? The doubters were wrong when Medicare (aka "Socialism!!") was originally implemented but it's turned out to be a highly successful program. And, for most people, it IS affordable. If the program begins to lose money (rather doubtful once people in private health care plans start to realize that its benefits are superior to many of theirs) we can always raise taxes on the affluent- assuming we end up with a president and a congress who are willing to do such a thing.
1
Do you seriously believe that it's even remotely possible that "Medicare for All" legislation could be enacted in this country?
A substantial number of voters in this country are under the complete control of nationalist right-wing demagogues and politicians. Those voters are constantly being programmed to believe that Socialism in an unacceptable evil. and that such a plan is Socialist in nature.
Together with the swing voters, who are easily deceived regardless of what they believe, the right-wing electorate has a majority.
Good grief, just look around. Spend at least some time listening to Limbaugh, Hannity, and Trump. Remind yourself that everything they say is blindly accepted by a voter bloc more than large enough to defeat any attempt to socialize healthcare.
Pay attention to what they have to say about the other issues on their agenda.
Those issues are the ones we really have to face, not the ones that are dreamt of in your philosophy.
Strange, isn't it? Unfortunately it's all going to get stranger, because in the United States, it can.
4
The current system is a sick joke on the people. Once again the media cites increased taxes as a negative without mentioning that that would be more than offset by no premiums, co-pays, etc. Single payer is the best system and should be implemented over time.
4
Let people who work for private insurers retire, retrain, go do something worthwhile. It will be good for their souls. Surely it beats being paid to deny care to the desperate to meet financial targets, or being complicit with Pharma and hospitals driving up prices to insane levels.
Google WellPoint and Recision. Read about how these insurers tried to drop female policyholders who developed breast cancer by hunting for minor errors on their application forms as a pretext. Watch the movie Sicko by Michael Moore, and see how insurers incentivize ex-doctors to find medical rationales for not paying for treatment. Read about how UnitedHealthcare pays its CEO over $100 million per year. Then see if you can muster any sympathy for this industry that preys on desperate and vulnerable patients.
4
@Xoxa
Yes, they can follow their dream and become Hip Hop stars.
If anyone thinks the massive medical insurance industry and their thousands of employees will allow a government entity to dismember their business hasn't been paying attention to the way the current US government functions. The NRA a somewhat minor lobbying group has congress in its thrall; try getting reelected with millions of lobbyist dollars in opposition. The drug industry and the AMA will probably join in the effort. The ACA was an effort to function within the system; expand it, fine tune it and try to get something concrete and workable and stop fantasizing about living in Sweden.
2
It appears that the writers have no idea how Medicare works. It would be nice if the reporters had done a little research on how Medicare presently works and the various options that private insurance competes so strongly offer on TV. Does “Medicare for all” want to ban private insurance? If it is going to be like the present form, the no. Gat the facts right.
1
Profit has no place in health care. People’s health is not a goldmine to be plundered for the sake of lining the pockets of Wall Street.
If an insurance company wants to re-evaluate its mission, cut out bloodsucking investors, become a non-profit, lower its prices, give decent living wages to its workers, and reasonable salaries (six figures instead of the outrageous multiples of seven figures) to its administrators, and be part of a movement to ensure all, including the least among us, are covered, then they should be allowed to continue. If not, wipe them out. They have been a vampiric scourge on humanity and I couldn’t care less what happens to them and their enabling employees.
The story of dying archaic industries and their employees is as old as human history which survived just fine the loss of the horseman, lamplighter, and iceman. As Republicans like to say, “pull yourselves up by the bootstraps”.
4
Just be careful that the Insurers who stay don;t get to cherry pick the "best" patients to insure. This hubbub seems like typical diversionary rhetoric used when the Pols are passing something bad for us.
I've been hearing the many calls for "Medicare for all" being suggested by our Democratic candidates [aka "The Bandwagon"] and I am listening as I hope for improvements to be made to the system now in place - full of imbalances, unfairness, bias, etc. I am still waiting for one of the candidates to address the part of existing Medicare - - the part which states that you [the individual] are responsible for approx. 20% [Medicare B only covers approx. 80%]. In my case, Blue Cross covers the remaining 20% [yes - I am required to continue paying monthly premiums to B;ue Cross as a retiree in addition to monthly Medicare B premiums]. The candidates proposing "Medicare for all" should consider/address how to incorporate the other 20% lacking in existing Medicare B coverage [Medicare A -hospitals being currently covered,i.e. paid for retirees/others over 62].
In the meantime, please "tweak" (improve) the existing "Obamacare" - - perhaps a more realistic goal during these highly polarized partisan times.
2
The sooner we can rid ourselves from these predatory/parasitic "Health" Insurers, the better. Why we allow these CEOs to feed like hogs at the (financial)trough is well beyond my understanding.
And as others have mentioned, was our nation in crisis when we went from Horses to Automobiles? "The sky is falling, what will we do with all these unemployed Buggy-Whip manufacturing workers?". Asked no one ever.
3
Someone better tell the huge crowd of Democratic contenders that the wooden platform they’re all standing on to try and defeat Trump has a central plank with a huge termite problem. “Medicare for all” sounded so catchy though, almost as comforting and tripping off the tongue as “a chicken in every pot and two cars in every garage”. Maybe they could reuse that slogan if not for the fact that so many Americans now have to live in theirs.
1
It represents 17% of the economy and only Silicon Valley tech floods the deep swamp with more money and lobbyists than "healthcare" insurance corporations. Doubt Americans will ever see these guys go flatline--too much money, too many vested interests. DNC Politburo is about identity politics not fixing healthcare--soon to see the reality emerge.
3
These authors suggest we should keep an inefficient, uneconomical, nonsensical, cruel system in place simply because the people employed in, and in some cases making millions from, that system might have to find some other job. We the people of this country are expected to continue to support the aforesaid people--in spite of the harm the system they are employed in does to our country.
How is this not a national handout? How is it not welfare for undeserving recipients?
Yet again we are given to understand that corporate welfare is always okay (while welfare for poor individuals who don't have two cents to rub together is something to be ashamed of, of course). For the sake of every American having access to high quality health care in an economically-efficient system, can't the workers and fat cats in the health insurance industry just pull themselves up by their bootstraps and retrain for some other job?
3
So here we go again.
Democrats want to solve the Health Care problems in this Country while the republicans and the Health Care Industry want to keep the status quo because it is profitable for them and their shareholders.
It seems keeping American sick and at the mercy of the Health Care Industry is very profitable in this Capitalist driven society and the republicans are protecting their donors at any and all cost. At the expense of our lives.
Funny how the American Tax Payer can afford to pay for Trillions in Tax Cuts to the none job creating wealthy and corporate entities in this Country but they cannot afford to pay for decent affordable health care for themselves.
Why is that?
Most of the Health Care Industry in this Country is ran by old men that are set in their ways that put profit above all else, just like the oil industry.
They believe the old way of picking and choosing which Americans live or die while making a profit has worked for over 100 years for them and it should continue at least until they, the old men, are died and gone.
This is the 21 Century. If the American People can pay for Trillions of Dollars in Tax Cuts, they can pay for a single payer Health Care System that puts them first and profits last.
It is long pass time for the Health Care Industry to die.
If this is a problem for the the wealthy and their corporate entities they can always permanently self deport.
Since they are leeches on the American Tax Payers they will not be missed.
2
We have or rather had Obamacare — a private insurance based system to cover more Americans. The Republicans vilified it and road that wagon along with birtherism into the White House. Where was the insurance industry when Obamacare was being torched? They were no where but behind their desks writing big checks to Trump. Prior to the 2016 election I was against Medicare for all, for just the reasons outlined here. Our insurance system is a jobs program, designed to make money and employ millions of people. How do you sink that boat? Now after the election, I think it is time to blow the insurance industry out of the water. They had their chance. Voting for Trump has consequences. Either you want to be part of the solution or you don’t. The insurance industry decided they don’t want to be part of the solution. How many Russians did they meet with. They obviously are NRA gun right advocates and believe in birtherism. It is time for them to go.
2
Who cares what it would mean?
I mean really...think about it for a moment.
All those employees, shareholders, ceos, cfos, coo's.
They've been making money off of your insurance payments for well over one hundred years.
When profit is inserted in any product, there has to be a consequence. Either the product costs more, the product provides less, or both.
Profit must always be reserved first.
And so it is with our healthcare system. People have experienced lower quality of life, shorter lifespans, less services...all in the name of profit.
It should never have been this way. And in many countries it never was.
Maybe sometime in the next hundred years, our plodding, conservative, fearful country will get a grip, a clue, and move toward a single payer system.
That we have this ridiculous system is fitting for a country obsessed with the rights of corporations and capital holders.
3
Abolish private health insurance. You say that like it's a bad thing. Half the country is already on government paid care they are very happy. That's the Precedent in American History.
1
The entire medical insurance system in the US sits between the patient and health care providers is parasitic, and contributes NOTHING. Eliminate that entire layer and devote their revenue flow to actually providing health care
3
The title is deliberately misleading. The neterattie call it click bait. "Abolish insurance" is the right wing rally cry. Medicare is nonprofit health insurance which I purchase from my government. I am a very satisfied customer. I voluntarily pay for the insurance. No one in the government, unlike private insurance companies has an incentive to save medical costs at my expense or that of my family' healthcare..
Can Aetna say the same???
2
Precisely why Medicare for All ain’t gonna happen.
This seems like total nonsense. I have Medicare, and I also have back-up private insurance that provides my prescription coverage, picks up most of what Medicare doesn't cover and will step in with high-cost hospital coverage and even elective surgeries that M'care doesn't cover. I'm glad I have both and if I hadn't been fortunate enough to afford extra insurance I could survive quite nicely with just M'Care. Will big insurance companies fail or shrink? Of course they will. So did buggy-whip companies when cars came along. Tough beans.
2
Here will go again, a sand box fight re my dad is stronger than your dad.
Translation, both dads are good just like the medical insurance policy of our 30 peers country. However unlike our peer countries, we have leaders/populace who are fighting in the sand box.
Anything, anything is better than our de facto criminal plan (pre ACA) of be rich, don't get sick and/or don't have a bad life event while big pharmaceutical/hmo make trillions off the health of the average citizen.
Very few, if any of our peer countries have a totally socialistic plan. England may come the closest. All the rest are a mix of private insurance and gov't regulation.
1
This country is on a quick ride to becoming a country based on European socialism. First, we end all private insurance - too bad about all those people who work for them or those who own stocks - it is for the "general welfare" of all.
Next, it will be a nationalization of all the pharmaceutical companies. Heck, drugs should be free or low-cost for all! Costly research? People will still want to do those jobs, even if their pay is lower. And stockholders? Again, it's socialism - "general welfare for all".
What will be next? What other industry will be "nationalized"? Does no one realize that the National Health Service in the UK is having a very hard time with sustainability? That all who can afford to, come to our great medical centers here in the US, for their treatment?
Since schools quite teaching "critical thinking" skills, we now just make decisions by the seat of our pants with little thought to the repercussions each decision will cause.
I'm just glad I will most likely be dead by then...or will have died due to being told that my health care is not covered due to rationing, with the elderly being told they've already "had a good run".
3
TH=here is a place for private insurance, in today's Medicare, it is called Medicare Advantage.
What thsi article f ails to mention is that private employers get a tax break fro providing health insurance. They are part of the mess of the health care system. And, by the way, anyone purchasing health insurance is already paying a tax.
Where I used to work, to cover a family, a worker had to pay almost $600/month; fro coverage. For a single, it was about $200/month. The employer paid 60%, employee 40%. And each year deductibles, co-pays and co-insurance increased. Now, it is about $6000 out of pocket, or more.
What also is not mentioned, a Medicare fro All system will end rating territories, and out of network. It will also end those hundreds of drug ads we see everyday. It will eliminate the middle man between drug companies, and pharmacies. It will eliminate surprise bills, because an out of network doctor was used in an in network hospital.
Private insurance, and its employees, will still have jobs with Medicare Advantage policies. Saying that people will have to wait for access, is a fear tactic. Doctors are not going to leave the Us, as it is the last bastion of out of control, for profit health care.
The big change, it will not cost $10,000+ per capita fro US for profit health care.
Extending Medicare to all citizens, with Medicare Advantage, is the best compromise.
1
@Nick Metrowsky Indeed and in most European countries socialized medicine has a private insurance component.
1
While I share the enthusiasm of wanting to sweep aside the whole miserable for profit system with others, the reality is that the industry will really open the floodgates of lobbying money and outright bribes to ensure that never happens. And there are other approaches in use elsewhere that might work better and be less disruptive -- like some of the European systems. As with other major issues -- climate change comes to mind, the first challenge is to define the problem and the goals to be achieved, not the path. Then work out how to get there in a bipartisan manner. I find it amusing that the richest economy on the planet cannot find a way to take care of its own citizens in a fair and equitable way -- but has plenty of money to be an agent of death elsewhere. Not the kind of Bible stories I was brought up on.
4
I'm a family doctor but only a few months from retirement, so any reform won't affect my income.
Medicare-for-all would like decrease family docs' income. A parallel private system, as exists in many countries (including the UK, think of Harley Street in London) would allow us to see private patients in addition to public patients and thereby maintain income, and, more importantly, some degree of freedom from government servitude.
Good doctors, or those at least thought to be good, would not have to see only public patients. I would advise my younger colleagues to go that route.
2
Most people access Medicare via insurance companies now. Switzerland's system mandates the use of insurance policies to cover all of its citizens, except the poor. An expanded Medicare would benefit from maintaining the present system while insurance companies would see their gross profits increase, but their profit per insured could decrease via strict oversight.
@Steve Newman... how many poor people are there in Switzerland?
2
If Republicans wanted to save the insurance industry, they could have refrained from trying to destroy the ACA, which, after all, is made up of private insurance coverage. As has been widely acknowledged, the blueprint for the ACA was a Republican proposal. ACA's design was a big payoff to the insurance industry, and Obama accepted it in order to get something passed. The ACA could have worked, had it been allowed to be improved over time.
The expansion of Medicaid was the hidden Single Payer Easter Egg, however, because once the percentage of the population covered by government insurance reached a certain tipping point, and people saw the 60% getting health care as good as theirs, everyone would want it. The GOP fought that, too, because they saw what it would mean.
In the same vein, Democrats need to be willing to move incrementally toward their goal of single payer rather than expecting the populace to eat the whole pie in one gulp. It is too much to expect most people to understand the health care payment system because it is too complex. They have to see the changes at work to understand them.
2
When Britain started the National Health Service after WW2 of course the conservatives objected strongly but after it came into force and the initial demand peak was over industry discovered that a healthier workforce was a more productive workforce.
In my small company we pay about $36,000/year per employee for a good plan. With Medicare for all, we would pay our share just like any other company rather than being in an impossible negotiating position and being fleeced.
I view basic healthcare as a right for everyone.
As to waiting, my recent experience of needing care in the UK as a tourist, I spent about 40 minutes in the emergency room, was well treated and no charge was involved.
1
Medicare has supplemental private insurance for private purchase. This covers some medicare co-pays and supplements medicare payments to providers. I would expect Medicare for all would also have this option, and that . American insurance companies would compete for this market with perhaps better competition meaning lower prices.
New Zealand has parallel healthcare covered by private insurers, often work in the public sector bu also have private offices. The premiums for this private insurance increase with purchasers advancing age and "pre-existing" conditions and most people eventually drop the private insurance as they age. The public sector handles all emergencies, heart surgery, accidents etc. and all preventative care, immunizations, subsidized prescriptions The public sector has wait lists and limits for elective surgery and specialist care. Medication costs are government negotiated and are very reasonable.
I do not think the American health insurance companies will disappear, but there will be more true competition for the "Private" sector coverage, and the current systems' huge private premiums for much more limited coverage will instead go into most of the "Medicare for All" costs.
The title to this article is very misleading and "Medicare for all" will improve healthcare in the USA if given a chance
1
Insurance companies always cared more about profits than about the health of the insured. Should we, the patients, also care about their profits more than about our health?
8
My nest egg is permanently damaged from its Aetna hit when I was in my 60s---pre-Medicare---in NYC.
$2087.00 monthly premium.
How much does Aetna's chairman make annually?
6
Disregarding the flawed premise and conclusions of this article, let's remember that all of the proposals are going to require time to implement. We're not talking about flipping a switch and changing the entire system overnight here. Much of the rhetoric to date is conceptual. It's a process that will take time to implement.
3
We will see. I'd settle for making the insurers non-profits.
It is obscene to have for-profit health insurers. Their actuaries routinely deny coverage that kills people. It took a lawyer's pro-bono letter to Anthem to get them to cover cancer treatment deemed "experimental" for the sort of tumor a friend had.
She lived another decade, thanks to that initially denied treatment. The kept working for most of that time, and she paid her taxes. She'd been given a month or two to live.
Our current system is a form of managed cruelty. Pricing for trivial items can run hundreds of dollars. It's rotten. It needs to end. I'm just unsure that sweeping it away would help anyone.
9
Any proposal that eliminates or even diminishes my Kaiser Permanente health care plan (HMO) is going to meet with my strongest possible opposition. There will be horror stories from unhappy patients of KP, but for myself, my family, and during the entire time I volunteered at the local Kaiser hospital, I have never seen or heard of a more cost-effective, comprehensive, caring, and professionally excellent health system. Since turning 65, I've had Kaiser Advantage (ie; Kaiser + some meager scraps from Medicare) and that's okay.
Medicare for all is nearly the worst idea I have ever heard, second only to free college for all. It's a bad idea operationally because the Medicare system is already headed for bankruptcy and adding hundreds of millions of people who haven't paid into the system for 40+ years will only ruin it quicker for deserving seniors. A perfect example of the becoming-typical "I want it all, I want it now, and I want someone else to pay for it" American attitude.
Further, it is a bad ideal ethically because it debases the value of delayed gratification, work and save for what you want before you demand it. It disrespects the sacrifices of previous generations who gave us a system that might be sustainable if we hadn't become so selfish and impatient.
This is the Great American Flaw, and it's not someone else: it's you and me. We all need to spend some time asking ourselves what we have done for the country that we expect so much from.
5
Medicare’s overheads are a fraction of private insurers, the US for profit system is the world’s most expensive, thousands of Americans die each year because they have no access to preventative care, hundreds of thousands bankrupted by medical bills, millions more are uninsured, millions more insured but self deny due to costs, you are defending an inhumane system and attacking a system the rest of the world runs more cheaply, more inclusive, with better outcomes.
There is no defending our current system. No defending at all.
2
@Charles Becker Your argument is selfish and flawed.
2
@Charles Becker...yeah, no...one anecdote makes the current system just fine?
It is not a question any longer if Universal Health care in the US should be implemented, but how it should be implemented.
Our whole health care system is broken and needs to be replaced.
This can be done successfully if done with great care and deliberation.
All the current players in the system should only be allowed to the table as honest brokers.
Germany is a good example on how this can be done.
It is not in the best interests of the citizens of this country to keep the current system in place. Change is no longer an option.
5
Whatever Mr. Sanders and colleagues hope for in abolishing private insurance, that is not, in fact, "Medicare for all." Medicare for those eligible often have private insurance to supplement their federally provided Medicare coverage. Prescription drugs are not covered at all (except for those required in hopsital under Part A). One needs a private plan, with a third party "prescription benefit manager", often actually owned by the insurance plan.
I don't say there aren't beneficial results that could accrue from a national health care system, but it is not a description of how Medicare works, currently. That is all.
4
The private industry would specialize in supplemental to deliver Cadillac health care to those who can afford it and wish to pay. The idea that a single administrative architecture for a single payer system would streamline costs is recognized logic in all other service industries. The crazy-quilt system that is in place escalates costs due to the profit-taking layers of the industry. Delivery of service is not paramount, because profit is achieved by non-delivery of service. Medical practitioners are not properly remunerated for their education and service, because profit is achieved by minimizing labor costs.
4
Just like the Post Office, which then private industry took away from their monopoly.
1
I just don't follow the logic in this piece that Medicare for all is synonymous with elimination of private health insurance. There are many European models, where both public and private systems are functioning together well.
What is also clear, is that the private systems are under much more supervision and regulation in Europe, and I don't see that as a negative, given that profit is the driving force in the private sphere, with the catastrophic consequences we have to live under in the US.
8
Excellent, concise summary. Well done.
4
Some sort of "medicare" for all could only reduce health care costs by *finally* providing leverage to control prices from the predatory pharmaceutical makers and to take the parasitical cost that insurance company profits impose. To be clear, this wouldn't be free. But our premiums would buy more health care. What happens to health insurance companies is not relevant. They should not have existed in the first place.
3
Why do people have to be retrained for their jobs? Why would anyone loose their jobs? We still need medical care, we still need doctors and hospital administrators and nurses. The problem with the current system isn't with paying for these jobs, the problem is the enormous amount of profit generated by the health care system. That's what we're all paying for. Capitalism is supposed to "raise all boats" when all it does is make a few investors rich and health care affordable only for the wealthy (just like everything else capitalism touches (see Great Recession)).
I think we could have universal care if we just forced any health care provider to be a not-for-profit entity. Keep the salaries and watch our insurance go down.
Government doesn't have to do anything but regulate in this instance.
2
This is very alarmist. Medicare is administered by private health care companies. Humana in my region. Medicare itself is NOT an insurance company. It makes the rules and the private healthcare company administers it. A much more palatable situation would be for the 5 health insurers that are the biggest (roll in some of the smaller ones if you like) would be tasked with administering Medicare for All/America, whatever. BUT, commit to converting them to NON-PROFITS over the next 5-10 years. That way, you would not have to freak out the markets, the companies, the public regarding what will happen to these large companies and their workforces.
2
How many people have died due to private insurance denials or unavailability and unaffordability? I remember the decades of stories.
Now ask me if I care about the insurance industry going out of business. The business, no, the people, yes.
Medicare for all? Go for it! You'll be saving lives like cops, fireman, and lifeguards.
3
There are many examples around the world of government sponsored, national health insurance schemes with the important element of community rating.
In many instances, these systems operate hand in hand with private health insurance, where privately insured individuals may enjoy quicker access, greater choice of physician, place of treatment, prostheses etc.
Countries with national public schemes tend to have better health outcomes for much more modest outlays than the US which currently has the highest per capita spending on health of any country with relatively poor outcomes.
1
Private insurance has been a feature of Medicare (Advantage) for some time. Some people prefer Advantage over basic Medicare and it has pros (and cons).
I just don't see Aetna, Blue Cross and the other large health insurers giving up and disappearing. This is a survival fight for them. I believe they will simply stop engaging in public debate and use lobbying efforts to persuade Congress to keep Medicaid for All stuck in committees or to vote against it should it come to the floor.
1
The United States Congress should pass Universal Healthcare with budget ceiling of 6% of GNP, which equate to the 8% of GNP spent by other countries. However, like other countries our Universal Health program should not provide for name brand and experimental pharmaceutical drugs; end of life care; elective quality of life and on demand surgery; open emergency room access for non life threatening episodes; and medical care that does not make economic sense. All non covered care should be available through private insurers similar to Medicare Part B coverage. However, without a budget cap ceiling there is no way health care coverage will not become a Congressional Christmas Tree that will place great debt burdens on our children.
@Mark Singleton
Curious..why not cover end of life care? Are you suggesting eliminating the Hospice Medicare benefit?
1
I'm a physician. Your sub-headline asks what abolishing the insurance industry would do the industry's workers, the economic activity it generates and even the stock market. Sorry, these are not the issues we should be discussing. The "Health Care Industry" is not a "Health Care System", its an industrial Mosh Pit that is driven by greed, division and exclusion of the sickest from care. It is the primary reason that we have the least healthy population of any industrialized nation. It is the primary reason t's compensation parameters are why Health Care providers, whether individual practitioners or employees of large facilities, order excessive tests and procedures while ignoring preventive care and health promotion; it's exorbitant expenses and myriad exclusionary rules are why people people bargain their health against other needs like housing. We need a factual and honest discussion that exposes the Congresses criminal disinterest in delivering actual Health Care that now ranks the people of the richest nation on earth 45th in life expectancy, behind such countries as Malta, Cuba, Spain, Iceland, South Korea, Canada, French Guiana....
The Health Care Industry is not focused on health.
9
@CityTrucker
As a nurse who morphed into a health policy analyst, I endorse the doctor's comments. What real value do private insurers bring to health care? The purpose of an insurance company is to make money, and they certainly can't do that by spending their assets on health care. It's always interested me that private insurers call the money they spend on health care "medical losses". It's like a university calling faculty salaries "educational losses". It's very revealing as to what they consider their mission to be.
7
Abolishing slavery had a tremendous impact economically on a lot of people. Most of it good. A few slave owners, not so. Too bad. Same with the health care industry. A few will have easy profits cut, most will benefit.
1
I recently ran across the hospital bill for my birth in Canada. It was $250 which equalled about 3 months pay for my father at the time. Luckily, private insurance, through the company my father worked for, paid about half of the bill. I am not sure how the rest of the bill was paid, but it certainly would have been a huge burden to my family.
Fifteen years later, Canadian universal healthcare / medicare started. No one giving birth had to pay for their Doctor, the hospital, the nurses, the nursery cart - the tissue paper! - or the care of the baby - no matter how much care the child needed.
Although our health insurance industry was hit hard at the time, the employees of the industry easily transitioned to the administration of the public sector and the private sector continued to provide drug coverage and supplementary health coverage. To this day, our health insurance industry remains strong and profitable.
4
A very good article. Personally, I feel the process of changing over would be very wrenching. In the end the process would wring out the ludicrously high profits for so many companies and individuals, exchanging for the inefficiency of government medicine; exchange corporate beaurocracy for government beaurocracy. My opinion: use the German or French systems. Wildcard: patients themselves, Americans are not Canadians.
2
@Mel I've had Medicare now for six years. I have yet to experience anything that looks or feels like inefficiency.
1
Just like people have the right to healthcare, people should have the right to pursue better healthcare if they want it. While there should be decent baseline universal coverage, people should be able to pursue more coverage, even if they have to pay for it.
1
No precedent? How about every other developed country in the world?
8
No country with universal coverage outlaws private health insurance. The two are not mutually exclusive, and of course "Medicare for All" will be Orwell-speak for "Medicare for All, Except for the Rich and Connected (like politicians)".
One day, the U.S. will get to this point, and there will be an extreme two-tier system of excellent, no-holds-barred concierge care for the elite and just the bare basics for everyone else. Right now, we are nowhere near that point, but the Socialists will push us there, just like in Animal Farm.
The sad part is that most of what is treated in expensive chronic care nowadays is rooted in our diet and lifestyle: morbid obesity, type 2 diabetes, obstructive sleep apnea, hypertension, vascular disease, osteoarthritis, and even some cancer incidence are all mostly related to American gluttony. We pay thousands of dollars PER PERSON, PER YEAR to eat as much as we want. Horrifying.
Cost of not eating extra calories and going on a 2-mile walk every day: zero.
6
@James
We already have a three tier system. Wealthy people get suites, individualized services, and special menus. Beyoncé had an entire hospital floor cleared for her when she gave birth. Tier two: Those of us with ordinary coverage get expensive - but not exceptionally great - care. Lots of us forego it as long as possible because of high deductibles and copays.
Then there is tier three: nothing until we are so sick it may be too late. Even then people leave the ER with prescriptions they can’t fill because they can’t afford them.
So, cry me a river about the insurance industry and loosing today’s insurance plans.
By the way, obesity is not from gluttony nearly as much as it is from our industrial agricultural system that is killing us with hidden sugars, fats and additives. Wherever our food is adopted around the world, obesity follows. The world has not become full of lazy slackers; it has Americanized its diet, and that is the reason Europeans don’t want our food.
6
@James
You are in major denial if you think you can just eat yourself healthy.
You are in denial of your own mortality and morbidity. Illness happens. You don't need to blame the person for their illness.
If your theory were true, simply by our own will we would never get sick or die. But eventually sickness and death happens to everyone . How many 110 year olds do you know? This is just your way of protecting yourself from thinking you will ever get sick.
I have worked in health care for over 45 years so I've seen a thing or two.
2
It seems to me that private insurers are panicking because exorbitant salaries have been the norm for all those money-grubbing companies and their execs. It's the fat cats who stand to lose, but the worker-bees will always be essential to the health care system of whatever configuration.
Medicare for All could be administered by all those private corporations which already have experts (clerical staff) on board shuffling money through accounts receivables and payables. The only significant change I see is in the corporate structure---they'd become non-profit entities with contracts from the Feds, managing the Medicare/Medicaid programs.
Anything fundamentally impossible with that approach? It can work as easily as the accounting staff can make it work..........that's it, folks....Medicare for All, billing centers across the country serving Americans and their physicians, hospitals, pharmacists.....
And higher taxes for the super-wealthy, so that health care is available to everyone. We must all pay our fair share, according to our wealth or lack thereof.
5
Americans have been spoiled by employer and government-provided healthcare. They want what they want (doctors, procedures) when they want them, where they want them, and they don't want to pay for it. Americans on the whole have not yet fully answered the basic question: Is healthcare a right or a privilege?
Ask the average person if they are willing to pay for their neighbor's healthcare, and the majority of "rugged individualists" will say they do not. But that's what "universal" healthcare is, and it's antithetical to the American character.
The answer on what to do about the industry is simple:
"fetter" capitalism in this industry? That's what the majority of other nations do. Regulate how much the insurance can cost, regulate costs/charges, regulate the profits. The consumers can't continue to be so math challenged that they are unable to compute raising taxes can be the same or less than premiums, deductibles, and out-of-pocket expenditures. Dramatically reduce, but not wholly remove, the profit incentive, and the industry will contract via self-selection, and the entire marketplace will evolve.
2
Surely someone has an estimate of the cost of "doing nothing"? That would seem to be the cost measure of interest since any new approach, presumably, would cost less than "doing nothing". Kinda the same logic being used to discuss climate change... what's the cost of "doing nothing"... i.e., continuing to pay for the floods, fires, tornadoes, hurricanes. sea level rise, mega storms, etc.
2
@Taoshu
Several years ago a leading medical journal published a report on the millions in cost of caring for one homeless man with multiple health issues. The only care he got was in the ER because he had no health insurance. Even that care was ineffective because he could not afford necessary medications.
We know the cost of doing nothing. It is very high and has the worst possible outcomes.
1
The authors are, perhaps unwittingly, demonstrating exactly why Medicare for All reform is necessary. What they describe is a massive for-profit exoskeleton that is layered on top of healthcare in America. This insurance company extra skin provides two things that help utterly no one other than company shareholders: excessive profits, and non-medical people making daily decisions to limit covered items. They provide virtually nothing of value to most Americans.
It is true that radical reform is necessary.
6
Can we just rehire a lot of the laid off people to work for Medicare?
Also there's always going to be some sort of supplemental plans. So I doubt health insurance will really disappear totally.
4
Insurance is a con-game that promises security but fights providing benefits wherever possible driving up everyone's costs. In the U.S. there are at least 5 separate bureaucracies: the hospital, the doctor, the insurer, medicare and medicaid. Quantify the "overheads", add profits, and the result is WASTE on a colossal scale.
3
The "Medicare for All" vs. "incremental reform" dichotomy is misleading: What we need is Medicare for All, phased in incrementally! Allow for-profit entities time to convert to a nonprofit model, insurance companies & pensions time to diversify, employers time to adjust compensation models. It can be done! All we need is some national consensus.
2
Doing away with private health insurance would bring America into the modern world in health care. No other civilized nation depends on "market forces" for the medical welfare of its citizens. It's time to end the racket we have in this country, and the sooner the better.
6
Sorry, but this article seems like trolling. Sanders may want to abolish private insurance, but I'm not aware that it's a general view -- among Dems or anyone else.
And why should it be? Every other developed country has universal healthcare, but NOT ONE OF THEM has abolished private health insurance.
Of course, PHI is a minor part of their systems because it can't compete with the decent, low-cost, universal gvt-backed offering. In the EU, for instance, PHI accounts for less than 10% of total health expenditure (http://ec.europa.eu/social/main.jsp?langId=en&catId=754&newsId=559&furtherNews=yes), and in the US it would likewise wither in the face of competition from a sensible Medicare for All.
Of course, Dems like nothing better than shooting themselves in both feet, but abolition of private health insurance is not only political suicide, it's utterly unnecessary.
3
It definitely would not abolish private insurance companies. Anyone who has Medicare now must be fully aware of all the private options that are available within the Medicare system. Medicare only covers 80% so most people either get a supplemental plan (private) or an Advantage Plan (private, reimbursed by Medicare to the company). PLUS, everyone needs an Rx plan, which is totally run by private companies. If you don't get an Rx plan, you pay a penalty when you DO finally get it for every year you didn't have it, and that penalty continues until you die.
4
The third paragraph says abolishing private insurance would be profoundly disruptive. Consider that death is profoundly disruptive. Our current for profit system kills people (including your family) who could otherwise live. If the primary concern is economic, let people choose a government system or private insurance or phase in the change over a number of years.
5
Can we change the Democratic Party bumper/sticker on health care from “either ‘single-payer’ vs ‘no change’”, to simply “let’s do health care better?”
Medicare for all sounds impractical and like a sucker’s bet to alienate the average voter against Democratic candidates advocating for it. There have to be better ideas. For example, Germany’s health care program has multiple non-profit insurers competing for market share. The program is compassionate, regulated like a utility, and its competitive approach promotes efficiency and strong customer and provider relationships. No, it’s not Medicare, nor is it “government insurance”. Grmany’s program seems to get higher marks from the country’s population than Canada’s does, and way higher marks than USA’s does.
So maybe we can scour the world and see if other countries have decent and workable models to consider? Why settle for “Medicare for all”, when there are potentially better options out there?
6
@NY_Invictus
Agree.
If the democrats are looking to lose the election this is an excellent first step.
1
@NY_Invictus
Your absolutely right we need not reinvite the health care wheel. Like climate change we have no more time to be stupid or lazy .
We are behind the rest of the civilized world because of our constant desire for more and more profits. People are dyning and we worry about corporations , the rest of the world values there citizens and we better get on the train and start doing the same.
1
No it wouldn't "abolish private insurance" anymore than public schools and colleges abolished private ones. It would simply centralize payment for basic medical care, same as Medicare does. Those of us my age know Medicare works fairly well, and many of us have Medicare Advantage or similar private supplemental plans.
We need to cool the hyperbolic exaggeration in such discussions.
9
I do research for attorneys who are trying to find the costs of medical care for clients who've suffered catastrophic injuries. It is really difficult to get information from hospitals, doctors' offices, etc. Prices are deliberately made arcane and of course they are outrageously high. If single payer or Medicare for all became the law, I'd lose my job and have to find another way to make a living. And I say, go Bernie! bring it on!
9
‘Medicare for all’ is just shorthand for a baseline level of care that minimizes the cost of administration for insurance payments.
It would not make higher levels of private care illegal.
It would not make higher cost for private care illegal.
But the present Byzantine system of employer subsidized, government subsidized, hospital subsidized, no competition, fragmented for profit insurance would be wiped clean to help bring health care costs down 67% per capita, in line with every other industrialized nation.
The old trope about this hurting medical innovation is nonsense. When innovation is properly defined, as worthy of a patent and a monopoly for a fixed period of time, there will still be innovation.
It is the Martin Shkteli’s of the world that illustrate how the patent process is abused and the public pays the price.
So there will be a much smaller market for private insurance leading to consolidation- as happens in every industry.
Medicare and Medicaid will have real bargaining power, and the great corporate tax giveaway of 2017 can be used to pay for it.
Don’t tax employers through medical insurance coverage for hiring employees.
Tax them regardless of employees, as the share of taxes paid by corporations relative to profits and GDP has fallen for the last 50 years.
The federal government keeps shifting revenue collection to regressive payroll taxes, and enough is enough.
5
Is it just now people in the media are publicly asking this question, which most people who oppose a single payer healthcare coverage by the federal government already know how disruptive this would be not just economically but also diminishes the quality of healthcare that would be available.
Ironically the politicians who support this such as Bernie Sanders, Liz Warren and just about every person vying for the Democratic candidacy for 2020 want to breakup other companies they imagine are monopolies but want to create the largest monopoly in the free world.
Hypocrisy is an understatement and makes a person wonder if these politicians propose such socialist programs only to undermine this country.
3
As a Canadian wintering in Florida, I have for many years found the U.S. healthcare debate an astonishing example of hopelessly bad policy development. This goes back to the very bad idea of putting Hilary Clinton in charge of the portfolio at the beginning of her husband's administration. The U.S. polity has never come to grips with the essence of the issue: what do the people want? Instead, special interests and politicians have stayed out in front of the question, providing answers before determining what the actual population might prefer, absent the influence of financial or political agendas. One side wants the profiteering health care "industry" to respond to a "market" while the other side wants health care for all at public expense. Both these positions leave out the thing that counts: what is the desired outcome in terms of the health of individuals? Is an individual's health determined by his/her ability to pay, or to be employed by an industry rich enough to provide insurance? Or is it something more basic to the interests of the entire community, i.e., the value inherent in a healthy population. Get out and ask the people. Take time to do so, and listen.
6
I can see that the authors of this piece are terribly afraid that an industry that creates excludes millions of people provides less service for a much higher cost and contributes to Americans poor health and shorter life spans. Too bad they cannot see that if everyone in the U.S had healthcare, including dental, the boom in healthcare jobs would be explosive. The C suite types, the Pharma Bros, the commissioned sales people and the hedge fund managers would no longer be making bank on the suffering of other Americans but decent Americans can live and live well with that trade
off.
4
FACT CHECK - Which candidates have proposed abolishing Private Insurance other than Bernie Sanders ? The few who have gone there has quickly baked off. Another question is the constitutionality of such an action.
2
The idea that we can just flip a switch and have Medicare for all is insane. The process must be gradual and give the government enough time to ramp up the infrastructure and administrative capacity to actually make it work. Giant rollouts are a huge risk and can cause major backlash, just look at how the launch of the Obamacare exchanges went. If we take that approach on single payer, we’re going to have way more serious problems and unintended consequences. It would be the left wing US version of brexit.
There are many ideas for a gradual rollout that would actually be usable. In the primary(and only there, Trump must go), I will not vote for a candidate who does not have one.
5
We "flipped a switch" and turned on Medicare, which we were told would ruin everything. Hmmmmm ... Seems to me Trump has ruined more things in 2.3 years than Medicare ever did.
Just copy the Canadian healthcare system. Tommy Douglas, the father of Canada's Medicare for all system, was voted as being "the greatest Canadian ever" by a country-wide CBC poll in 2004. That just shows how much Canadians love our Medicare which provides services comparable to the USA at a far lower % of GDP.
2
I'm on Medicare. Back-up insurance (non-government) covers the 20% that Medicare doesn't. With Med-for-All there would still be a need for private insurance. Some displaced private insurance workers could transfer to work for Medicare.
1
Removing the layer of expense and bureaucracy that the insurance companies offer as their product for interposing themselves unnecessarily in the process of getting medical treatment is a great idea. Given that they make money by doing everything in their power to delay or outright avoid paying claims, this would be a welcome development. Itthey want to write supplementary policies that cover rooms, surgeries, etc as is done in countries that have single-payer, they are welcome to that market.
3
And inserting the massive bureaucracy that is the federal government would improve things? If the goal is efficiency, why not just outlaw insurance altogether? That seems to be the logical conclusion to your objections.
4
@Adam Because the most likely consequence of outlawing insurance is Medicare for All, or "one shoe fits all," a system which would also massively increase the size of bureaucracy. Just like people have the right to health care, people should have the right to pursue better health care if they want it.
@Adam Medicare is the most popular insurance in the country. My husband battled brain cancer eventually on Medicare and it was a great insurance for him
The ACA was the last opportunity for the private healthcare industry (which had become more of a healthcare PREVENTION industry). We are no longer a country where many workers are employed by big companies like General Motors or under union contracts, and our antiquated healthcare insurance system of the past was failing to ensure huge segments of our population. Obamacare was the best shot to save private insurance while expanding the system.
And Republicans did everything they could to destroy it, and they did succeed it undermining it significantly. Because, you know, people who aren't rich are bad, and that black guy we elected president had to be destroyed, even if it blew up lots of other things too.
So here we are. The private insurance companies can survive by becoming administrators of a better system--and if the healthcare sector really cared, they should have defeated Republicans at the polls to save themselves. But they didn't.
3
The article forgets to point out that employers would no longer shoulder the burden of providing health insurance benefits, a boon for employers nationwide that will save them millions in the long run. How can companies other than those in the health insurance industry NOT support Medicare For All, especially if they care about their bottom line? This also gives employees and prospective job seekers much more flexibility in moving to better jobs based on other metrics that doesn't involve their health. Taxes may end up being higher, but everyone will benefit from having much cheaper healthcare than the current system.
9
"Most other countries with single-payer systems allow a more expansive, competing role for private coverage. In Britain, for example, everyone is covered by a public system, but people can pay extra for insurance that gives them access to private doctors."
Private insurance in the UK "competes" for a limited range of medical services, and I would not describe health insurance as "expansive" (although the Tories have been trying for years to break up the NHS). For example, it does not cover emergency services, or gp services. Gps are the gatekeepers to more specialised care. The private doctors are usually the same doctors who work for the NHS; what the insured gets is to jump the queue.
Private health insurance here is very cheap, especially when contrasted with the US, but the reason for that is that the private doctors and hospitals rely on the NHS to provide the more expensive and less profitable services.
And when the private runs into a problem they cannot handle, they send the patient right over to the NHS.
1
@Joan personally I wouldn't want our healthcare modeled after the UK's. There are much better models
This is a very bad idea. Medicare should be available to all who want it. Private insurance remains for those who choose it.
2
Astonishing and ambitious. If successful, it'd go down as one of the remarkable achievements of human endeavour.
But, but... I worked for the UK's National Health Service for nearly 40 years and I ended up disillusioned with it as a credible care model.
Demand ALWAYS outstripped supply - no matter how much public money was poured in. There's always something new to offer but no new resources.
Endless moaning and complaining - from patients, staff, politicians, the public, the media. Feelgood factor about 10% of horror factor.
The care, particularly emergency care, was pretty reasonable most of the time; the *perception* of that care was terrible.
The whole system was balanced on a knife edge during, pretty much. my time there. Since 2008, the global financial situation coupled with ruthless austerity from ruthlessly right wing governments (including Blair's 'socialist' one) have tipped the whole thing into meltdown. Most of my doctor time was spent as a paperpusher trying to fix a broken system and to cover over the truly awful standards we'd sunk to.
Be careful what you wish for.
6
The financial disruption is part of why the ACA did not go this route in the first place....I think a version leading to eventual single payer or Medicare for all is something we eventually need to get to, but do it over decades not a single presidential term. Add the most vulnerable into an expanded Medicare first (workers over 50 whose jobs are offshored or that technology changed) and gradually expand it as private insurance gradually moves to a supplemental market, jobs not replaced as the company downsizes. That's the least disruptive path.
4
My mother’s insurance provider has lied to me about her treatments and dr requests for specialists, saying there were no referrals until I got a professional friend to look at her chart for me.
I don’t pity their financial concerns.
8
So what?
Medicare for all moves healthcare away from a privilege for the employed and the rich to a right for the many. Every civilized first world nation has various forms of universal healthcare except for America.
The health insurance industry along with the private and public connection offering healthcare as an employment benefit is misguided and misled. While the unfettered and unhinged privatization of profits in the pharmaceutical, medical devices, hospital and medical professional industry puts positive human health care second if not entirely subordinate.
Medicare must have the ability to negotiate lower costs for all players in the healthcare related industries
8
Disruptive it would be. Another plan to get to universal coverage at single payer system levels of costs is a desirable goal. When people point out how profitable the current system is for providers and insurers they disregard the fact that health care is not a wealth producing activity it’s one that uses it up. They also ignore that great numbers of people are impoverished and the taxpayers end up caring for the mostly costly to provide care, subsidizing private insurers profits. The current system is not sustainable.
4
It doesn’t have to be like that. I am from Thailand where all Thais have access to free universal health care but those who are in work force has thier own social health insurance. They can choose which hospital they wanted to be treated at. There are all kind of health insurance being offered in Thailand. If you think that free healthcare for all killed insurance companies, you are wrong. Cigna won’t do any business there if that is the case.
6
Our healthcare system is what Bernie and others are talking about. Our costs for the individual are essentially non-existent ($150 limit per year for the entire family on medication, and $30 doctor visits). Hospital stay and medical procedures are completely covered. The end result is a cost of just over $3,000 per person (the US is over $9,000 per person) but the results are where the stark contrast comes in.
The chances of death from surgery is also a third of the rates in the US (partly to do with the unnecessary surgeries or the delays due to health insurance arguing the validity of the procedure with the hospital).
The life expectancy is not better in the US and in younger patients is worse (but again, the numbers in the US include an opioid crisis and daily gun shooting which we don't have here to make a fair comparison).
The biggest difference is the number of bankruptcies due to medical bills in the US, currently over 650,000 bankruptcies; in New Zealand: 0
Your entire healthcare system is, if not sending you to an early grave, definitely sending your chances of retirement to an early grave.
The US also has a slip and sue mentality when it comes to malpractice, we have ACC which mandates and limits liability but also provides protection for the victims. Ask your obstetrician what they pay in health insurance and how many babies they have to deliver a year to pay the insurance premium?
7
Medicare for all would abolish bankruptcy due to medical bills. Better late than never. Commercial insurers will continue to thrive, selling private insurance to those who want it, selling Medicare supplement plans, and administering Medicare claims for the government. But if they don't thrive, I don't care. For-profit health care is a scourge, and the sooner we banish it the better.
8
The Upshot and various other relevant articles on this issue have done a service highlighting the fact that one size (single payer) doesn't fit all. The Europeans outside Blighty/Brexit land have hybrid systems in which private insurance plays a part.
Universal coverage is the goal, not demonizing an industry or the stock market or our 401K portfolios even if that animus against health insurance as any part of the solution sends a thrill up the leg of the hard left.
We campaigned on expanding and fixing the ACA (demonized by big lies from the GOP and Fraud Noise cable network). We did not run on eliminating a large component of our economy/jobs and or stealing away (as our opponents will surely say) your health insurance. Support for the Sanders/Gillibrand et.al. plan falls away once you explain it to the public.
Some are fixated on process and ideology. Instead focus on the least expensive way to achieve coverage for all with all options on the table including a role for private insurance in partnership with government. If you say no to that tell me how your pie in the sky who cares about higher taxes or even more massive deficit spending approach gets through Congress. The deficit is already massive, and try winning on a platform of higher taxes for all.
Slogans are easy. Thought through programs take long and involve a lot of study.
3
You must realize that many of us on Medicare don’t just rely on government run Medicare for all of our healthcare coverage. Many of us buy supplemental plans in addition to regular Medicare. Many others of us buy a Medicare Advantage plan instead of regular Medicare. Both of these options involve private health insurance companies. Advantage plans are available through private health insurance companies that contract with regular Medicare and cover many things that regular Medicare doesn’t cover as well as prescription drugs. Medicare supplement policies are sold by private insurance companies and help cover many of the costs that Medicare doesn’t cover. The point is that most of us aren’t just covered by regular Medicare and that private health insurance would certainly not go out of business under a Medicare For All program.
3
But I think people should be able to purchase their own insurance, not merely their own supplemental insurance.
People need to know what Medicare actually costs, Part B costs $135.50 per month. But that is only a quarter of the actual cost, which is therefore $542 per month. Part A, Hospital insurance, also has an actual cost, charged for people with vitually no work, and that is $437 per month. So the actual cost of Medicare is $979 per month per person.
Something to think about before blithely going with ‘Medicare for all’.
2
Whaddabout whaddabout whaddabout ME? The fact that articles like this get written should show us how many "me"'s we are paying for who don't need to be there. Why do we need "investors," not in the delivery of healthcare or the research to make it better, but in the paper shuffling payment for services system? As for the insurance companies themselves, they're smart capitalists, aren't they? I trust them to find a profitable niche either in the healthcare market or employee benefits market or to diversify into other businesses and industries. If you believe in capitalism, you believe those insurance CEOs and Wall Street bankers will see big change as big opportunity. Employees, as if anybody in capitalist Trump World cared about employees, could go to work for the greatly expanded Medicare program, many of them for better wages and benefits with more job security.
8
The insurance industries would have to diversify and perhaps contract to the government to process medical payments which is really all they do now. What did the alcohol industry do when Prohibition passed? Alcohol was deemed immoral then, profits on American’s illnesses is immoral now.
3
In this country we spent ~3.7 TRILLION dollars last year
No matter what system we have we're likely to spend at least that much if not more in the coming years.
That 3.7 TRILLION dollar bill gets paid by someone
Either the patient, the patient's insurance, the Gov't
SOMEONE pays that bill...
Medicare per all is routinely touted as being "too costly"
"No way can we afford it" etc etc...
Well what would Medicare per all mean?
It would mean that insurance companies would no longer be in business in the healthcare field
They are for the most part FOR PROFIT enterprises.
So theoretically we'd no longer be paying for a CEO's corporate jet... Or for the advertising dollars those companies spend... or would the Lobbyists who represent them in the back rooms of Congress get money from them...
Then if we combined Medicare for all with allowing the Gov't to negotiate Drug Prices we may actually save a buck or two...
Either way whether we have Medicare for all or the current system we're going to spend ~4 Trillion per year
That being the case
I'm good with Medicare for All
Sign me up!
7
Maybe the problem with the term "Medicare for all" is that it does not appear to be what is meant. If it were literally true then private insurance would still have a place. Medicare determines the benefits but people like me opt for additional coverage via a medicare supplement policy from United Healthcare or other health insurers. Some of my friends opt for Medicare Part C so all of their benefits are provided by a private insurance company. Whoever said that there would be no place for private insurance in Medicare for all doesn't know Medicare or should a different way of describing their proposal.
All prescription drug plans are provided by private insurance companies under Medicare Part D. There is a serious problem with the way this works and needs to be fixed. Big Pharma basically designed Medicare Part D as a way to bilk the public out of billions in a monopolistic design in which the government is precluded from negotiating with the drug companies. Any redesign of Medicare needs to fix this design flaw.
5
If Medicare for all results in the loss of a half million jobs in the private insurance industry, that result benefits everyone by eliminating the cost of unnecessarily complex, unproductive and wasteful administration. The units of production (medical treatments provided) are not reduced, just the overhead costs. Hard to see how loss of unproductive administrative jobs will harm the economy.
5
Several private insurance companies now manage Medicare benefits for those in their geographical jurisdictions. That could continue once Medicare is extended to all. Same with Medigap policies.
Yes, we need to work out a reasonable transition. But Medicare for all is the only policy that makes sense. Sweden has a longer life expectancy than does the U.S., yet it spends only about half as much of their GDP on healthcare as we do. Having a better safety net than us is one of the reasons it was recently ranked as the 7th happiest country in the world.
6
Your description of private health companies feels like you're discussing government job programs. Well, if the government needs to protect these corporations, that action is tantamount to socialism—so why not just take them over. A national program would require more offices, workers, managers. Anyone agreeable to becoming a government employee working in a nonprofit should be welcomed to stay on. What we have now is corporate socialism. I'm sure advertisers are also interested in the status quo—especially for their bizarre drug commercials, listing hideous diseases and torments while people smile to upbeat music.
We are close to nine billion globally. Future agencies and corporations will be huge, and being huge, will be subject to graft, confusion, embezzlement, pilferage. We'll need anthropologists to study the nature of huge organizations. Find means to control disorganization and the ungainliness of massive agencies. Tamp dysfunction down as much as possible. But why would the work force decline? National health care will need them.
1
I am old enough to remember when that great socialist, Richard Nixon, proposed a system whereby if you couldn't get insurance through work, you could purchase it from the government. Add in the ACA subsidies and it seems to me a framework that is workable and would promote a gradual transition from private to public.
4
Health insurance companies have lobbied very hard to stymie and kill efforts to reform the health insurance system. Perhaps their intransigence will be their doom.
3
I am very pro single payer or regulated with public option, as it is in Germany.
However a serious reality check is in order. ALL Federal spending totals about 23% of US GDP - perhaps 19% paid thru taxes and the rest as deficit spending.
Healthcare takes up some 18% of US GDP
So anyone advocating a “miracle single payer Medicare for all” plan had best “get real” that it will mean US taxes increasing to about double the current rates.
Let me know when that reality check is over, because the GOP led hysteria about a mandatory tax hike of 100% to fund a “free” healthcare pipe dream will never be overcome in my lifetime.
2
This is not true. We are already paying more than $10,000 per person annually to insurance companies. That would go away. Maybe we could just make the companies to pay that money to the Feds. Of course with the single payer system you wouldn't need to pay millions of sales guys and marketers plus dividends to stock holders. Health care insurance industry is a huge parasite.
Assuming that Democrats regain the Senate and Presidency in 2020, while retaining control in the House, there needs to be a gradual transition to a full Medicare for All program that does not unnecessarily alienate voters, who will then seek to throw out Democrats in 2022.
We may believe that their fears are needless - but we ignore them at our peril.
If you lose control of the House in 2022, you lose the ability to advance any other legislation. And it's not as if health care is the only issue that needs to be the agenda.
We need to give Americans choices, one of which will be a huge, properly funded federal non-profit with no limitations on its ability to negotiate with healthcare suppliers (and thus reduce costs).
Any other approach is tantamount to political suicide.
5
I live 1 1/2 blocks away from a hospital with an ER. If I went to that ER I would have to sell my first born child to pay the bill! It's not in my "plan", since my husband works for a different hospital system and our "plan" only includes that particular hospital and it's offshoots.
It's ridiculous how much I, and every American (under the age of 65) worry about going to the "wrong" doctor or hospital. There is no logic behind it either! Single payer/Medicare for all is the only logical option.
14
The industry probably underwrote this 'fear' propaganda piece.
The article shows the extent of greed that has insinuated itself in healthcare.
Once upon a time, ALL healthcare was non-profit. For profit healthcare was not allowed. Sometime between Nixon and Reagan the lobbyists managed to get bills through Congress legalizing for-profit healthcare.
Suddenly, money that could have been used for research, providing care for more, was used for exorbitant CEO salaries and bloated shareholder payouts.
Just imagine what our healthcare could have been instead of lining the pockets of the rich.
This article uses the economics of greed to try and justify keeping status quo. It makes no mention of the suffering this greed has engendered.
8
@John L
RE: Once upon a time, ALL healthcare was non-profit. For profit healthcare was not allowed.
Whether you made this claim up or heard or read it, it's not true.
1
This cost/benefit analysis is morally obscene, seeing that the principle that the Medicare-for-all people appeal to, that health care should be a right, not a marketable commodity, is plainly correct. "Capitalism poisons everything," so naturally the way health care is dealt out in this country is going to lead to bad health outcomes, and to unjust financial hardships for many households. If Medicare-for-all is judged to be quixotic and impractical, and if a reformation involving some compromise turns out to be the only acceptable option, so be it. But in the course of the transition process, we must never allow the insurance industry and other commercial interests get away with any claim that they are in a morally fine and noble position.
7
Workers in the health insurance industry can seek employment with Medicare. Since Medicare, for all its flaws, is still far more efficient than private insurance, fewer additional workers may be needed, so the rest will have to find other employment. As someone who survived multiple layoffs and an employer bankruptcy during an otherwise successful career, I say that’s life.
The government will have the money for a public plan because Americans will stop paying private insurance premiums and shift some of those funds to the feds, just as seniors now pay the government for the coverage Medicare provides.
I hope I’m still around to see some form of public health insurance for people under 65. Disruption in certain industries is good for society. It’s why Uber is far better than my cruddy local taxi company at the same cost and why my eyeglasses are less than half the price they used to be.
4
Does everyone remember the terrible financial consequences to the nation when the Model T replaced personal horse and buggies and livery stables?
And the awful disruption switch from oil lamps and whale oil to the new gas systems, then so soon after, from gas lamps to electric lights. The tragic loss of the entire the whaling industry!
And how the rise of the passenger airplane wiped out all the far slower private railroad classic passenger trains.
How on earth did we mange to recover from such negative impacts on our economy and our life style?
27
Why not just make Medicare a public option within Obamacare's marketplace?
3
Baloney! A Medicare option for everyone doesn't mean everyone would choose Medicare, or only Medicare, or that businesses wouldn't compete with enhanced insurance offerings for employees they really want.
Unless the health insurance sector is an empty shell, capable of no innovation and adaption, and profitable ONLY because of the baroque system they've perpetuated and lobbied for forever in the US, they will survive using a more efficient, effective, and equitable business model.
7
Is there no place for the current insurance industry to play a role in administering a Medicare for All plan? As this article points out, a third of Medicare and four-fifths of Medicaid beneficiaries get their benefits from private insurers. Why can't they continue to fill this need in an expanded system?
1
I don't think you've gotten all the facts. currently, Medicare claims are processed by regional entities that are owned by the big insurance companies. it seems reasonable to believe that reliance on subcontractors (ins companies).
yes, in other countries, supplemental insurance from private insurers is available. again, that model may continue, depending on the design. the marketing, support and executive ranks would probably be at greatest risk. again that would be mitigated or expanding, depending on the design. its my understanding that the hc insurance (for all) model to review is the system in Taiwan. how an article that is less alarmist.
3
The notion that there is competition between healthcare providers is a joke. In the city I live, Sacramento, two of the primary care providers have been colluding to fix prices. If competition were effective at keeping prices down and access open, then why do we spend 20% of GDP on healthcare while leaving 15% of citizens uninsured, another 20% barely insured, and another 20% underinsured, such that the leading cause of bankruptcy in the US is healthcare costs. In the rest of the developed world they spend between 12% and 9% of GDP on healthcare and cover everyone to high degree of quality. We rank #1 in cost, by a wide margin, and 37th in quality of healthcare. That is abysmal Bang for the Buck. No one out there is copying a page from our playbook.
As for what sort of system to replace the current mess with, read Krugman's piece. We can copy the British model of fully socialized medicine; they rank #1 in the world. We could copy the Australian system, which is essentially Medicare for All; the Aussie's rank #2 in the world. We could copy the Dutch system of highly regulated private insurance; they rank 3rd in the world. Any of those three would count as a massive improvement in quality of healthcare and in its economics. Whichever is easier to make work is the one to pick.
6
Health care in America: overtreating the wealthy, undetreating the poor, burning-out health care professionals, fattening the wallets of politicians, and providing corporate welfare to the .1%.
The revolution is long overdue.
I am disgusted by the subtle scare tactics deployed in this article. This is not about stock portfolios; it's about justice, equity, and human rights.
12
"Legislators writing the bills acknowledge that people in the health insurance industry would lose their jobs. Proposals in the House and Senate would set aside large funds to help cushion the blow to displaced workers, offering them training, benefits, and income supports."
Beware of that promise. It was made to hundreds of thousands of Ma Bell's employees when she was being executed. 200,000 of us lost our jobs and we received no assistance at all from the government that did the deed and made the promise.
It’s a bit of a pity that the MFA folks are approaching this with the type of dogmatic yelling you normally see mostly in people who want moozlims banned because they carry Ebola or some such nonsense. And roughly the same degree of knowledge.
1. People are not going to agree to have their employer bennies yanked in return for significantly higher taxes and a government plan, okay? You can wave numbers all you like; not gonna happen.
2. You can’t just throw half a million people out of work, or abolish big insurers, or cut the private businesses back to supplemental civerages only, okay? Yes CEO salaries and yes this and that, but no pol in their right mind is gonna vote for that...unless they plan on immediately emigrating to Mars, which likely wouldn’t even be far enough.
3. MFA is a TYPE of universal coverage, and not the only one. No, European countries don’t have it. Neither does England.
4. The point is universal, affordable coverage, not that you get your way, so stop shouting, and stop fudging the numbers.
5. While you’re at it, stop pretending that everybody gets everything and nobody pays nothing. Oh, and stop ignoring the fact that half our costs come straight out of our lousy diet, health, and exercise, as well as our propensity for screaming until we get the latest pill or surgery or treatment and live forever.
The Upshot does a great job, and has taught me a lot. They”d teach you too, if you’d shaddap and read first.
3
Who cares? Destroy it completely and let the pieces fall where they may. It's an evil to charge for healthcare when it should be free and paid for by taxes.
3
Our health care system is a profiteering juggernaut enriching those who prop it up politically—but an expensive morass and horrible lottery for the rest. We bankrupt people in a manner unknown elsewhere simply because they get sick.
As appalling, we have broad swaths of people with no dental care—and no teeth: we are so inured to this barbarity that some think it is fodder for jokes. (We also have children without vision care—is that funny, too?)
ACA brought incremental improvements. But these were paid for by those whose premiums shot up, because God forbid insurance company profits might be hurt: ACA was renamed "Obamacare" and attacked by Republicans for ridiculously partisan reasons, even though it is essentially a corporatist plan and could have been called Romneycare.
The point is that we have had no genuine systemic changes of the kind needed to bring us into the civilized world—and we are inured to the savage inequalities & obscene profiteering built into our present system.
But come to Japan, where I live half the year, & observe a system of national health coverage for all, where no one is humiliated, care is excellent, dental & vision are of course also covered, costs are controlled, full-pay is like our co-pay, & kinks in the system are worked out. It will open your eyes to why we need radical changes in our system in a way that ACA pathetically did not achieve.
If that means grand-scale displacement, so be it, because our Dickensian practices simply must go.
10
these so called private insurance companies have been getting away with murder, literally, for way too long.. they need to be shut down, and the workers can take over the call centers so we don't get reyansh in india.. bring the call center jobs back to America
3
I'm not losing any sleep over this issue. We can deal with it after we set up our colony on Mars.
1
This is what we are paying for.
In the last 5 years:
Humana shares up 273%
Cigna up 166%
United Health up 247%
Anthem up 302%
S&P500 up 51%
25
At the heart of our fear of "socialized medicine" is a fear of TAXES! Just mentioning the word induces mass hysteria and destroys the best intentions of well meaning politicians. Would Medicare for all raise taxes by $10.5K annually? (because that's what we pay per capita for health care). And get this--even if taxes went up by that amount, you'd still come out ahead because that money would be deductible, thus saving roughly $3-5K in taxes not paid.
In the most socialistic models of health care...England pays $4300 annually, Canada $4800, and Australia $4500. So we have some tough decisions to make; do we want to insure 85% of our population and pay over $10K per capita or should we go off the deep end and opt for 100% coverage at half the cost? It's a tough call.
Perhaps the underlying flaw in our health system is our inability to do basic arithmetic. Or our love of medical bankruptcy. And then, of course--liberty.
7
Why not replace the present opaque and inefficient for-profit system into a well-regulated public utility? Replace it with something like the system currently in place in Switzerland and elsewhere? Present insurers and providers could become part of the regulated system and/or offer benefits above and beyond those legislatively mandated for all.
See:
https://scholarship.law.duke.edu/cgi/viewcontent.cgi?referer=https%3A%2F%2Fwww.google.com%2F&httpsredir=1&article=3309&context=lcp
4
I had a friend who had Medicare and a Part B plan. He got cancer and was bankrupt in a month.
3
Medicare for all is a slogan used to convey the idea that anyone who wishes to participate in the Medicare system, whether employed or not, retired or not, 65 or not, or whether coverage is available through an employer or not. There's simply no reason to believe that the private insurers currently participating in the Medicare program -- and the Medicaid program -- would suddenly be forced to disappear. Most candidates aren't talking about overhauling Medicare or Medicaid. They're talking about extending coverage in Medicare, to all. So, there'd be a role for private insurers in this system, which would expand correspondingly as participation in Medicare expands. In addition, there'd be a role for private insurers in the "wrap around" market. Again, just as some Medicare beneficiaries currently buy private insurance to cover what's not covered by Medicare, that market would expand, correspondingly, too. Moreover, even if the same proportion of those newly eligible Medicare enrollees were to choose traditional fee for service Medicare, the claims processors who process claims for United, Humana, Cigna, etc. would be needed by CMS to process claims for Medicare. The sky would not, in fact, fall, as the insurance industry claims. As for the stock market risk, it's no different than owning oil industry stock when it's displaced by green energy competitors. It's a risk. One that shouldn't drive whether people have access to health coverage and, hence, health care.
4
It seems to be “alarmist” to put forward that “ taxes will have to go up”, without also clearly accounting for what “private insurance” currently costs. My employer’s self funded family plan health insurance costs $27,000 a year- I am responsible for 20% or $426 a month plus deductibles and co-pays. The portion my employer covers IS hidden wages OR taxes already.
Due to a health scare in my early 30s my career options always revolves around being able to be insured- as my husbands work never included health insurance.
In Norway and Sweden where I have many relatives, their health care for some very serious complex issues has been top notch. Entrepreneurship in Scandinavia is quite high- and they can embark on creating new companies without worrying about “going without” health insurance.
They think our health insurance system, and the possibility of going bankrupt due to health care costs is barbaric and cruel.
9
Why would allowing people beginning at age 50 to buy into Medicare[ that is paying a premium for coverage] cause all the horrible things the authors suggest.
People if they wanted could still retain their private coverage.
3
SINGLE PAYER Medicare For All would mean GOOD RIDDANCE to our corrupt private health insurance system and all who profit from it! It can't happen soon enough for me.
7
This is a great platform to push if Democrats want to loose a general election.
@Matt Not a correct statement. Over 50% of America is in favor
Funny thing, for the twenty years my mom was on Medicare, she also had to buy supplemental to cover about 20% Medicare doesn't cover. The headline is false and misleading and makes me wonder why I subscribe.
5
What an utter nonsense. Germany pretty much has 'Medicare for all' and still about 10% of the population are insured on the private market. Public and private insurance can coexist.
10
Medicare for all and abolish private health insurance? Great! When do we start?
4
I love it! The article announces the possibility of Medicare for all, bringing America into the 21st century (the 20th century, actually,) and the subtitle asks what will this do to the stock market. This says it all!
11
The health insurance workers can find jobs with the government managing the costs of health care for Americans.
The CEOs can go back under the rocks they crawled out from.
8
I am all for "Medicare for all" as long as I can be promised that me and my family will receive EXACTLY the same care as my senator and his family.
4
You don’t get it now so why hinge your approval on getting the same coverage as Congress?
Will Medicare for All also cover illegal aliens, and all the people who enter the country once the Democrats open the borders? (Of course, none of those people actually ever paid into the program, the way Americans who worked here did, and the way seniors did all their lives.) How much will it cost to cover all those new arrivals? If we add that cost to the trillions the Democrats want to spend on reparations to African Americans, wouldn't that be kind of a large sum? Where will all this money come from?
2
As a Medicare providing physician for 35 years, and a Medicare patient for the last five, it is very difficult for me to understand all the negative reaction to this proposal.
Perhaps it would help to think of "Medicare for All" in a general sense, while acknowledging that there are lots of details to work out.
The details do not mean it can't be done and, besides, the goal of universal coverage is still desirable, unless you are convinced healthcare is a privilege, not a right, in a prosperous, otherwise civilized society.
Everything can be worked out over time...gradual phasing in, transitioning to public>private insurance, uncoupling the employer linkage, organizing the finances, assessing need for taxes to replace premiums no longer being paid, etc.
It may take 5 or 10 years to get it right, or more, but single payer and universal coverage are still achievable endpoints, if we can just listen to the signal, not the noise.
"Devil in the Details" does not have to mean "Dealbreakers in the Details."
As far as rationing is concerned, what's wrong with replacing our current economic profiling with evidence-based distribution of limited resources?
8
Oh NO! Turn off the gushing valve of taxpayer dollars that is flooding into private, non-working, insurance companies. Whatever will we do????
5
Why does everyone talk about Medicare as if it's 100% government-run and provided? In Medicare, you have a choice to either go with Original Medicare or join a Medicare HMO or PPO which are provided by and through private insurance companies. Medicare for All will allow insurance companies to participate and consumers will have a choice of government-run or privately-run insurance.
8
@Meggee wrong. MFA is not Medicare as you know it.
https://www.healthcare-now.org/legislation/hr1384/
I am confused why anyone is in such a hurry to change the system so drastically. Lower the age for Medicare to 50 or 55 and see what happens for a few years. If the sky does not fall down and things seem to improve, it will be easier to expand it further.
If we think about various forms of medical charity, expanding coverage will even help those under 55 (or 50), because there will likely be about the same total $ in charity available divided among far fewer people in need. There is some chance this could mean almost no one is left out, or that there is an age cutoff where that happens that could be determined with modest amount of data and some straightforward math.
3
I got to questions.
1. Is this necessarily true? Medicare does not eliminate insurance so why must Medicare for all eliminates insurance (not that I am either for or against this at this time)? I understand universal coverage in England is single payer by the government but not so in Germany.
2. In terms of cost I don't understand why a government run (assuming it is single payer) program will necessarily cost more. Yes they have bureaucracy but so do the privately own insurance companies. And they don't have to make a profit.
1
@Notmypesident
The UK is not universal/single payer. It, like most of Europe and the entire rest of the world, apart from Taiwan and Canada, is a buffet of private/public, with rationing. Just as is the U.S.
Medicare For All makes a nice campaign slogan, directed at shallow thinking, or non-thinking, voters. How we get there is not their problem. Nor is it the problem of the slogan bellowing politicians. The best quote I ever heard about Bernie Sanders is "All hat and no cattle."
However, if a public option, essentially Medicare, were offered to all under the Affordable Care Act, an orderly transition could occur. After all, our true goal should be that all residents have quality, affordable healthcare. How we get there is a separate, and unfortunately, a somewhat complex issue. The Bernie Sanders types understand that the typical voter has no time for complexity. This, by the way, may be the undoing of Elizabeth Warren, who seems to love dealing in the complex.
There is a role for private insurance within existing Medicare. If private insurers could compete with a public option under the Affordable Care Act, so much the better. This would also preserve employment based insurance, which most people find acceptable.
2
The Medicare system we have now is supplemented by private insurance. And private insurance in countries like Canada still exists as a supplement. So I don't understand this.
3
Medicare today requires Supplemental (private) insurance. Why would that NOT be the case if it were extended to all? Private insurers would still get a piece of the pie, albeit smaller.
5
There is very little attention paid here to the enormous cost to small businesses who try to insure their staff. Reducing this burden would be hugely beneficial to small firms who make up 60% of the hiring and much of the innovation.
3
Obviously, extending access to health care through a government program must be phased in. Perhaps people who lack access to employer or union sponsored health insurance could be allowed to choose either to buy on the exchanges or to enroll in Medicare. Medicare would have to increase payment to medical service providers to mirror what was available under private policies on the Obamacare exchanges. And private insurers could be more substantially regulated--any attorney who practices in the health insurance area representing claimants could prescribe a laundry list of the most common insurance company offenses that regulation could get rid of. For starters.
1
At this point, I'm not going to read all these proposals, but really?
Everyone I know on Medicare has at least one private insurance policy in addition to Medicare.
Why would insurance companies stop selling Medicare supplemental insurance?
1
How to pay for all of this?
One of the largest expenses that companies have is their share of medical coverage for employees, typically paying 70 to 80 percent of the premiums. Those same companies recently got a tax break from 35% to 22%. I believe that business could ultimately live with restoring the 35% rate, provided that the government take over their burden of medical coverage for employees.
3
Is there any reason, other than a political one, why addressing the urgent need for affordable group health insurance for those who are without it can’t be done right away? By the time a sweeping change is made - and if it’s made, considering the “socialist” label - how many people will have gone bankrupt?
4
That's okay. We've suffered under the hands of the private insurance companies for a long time. They've had their day. Now it is our turn.
24
A tale of 2 insurances:
1. I, a divorced mother insured with an ACA silver plan, go to the ER for cellulitis. So far, my hospital bill is approaching $1400.
2. My son, covered under his father's NY State employee Empire Plan, goes to the ER for kidney stones. His expense: a copay of $70 which we paid before he left the hospital.
I don't object to people having good insurance, but as a taxpayer, why can't I have the same good coverage state or govt employees apparently have?"
17
@KS
Because the U.S. govt. chose to bloat up the national debt and double the population since 1965 with those who (a) don't pay taxes and never will (b) cost a fortune in government benefits and always will.
It's not necessarily so, as the song goes.
In this scenario, the state provides baseline medicine for all, however people will (probably) be limited to selection of who they see and the urgency, as well as private rooms etc.
Private medicine will supply the width and ease of access plus extras.
The UK has exactly that, the NHS (National Health system) is a universal free at the point of service to all, but the private medicine is a large "industry" living in parallel, note that most consultants are "shared".
Private medicine is accessed via insurance policies of various costs and benefits, costs are sensitive to age, medical history etc.
4
I don’t know how people live without access to medical care. The amount of time and energy Americans seem to spend on their medical needs seems incredibly wasteful and cruel.
Medical care can be insanely complex, using money as the determining factor in deciding how anyone’s medical needs should be met is ineffective and inefficient. Letting citizens go without medical care is one of the top indications that a country needs assistance, usually in the form of money.
A country’ greatness is determined by the quality of life each of their citizen’s experiences. If a citizen breaks a leg in a great country, they only have to decide if they need an ambulance or which hospital they want to go to. Medical care facilities should be allowed to focus on medicine, not weird country clubs entrance requirements.
10
Is the same argument we will have with a cure for cancer? " Oh , what about all the people who work in the cancer business, what about all the drug companies that will lose money because they can't treat cancer any longer?" People recover , companies adapt. Medicare for all , insuring that Health care is a right and part of the benefit of living in the US is the primary directive. At least the people who lose their jobs in the health care industry won't go bankrupt if they get sick. You ask anyone in the Healthcare industry who they would rather deal with , Medicare or Private insurance , 95 out of 100 will answer Medicare. I have seen 1st hand a client with private insurance be denied life saving services over and over again while a similar client with Medicare has no problems .
12
No! No! No! The term "Medicare for All" does NOT imply the elimination of private health insurance! If politicians want to eliminate private health insurance, fine, but DON'T call it "Medicare for All". Private health insurance is an ESSENTIAL component of current Medicare. Anyone ON Medicare knows this.
The other night, on Colbert's "Just One Question", AOC was asked "How would Medicare for All' even work?". She gave the correct answer. "Well, you know Medicare?... extend it to everybody."
I'm a Berner, but Bernie, Kamala, and others are muddying the waters by confusing "Medicare for All" with a "Single Payer System". Medicare is NOT currently a Single Payer System. If you extend current medicare to people of all ages, it is still NOT a Single Payer System because private insurance is an essential component. Most people on Medicare have either private supplemental plans or private medicare advantage plans. I'm quite happy with my United Healthcare AARP Medicare Supplemental Plan F. I wouldn't object to a "Single Payer Plan" but this is an entirely different animal. The problem is that most people not on Medicare know nothing about how it works. I didn't before I enrolled.
20
@ShenBowen and you don’t know how Medicare for All works either. It pays for medical, dental and vision with no deductibles or copays. The reason private insurance disappears is that there is nothing left to insure. Maybe cosmetic surgery? The thing that’s confusing people, including you, is that Medicare for All is NOT Medicare as it exists right now - it’s much, much better.
4
@Trader Dick: I disagree with you Trader Dick. People should not be twisting the meaning of words. Medicare for All is exactly what AOC says it is; we know what "Medicare" means and we know what "for All" means. Current "Medicare" is dependent on private insurance. I have no problem with a single payer system, but using the term "Medicare for All" to describe a single payer system is EXTREMELY misleading. Are you on Medicare? People on medicare know that it involves a public 'base' insurance and private 'supplemental' insurance. Most people DO have some form of supplemental insurance. So, if you want to describe some future medicare that's a Single Payer System, you really need to call it another name, like Medicare-extended, or Medicare-SPS, it's NOT the current medicare.
Why does it matter? It matters because the beauty and practicality of "Medicare for All" it that it doesn't require any change to Medicare administration, which currently works very very well. All you have to do is gradually lower the eligibility age until it is zero. This way, the system can be expanded year by year, so it doesn't suddenly collapse (as did the Obamacare websites). Everyone I know on Medicare loves it, and extending it to lower age groups should work very well. As I say, I would have no problem with a Single Payer System, but call it something else, because that's not what current Medicare is.
@Trader Dick
More free stuff, eh? You have absolutely no concept of that you speak Just like every other comment down to this point in the list.
Why? bc elastic pricing levels across various access to services, care & phama., etc. basically work to function as transfer taxes & wealth distribution schemes basically supporting the current system.
There simply are not enough peas in the pod.
Even medicare has draconian IIRMA Tables !!!
Advantage Plans have draconian deductibles and copays w/ an absolute prohibition on enrollments in supplemental.
Who pays those hi annual deductibles and how is it financed?
Take away private insurance, the money train drys up. If you're happy with your HMO you can keep it. But many providers do not participate, exposing patients to out-of-network highway robbery. Especially in hospital & specialty based svcs..
Then consider whether the supply-demand imbalance of unlimited "access to care" will crush the system?
Doctors, Hospitals, Technology, Pathology Labs all have costs to operate: salaries, rent, hardware ..... ad infinitum. Who pays?
Since free money's not there to finance infinite demand & single payer (for all) w/o eliminating private insurance, forcing everyone under a single socialist tent will never work. Just ask bankrupt ACA.
What a ridiculous statement: "No precedent in American History." Did they say that when cars replaced horses? Oh, those poor buggy whip manufacturers. What if the perfectly safe car is invented? 50,000 lives a year saved, but my goodness there goes the auto body industry. When change is due, change comes. Oh, yes; the poor investors. There's something deeply immoral about profiting off illness..and I'm sure the market will find other ways to make a buck.. And I'm also sure there will always be a place for private insurance, as there is now with the existing Medicare system. The concept that health care is a right should be as ingrained as the concept of a strong military protecting the citizenry..and the resources for adequate health care should maybe approach what's put into the military? Those who stand to lose an investment buck will always whine. But the time for a one-payer system is long overdue.
10
@Stu Reininger after all, if EVERYONE had healthcare from childhood, it would even make for a STRONGER military for the citizenry since the pool of eligible, healthy youth would be much bigger (compared to recent lamentations of a shrinking eligible recruit pool of qualified candidates)!
(just using one example of your statement)
3
Medicare for all as a safety net is one thing. The current Medicare is not sufficient and must be supplemented with one or more other plans to get good care and have it covered with minimal out of pocket expenses.
4
I have no sympathy at this point for private insurers ... none. Stocks will have to be sold off. many people will have to find new jobs. So tired of letting them run everything and continue to rip everyone off, sowing mass confusion. And it just gets worse & worse & more expensive every year. And deep down everyone, even the Republicans know it. The sooner this for profit system ends the better.
39
Are you serious?! No tears here...
Take those money-grubbing companies down! It’s their fault if the employees go down with them. Oh that’s right — the multi-million dollar bonuses at the top will insulate the executives. So sad...
11
This should never be an issue of profit over well being. Health care is an inherent human right and it is sadly lacking in the US. The economic and societal benefits of universal health care will far outweigh the economic consequences of doing away with private insurers.
8
My feeling is that like, Medicare, there will be supplemental plans to select that "fill in the holes" that Medicare doesn't cover or is skimping on.
6
The American people have been bamboozled for decades over health insurance vs "health care". The health care-industrial complex, outrageously corrupt wasteful military spending, the fossil fuel industry, are 3 prime examples of what not to do in a civilized society that claims to have the well-being of all citizens as the primary goal. This has been a crock for decades.
Will someone with ink and paper, honest media reach, please explain to the American people why the U.S. spends over $10,000 per person per year on health "care", and we are ranked #37 - with Cuba and Estonia - at $1000 per year (10% of U.S. cost). The 6 top ranked nations in quality health outcomes - healthy people - all spend less than 1/2 per person as the U.S. This would reduce our costs by $1.5Trillion, per year. Let's cut that in half and we save the equivalent of more than the entire military budget, every year.
A basic question: what is the purpose of our health care system? Is it profits and high salaries for a few people, shareholder returns? Or is it "great" health care for all Americans? Losing jobs has never been a problem for our capitalist system - coal miners have lost nearly 1 millions jobs over the years? Corporate America was giddy when people like "Chain Saw" Al Dunlop cut 100s of 1000s of jobs merely to increase profits. Job reductions is a red herring. This is purely about profits in a predatory capitalist society - it has little to do with health care. Truth, trust honesty.
10
@LoveCourageTruth "Profiteering is the true American Way." - DJT
Sunk Cost Fallacy
If we have national healthcare those people losing their jobs will be less of ancatstophic event! I’m tired of being a slave to my job just because I’m afraid of losing coverage.
5
How many election's will Bernie and now AOC cost us? American's want choices. You can't shut down the health care industry overnight! People will lose job's, the economy will get creamed, it is just a dumb idea whose time has certainly not come.....not when there are so many other good option's. Affordable quality Healthcare for all....yes indeed.....but how we get there needs a serious debate about our choices. The country will never buy Medicare for all at this time. The far left is as divisive and dangerous as the far right. Only 1 winner and no compromise. Faggedboudit! This is a good way to lose an election. Just think, 4 more years of 45!!!
2
...and this would be a 'bad thing'......why?
2
I hate to say it - but the pure ignorance and fear-mongering in this poorly researched piece and many of the mis-informed replies makes me want to pull out my hair and scream. Our current system is literally causing unnecessary and early deaths and financial ruin for millions. Full stop. NOTHING is worse and more important than that fact. Nothing.
As an avid and staunch supporter of a single payer/Medicare for All system for the past 30 years, I recommend all readers visit Physicians for National Healthcare and their FAQ page. The site is rich with information: https://pnhp.org/what-is-single-payer/
You might also download Senator Bernie Sanders Medicare for All proposal here: https://www.sanders.senate.gov/download/medicare-for-all-act-of-2017-executive-summary
Above all - to the writers of the NY Times and the readers - PLEASE, PLEASE, PLEASE educate yourselves before using this platform to post information. You do influence others - so please get this right. For you, it's just an article - but for most of us, it's a matter of life and death.
44
Capitalism is great for goods of choice, cars, televisions, pools, fancy vacations, steaks, and cookies for example. If the item is too expensive don't buy it.
Capitalism doesn't work well with items of necessity - when the item is necessary for survival, there is no choice for the consumer and the provider is free to artificially raise prices. This is why over 100 years ago items of necessity, such as water and electricity, were declared public utilities and heavily regulated by government. The same should be true for health care in a civilized country.
I don't understand those who defend the current system. Would you rather pay $10,000 a year in premiums and perpetually argue over what is covered, what is not, who is denied, who is not, haggling over every bill, etc. etc., or just pay $10,000 more (or probably even less) in federal taxes and have everyone be covered for everything? Are obscene profits for insurance companies and the mindless genuflecting to the almighty capitalism really a better path?
9
Why not adopt the German system: government care combined with private insurance? The best of both worlds. And not so disruptive as what's proposed now.
3
This would no doubt be a huge change and would have negative and positive effects economically. "Medicare for all" is a great sales tag. Should it get any head of steam, the insurance industry is sure to roll out the usual ads to make it look like a disaster. What is would do is exchange the profit making insurance system for the vast bureaucracy of the federal government. Not necessarily a great trade. What would probably be better would be for states to be empowered to let individuals buy into Medicaid or Medicare and to set the terms for such participation. This keep control at the local level.
Ultimately, if enacted, Medicare for all will make only a small difference in holding down health care costs, because the problem still is in the system of health care itself, not just in the insurance model of reimbursement. A more primary care focused, preventive model of care is needed to get America healthier, removing incentives for high priced specialists and pricy designer drugs, high tech surgeries that are no better than regular surgery.
Instead of health insurance profit draining our wallets, bureaucracy will choke the system in its own way. Some things will improve, some will get worse, and we'll all end up wondering, was it really worth it? Perhaps we need to go through this charade in order to learn the truth. It has been said of America that it needs to try every solution to a problem before it finds the right one. This may be another good example.
Interesting that subsidizing and propping up an industry that should have long ago followed the buggy whip industry into oblivion is the moral choice we take over copying proven health delivery systems from almost every other 'civilized' country in the world to ensure that NOBODY gets left behind. And by interesting I mean morally reprehensible.
4
“The private health insurance business employs at least a half a million people...”
That estimate seems very low. Will another reader with insight please comment?
Mao had some really great ideas about collectivizing farms and increasing the overall efficiency of China’s economy. Probably even better on paper than healthcare for all. Too bad it ended with tens of millions is deaths. We should be very afraid of people who want to destroy a life-sustaining industry and replace it with a great idea on paper.
2
@Eric Salathé
It's more than a great idea on paper, having been implemented in many countries around the world. Better yet, we can examine those existing systems and adopt those pieces that work well and improve those areas where there are shortcomings.
2
@Eric Salathé sorry but you lost me at Mao.
At the time of the "Great Leap Forward" (to which you refer), China was still, for all intents and purposes, Medieval and no where close to the level of civilization advancement of the US and most other western nations (and Japan). Not even close to Taiwan, across the strait.
@Eric Salathé - a "life sustaining" industry that profits by denying people healthcare?
I once had occasion to visit a sports medicine specialist in the UK as a private patient. He was top of his field and catered to at least one top London soccer team. He also saw national health service patients. I sat in his waiting room with the NHS patients and as far as I could tell got absolutely no advantage over them. That's how I see this situation - the US is the private patient paying more than everybody else for the same care.
1
Nonsense! Supplemental insurance will still exist, as it does here in Canada to cover procedures and services not covered buy Medicare and to cover vision care, dental care, and a percentage of copayments. Health insurance companies in Canada still make healthy profits and provide necessary services.
8
"But doing away with an entire industry would also be profoundly disruptive." Okay, that can't be denied. But you know what else is profoundly disruptive? Thousands upon thousands of Americans going bankrupt from out-of-control medicals bills. Seniors who can't afford their medicine. Millions uninsured. Greedy companies denying coverage so they can pay CEOs huge salaries and bonuses and appease their stockholders. So yes, abolishing private health insurance would cause some short-term pain. But we can't keep kicking this can down the road. Remember when Americans weren't afraid of a challenge?
9
It is ironic that Medicare for All would hurt someone like me,a senior already on Medicare, because of the substantial increase in taxes a program like this would require.
It is foolish to think this can be accomplished without major disruption to our society, a disruption that in the end may weaken the country more than the benefits this new healthcare system may provide. Think the DMV and how wonderful it is to spend time there. That’s a good example of what it looks like when the government, in this case the state government, has complete control over something.
3
so basically, you have your cabin in the woods and don't want any neighbors. would you give up your Medicare? I think not. obsma put max Baucus, darling of the insurance industry in charge of planning the aca. the 1st thing max did was abolish the public option. aca is a mess. Medicare for all either by lowering the age or by allowing people to buy into it.
Evolution, not revolution. Revolution causes devolution. What part of this is so hard to comprehend?
Medicare for All is a goal; an endpoint; an ideal. It is not policy.
Why do we have to keep bouncing from guardrail to guardrail? Hitting the guardrail too many times causes us to plunge into the abyss. Why is staying on the road so hard for the political class?
Stick with improving the start that the ACA gave us. Add a public option. Start enforcing monopoly regulations; limit vertical integration or at least the pricing monopoly that results. Attack drug pricing by allowing Medicare to negotiate prices, and by limiting the ability to profiteer - like we used to regulate utilities.
And, Democratic candidates, stop handing the GOP a stick to beat yourselves with.
5
• "Medicare for All Would Abolish Private Insurance"
Most Dem candidates are pushing for Medicare for All, but only Sanders is calling for abolishing private insurance as something we don't need (and he might be right).
• "Most other countries with single-payer systems allow a more expansive, competing role for private coverage."
Many other nations offer supplemental or additional insurance, but do they really offer straight out full service private option alternatives? I don't think so. That said, it may be true that having extra private insurance on top of that offered by the government is the best approach. France, often rated near the best, has this kind of system.
• "This idea — once at the edge of Democratic politics — has moved to the mainstream of the debate among the party’s numerous presidential contenders."
Dems have been pushing for socialized healthcare or insurance since FDR. Truman, Ted Kennedy, Bill Clinton, just to name a few. The author's memory is short.
• “We’re talking about changing flows of money on just a huge scale,” said Paul Starr, a sociology professor....“There’s no precedent in American history that compares to this,"
Um, I'm pretty sure the abolishment of slavery had a much larger impact.
Medicare for all means everyone is covered and coverage is more transparent. That's a moral right you can't get with a profit incentive insurance. Disruptive? Yes. But since when do we only do the right thing if it's easy?
10
@Tim L. -- I disagree that Democrats have been pushing for socialized healthcare or insurance since FDR. Remember, it was the Democrats who gave us ACA, leaving the insurance companies in the driver's seat.
1
@Don Juan
Maybe you should look more closely at history. I agree it's gotten more attention lately, but it's always been there. We got ACA because it's all Obama dared to do in a government owned by the healthcare industry which gave 225 million dollars to candidates just in 2018 alone (an off year election!). Obama ran on the public option, then falsely denied doing so. (politifact). The reason we don't have Medicare for All has less to do with the facts and more to do with our campaign finance system.
@Don Juan
Can't get comment to post... maybe links? See if this works.
Google "Universal health care was almost part of the original Social Security Act of 1935"
"Roosevelt planned for federally sponsored health insurance to be part of Social Security. It was thrown out in order to hurry the bill through Congress."
Google "69 years ago, a president pitches his idea for national health care"
"Back in 1945 — a mere seven months into a presidency he inherited from Franklin D. Roosevelt — Truman proposed a “universal” national health insurance program"
Google "Kennedy's Lasting Devotion To Health Care For All"
"In the early 1970s,.... Kennedy was pushing for a fully government-run plan, while Nixon wanted to require employers to provide private coverage."
1
Medicare for all would not abolish private insurance. Like most on Medicare who can afford it, I have a policy that provides supplemental coverage for areas that Medicare does not cover all the costs.
Yes, the role will be contracted. But they deserve it. An open market system won't work, and many people resent an insurance mandate. Maybe they should have rejected so many claims, not overpaid their top executives so much, or charged such sky high premiums.
The entire idea of private enterprise reaping big profits from the sick is distasteful and repugnant.
Maybe, instead of sudden "Medicare for all" we could start by lowering the Medicare age from 65 to 55, and every few years, lower it more. This would get the people at ages most in need of better health care coverage into the system and not burst the system at its seams at the outset.
And please, set American prescription drug prices at parity with what the same drug companies are willing to charge in other first world countries. The idea of American sick people funding the R&D for the entire rest of the world (their story of why they need to charge so much) says that we in the USA are the economic doormats for the entire world.
8
Medicare for all will be a disaster. First, proponents need to stop promoting this as “Free”. There’s no such thing as Free Healthcare. Everything costs money. And part of the purpose of patients having co-pays and for paying for part of their insurance coverage is so that they actually have “skin in the game”, because providing healthcare, as mentioned, is not free. Governmental management of ANYTHING is not known for its cost savings or lack of bureaucracy; it is well known for bloated overpaying for everything and incredible inefficiency. Additionally, one must note the most important point: our Congressional “leaders” who are promoting these changes, will not be thrown into the trenches with the rest of us dealing with this government run mess of our healthcare coverage; no, they will retain their separate coverage. If it’s not good for them, why should it be for the rest of us?
1
I know people who are old enough to retire but can't because they are working until they can receive medicare. The costs of health insurance are just too high for them to make that life-changing decision. For better, or worse, more people might retire if there were a medicare-for-all system. This could open up new positions and save companies money when they hire newer employees at a new employee salary.
3
There is a huge difference between imagining a drastic revision of one-fifth of the worlds largest or second-largest economy in your head and actually doing it in the real world, so the thing I'd most like to see from advocates of these plans is a huge increase in humility. It may be a good idea, but you'd better believe that implementing it is going to be orders of magnitude more difficult than the massively-optimistic descriptions that we're getting from almost all of it's proponents right now.
1
I'm still waiting for for-profit private insurance companies to justify their existence. As far as I'm concerned, they're just middle-men who add no value for consumers and serve only to extract profits (via higher costs for users) for their shareholders.
If you believe that health care is a human right, then actually providing quality health care needs to take priority over profits. One model would be for health-care companies to be regulated like utilities, with government regulators determining what they can charge.
5
Many health insurance workers will still be employed, since CMS contracts with health insurers to pay claims under Medicare and Medicaid right now. The marketing, sales, provider contracting, underwriting staff and executives will be looking for new work, but a lot of those skills are highly portable.
As to the impact on shareholders, I would suggest selling your positions and investing elsewhere. If you choose not to, that’s your problem, not ours.
4
If we dare to get rid of an industry just because it is unnecessary, we throw its workers out of jobs and its investors suffer large losses. Therefore it is a waste of time to ask whether an industry is necessary or not. If it is a large part of the economy, we have to keep it going. The Soviet Union faced the same problems, and China now has them. The military-industrial complex is our other example of an industry large parts of which may be unnecessary.
Capitalism is supposed to avoid this problem, but it doesnt because large industries have the resources and political clout to defend and protect their existence. Health insurance the way we do it makes doctors into bureaucratic paper pushers and imposes uncertainty, anxiety, and paperwork on patients. Managers and investors benefit.
We abandoned the Rust Belt and left people there to their own devices, while investors made more money elsewhere, but we cannot similarly abandon the people and above all the investors of the health insurance industry.
We are trapped in our own absurdity.
2
I thought we had Medicare for all over age 65 now. I am 78 and have Medicare Part A, which I paid for through salary deduction throughout my working life. I also have Medicare Part B, an option which costs roughly between $200 and $500 each month, depending on current AGI. I also have an optional supplemental policy from a private carrier. I rarely pay anything else for medical care except for very minor amounts for prescriptions, eg $10 for a drug that would otherwise cost several thousand dollars.
Why couldn’t Medicare for all work this way for everyone, no matter what age? If private insurance carriers had limitations on denying coverage of prior conditions and other unreasonable restrictions and did not adjust, they would gradually fail. Medicare then could expand as needed, giving the economy time to adjust more smoothly to change.
Of couse the monthly cost of Medicare would increase for wage earners, but that cost could be offset by a decrease in the cost of supplemental private insurance.
Oh, and what about expanding the categories of income subject to Medicare withholding?
2
It could, exceot it is extremely hard to get there from here, and too many lefties have kidded themselves into believing that your costs are extravagant and would totally disappear if they get ther way.
@ANNE IN MAINE -- Exactly, why not lift the limit on income pertaining to Medicare? It would solve a lot of problems.
1
My wife's place of employment provides great healthcare and I can say with certainty, that no I don't want Medicare until I am qualified for it at 65. Since both the Democrats and Republicans propose plans with no probable way of paying for them, makes this as unappealing as the scam tax cut. In a phrase - No Thanks!
2
@Christopher. You need to educate yourself. Your wife’s employer can cancel their plan or her employment at any time and the new Medicare plan would pay for all necessary medical, dental and vision care with no deductibles or copayment. Is your wife’s plan better than that? No, it isn’t. I spent my career consulting on employee benefits, so I know better.
And Chris, nobody cares if you’re happy with what you have, because it’s not about you, pal, it’s about the whole country.
Medicare for all is not Medicare, it’s closer to an extremely generous Medicare Advantage plan for all, but with an almost unlimited network. Before it’s tried “for all” it should first be tried for a few as a special Medicare Advantage plan, with a broad network. Small experiments should should be run to judge the effect on costs, utilization, and competitive advantage/disadvantage with plain Medicare.
A wholesale change to an untested system would be reckless.
2
@Tim you seem to be one of the few who understand that Medicare for All is a huge upgrade to traditional Medicare. I’m appalled at how Fe people seem to understand this. But your idea of a demonstration project doesn’t work. The cost efficiencies come in with the whole population being covered under a government-finances plan. That’s what enables changes in provider reimbursement mechanisms and drug pricing - some little private Medicare Advantage plan can’t bring those efficiencies to the table.
1
@Trader Dick
Thanks. I think an experimental Medicare Advantage plan would show that utilization would be dramatically higher, which would raise costs, other things equal. Cost efficiencies from economies of scale would only partially offset the effect of increased utilization, in my opinion.
Wonder why we pay more (17% of our GNP) for health care than other developed countries, yet the US has the worst rated health care system. The top two lobbying industries are 1) Drug Companies and 2)Insurance Companies. Still it would be sad to put these poor insurance company CEO's out of work. The average annual income for the Cigna, Aetna, Humana, and Welpoint CEO's is $10.9 million.
9
When did Americans delegate the power of making critical medical decisions to insurance company bureaucrats?
As I recall in the 1970s, HMOs were supposed to reduce the costs of healthcare for citizens.
That didn't work. Healthcare costs are outrgeous now, moreso than ever before.
If covering all Americans healtcare means disassembling private insurance companies, where do I sign up?
10
People can have Medicare and a supplementary policy to cover additional costs. Many people have that today.
5
@Allen. There would be no need for that, since gaps and cost sharing under Medicare would be replaced with 100% coverage.
No it would not. The insurance companies could still sell extra special insurance, you know like the kind congress voted for itself only. Everyone would be covered for the basics, but if some people wanted more coverage they could pay extra is the way I understand it.
It is the insurance and Big Pharma lobbyists who would suffer and Good Lord the most of the congress members who would no longer get big bribes to enable these industries to rob the rest of us blind. And we have so long been trained to live with this corruption at our expense. It is hard to imagine life with out the chains I know. Think of it. We the People actually get a break.
I know the Democrats, the corrupt ones do not care that Medicare for all polls at 70 percent. They will try to once again ignore what we want and only listen to the huge checks they get. We have to get the talking money out of politics and vote for the honest politicians who listen to the polls.
5
It would be Medicaid for all and private pay or employer based secondary
3
"Believers in markets argue that consumer choice and competition among private health plans improve the quality of care."
People can believe many things. What is the evidence for this statement? Compare the outcomes of any private health plans in the US with those in Canada and Europe.
The only improvement is in the bottom line.
"Others laud private industry’s relative nimbleness compared with Medicare, which can be bureaucratic and prone to political influence."
What exactly does this mean? Nimble in what regard? Avoiding paying for needed care? This isn't a slalom race.
I agree with a planned transition to single payer. Get on with it, and don't let it get derailed.
Sounds rather like juke and jive.
4
With employment at record highs, any plan that would replace employer based plans through private health insurers with some type of government run program, paid for by redistribution of income through higher taxes “on the wealthy,” would be doomed from the start and spell disaster for the Democrats. If I am employed today, I am likely to have decent health insurance through my employer. What is the incentive for me to give up what I have and support a program that will increase my taxes, and may be perceived to benefit those who are not working or not otherwise eligible for Medicaid? It’s interesting to see that many of the proponents of this pie in the sky revolution are public servants either on Medicare or on platinum level health plans (US Congress) that the rest of us could never have.
While the debate about Affordable Health Care Act will rage on, I supported the act(at the cost of higher personal taxes) because it addressed a large, but very specific problem(the uninsured) and attempted to forge an uneasy compromise between private insurers and the federal government. I did not believe that the structure of ACA subsidy program made any sense- no one should get such a large benefit for little or no personal payment. I hope the Dems come to their senses and get off the soapbox and begin to think seriously about specific solutions that have a chance at winning. Their sloganeering makes it very easy for the Trump machine to win a landslide victory.
2
Unfortunately industries get disrupted. But after decades of unwarranted growth and expense, I can’t imagine a better industry to be disrupted. Healthcare in America today is overpriced and prejudicial towards the wealthy who can afford it. As the article states, healthcare has become almost 20% of our economy. I pay over $3000 per month in premium alone for health insurance for my family. That’s 20% of my paycheck. Quite frankly the health industry has it coming. Opaque and ridiculously high hospital bills, skyrocketing drug prices, and very high insurance premiums are just a few of the problems. I sincerely hope and pray everyday that this country will wake up and create universal healthcare once and for all.
4
Thanks to Ronald Reagan “for profit” hospital and medical chains were able to get federal laws passed to gut federal regulations restricting the number of hospital beds per hospital district. Without strict bed limits, large for profit medical corporations were able to build massive hospitals with new beds that looked like high class hotels. These new hospitals could now “compete” with smaller community based nonprofit care that spanned the country.
“For profit” health care corporations carefully “cherry picked” the highest paying wealthier patients and privately insured — but quickly “referred” the uninsured to nonprofit hospitals. They performed a “wallet biopsy” at their ER, and made doubly sure to “dump” the uninsured and underinsured upon nonprofits and state teaching hospitals. Results: the elimination of most community based and nonprofit hospitals. And predictably the cost of private pay services SOARED. Big corporate interests will mightily resist ANY reduction of their “market share” and “big profits.” We sadly have reaped what Republicans and corporate America has sowed.
Other industries have had to adjust so let the insurance industry do the same. We have a very tight labor market so the salespeople at insurance companies can sell something else. The current system rewards insurance companies whenever they say no to a patient. We need change and Medicare for all would be a good start.
5
Sure sounds like a mess!
But, here's the deal. Our "for-profit" health care system is immoral. Why? First of all, because it profits off illness and injury of Americans.
Over my lifetime -- I'm 72 -- health care has gone from the country doctors and nurses who entered medicine to help their fellow men and women and children, to a bloated, profit-driven system that really has no interest in your health (because when you're healthy, they don't make money).
Champions of the "free market" claim you're better off if the health care industry is part of that market, but they ignore and try to hide this basic fact: health care does not belong in a free market because "sellers" (the health care industry) and "buyers" (the sick, injured, and elderly) do not have equal bargaining power!
When you become ill or are injured, you may not have the time or inclination to go "shop around" for the providers of your health care. No! When you walk into your doctor's office or into an emergency room you surrender yourself -- no bargaining possible or necessary; they take care of everything -- to a system in which they control the care and the prices your insurance company and you will pay.
That is NOT a free-market equation. That's a monopoly sanctioned by Congress, which lives off campaign contributions from the industry. And it's immoral. Period.
52
Just yesterday, I bought a fairly common antibiotic from Safeway pharmacy where I was charged $59 for copay. I thought it was too high and asked the pharmacist to check and I was told that the cash price of the medicine was $104 and $59 copay was a bargain. It was too late in the day to call my doctor and ask him to prescribe a lower cost antibiotic but what was infuriatingly mad was there was a webpage which had a Safeway coupon for the same medicine at $18 - except it stated that it could not be used to lower my copayment. What the heck does it mean? Does it mean that if I had no insurance and therefore no copay, I could get it with the coupon for $18? In any case, I am brought up to believe with that all coupons are scams of one kind or another.
Will I see any change to the way our country goes about providing healthcare? Probably not in my lietime.
8
@SV use the coupon or one of several discount 'cards' (e.g. GoodRX) INSTEAD of your insurance in the situation you describe, Simply inform the pharmacy that you do not want them to charge your insurance.
Medicare is not the solution for health care for the entire country. Medicare is an insurance program for the elderly and disabled that has been around for 54 years and is still poorly run. There is waste and fraud and one would require supplemental insurance if they have Traditional Medicare and wish to be fully covered. One must purchase drug care separately and there is not any dental coverage. Medicare also is notorious for not paying providers of care as well as private insurance companies. I think putting 500 million people out of work so that the government can run our health system is a loser of an idea. Also, to pay for this taxes will have to be raised significantly.
2
@NYChap
There are only 327.2 people living in the US. Where do you get 500 million people working in healthcare?
My parents together are paying 1/3 of what I pay for health insurance, and that includes supplemental, drug, etc, etc.
3
@NYChap
I’m going on Medicare next month. I can tell you right now it’s a lot cheaper and a lot better than what I’m stuck with now.
3
Medicare for all sounds great, so long as you don't have to pay the costs and expenses, and so long as you don't mind waiting to receive more than very basic care. That's why Canadians come to the United States for elective surgery. And that's why people in Europe get private insurance and see private doctors if they can afford to do so.
I just hope (ha ha) that proponents of Medicare for all will tell the truth about the costs and the waiting times for treatment. Unlike all the lies that were told about Obamacare (if you like your insurance, you can keep your insurance; if you like your doctor, you can keep your doctor).
I wonder if proponents of Medicare for all will also propose to adopt the tort system and damage award restrictions that exist in Canada and Europe.
4
@Tony My parents are very happy with Medicare; it's costing them very little, and NO, they are not waiting for care.
Me, paying three times as much for less coverage and waiting? Wish I could get on it.
3
@Tony I work as a manger for an elderly gentleman who is a millionaire several times over, and who is covered by Medicare because of his age. I have taken him to various doctors for appointments and have made various appointments for people to come see him at home - primary care, specialists, you name it - and never once been unimpressed by the quality of the care he receives. I have; however, been impressed by the fact that he doesn't have to pay for any of it! As a ripe young 33 year old, however, not only do I carry the joyous weight of student loans on my shoulders, but my silver level employee provided private insurance covers so much less than what he gets! I actually went to the ER on Thursday because I fainted twice in a row and hit my head (both times, go me!) on a tile floor and then proceeded to vomit everywhere, terrifying my boyfriend to no end, and I am now awaiting what my insurance will and won't cover and how much I'll get to be on the phone with someone begging and pleading about what I thought the point of insurance was...Whoosh! If only I could be a nonagenarian millionaire, then I'd just have Medicare and not have to worry about a thing!
2
This leaves many unanswered questions.
Why does it have to Medicare for all or bust? Why not Medicare for 50 that could remove tremendous pressure on the private employer based risk pools?
My employer puts in $2 for every $1 I contribute for a family plan, for a total of $18k. Would me and my fellow 150 million employer based insurance premium payers get that employer contribution back? If not, why not?
Besides greed and corruption, is there a legit reason we don’t negotiate drug prices?
Why doesn’t the general public understand that getting private insurer’s dirty hands out of the health care cookie jar is good for their quality of life?
5
When Trump was trying to sell us the GOP health care plan where we would have to pay 5percent more that shows you the GOP are for the wealthy . That amount more than half of the millions in America don't have to spend. Time for Government controlled health insurance. It is working for Europe and Canada. Plus they don't loose their bank accounts or homes when a major health problem occurs like in the USA. You end up broke.
4
Was this written by Republican apologists for our failed healthcare "system?" As the authors note, there are ample examples of other, far more successful systems of providing adequate healthcare for all.
What clearly does not work is a competition-based plan, largely because there is no competition. To be successful, competition requires informed consumers with adequate choices, two things we lack because the industry resists reform at every turn. Doctors do not publicize their success:failure ratios, hospitals do not publish their post-op infection rates, insurance companies do not offer meaningful alternatives to their competitors' plans, and the Republicans refuse to allow Medicare to negotiate lower drug prices.
Most of the Western world has better health care at lower costs. Study them, pick one you like, and go with it. But remember this: there is no perfect health care system. You can't satisfy everyone, so pick a plan that works best for the largest number of people. Just do it.
8
Nonsense. You do what other countries do and what we Medicare recipients do—we buy supplemental insurance from private companies to augment Medicare. Of course other countries also provide lower cost supplemental insurance than here in the US because it’s regulated—a word Republicans hate. It would be wonderful to have nation wide supplemental plans and drug plans instead of the 50 different plans offered in 50 different states! Streamlined, nation wide insurance plans offered without profit making insurance companies would be cheaper and more efficient. Physicians, hospitals and other medical facilities wouldn’t have to hire “insurance billing specialists” or outside billing companies to cope with a zillion different insurance plans. Why do physicians like Medicare and Medicaid? Because they know exactly how much they will be reimbursed, the length of time for reimbursement, and rarely have to appeal and resubmit claims. We need to take the profit motive out of health insurance or at the
very minimum, reduce and regulate profit.
4
Here's what advocates for universal health care have to do.
Stop calling it Medicare for all.
Choose a country where its health system has survived the test of time and is treasured by its population.
Then temporarily name the proposed system after that country.
Let's for argument's sake call it the Australian System.
Now you have a model that can be precisely evaluated because it has existed and evolved over 50 years and has always been supported by Rupert Murdoch so that's Fox News taken care of right there.
3
Sen. Sanders has been a self-described socialist, so his support of socialized medicine is unsurprising.
Any Democrat going along with it earnestly, though, is befuddling.
Enough of us remember the cold war and fear "death panels" (truth irrelevant) that this cause should be a political non-starter.
1
I wish that politicians would think before they propose draconian measures. There are other countries with successful public/private health insurance combinations.
Logistics aside, have the Democratic candidates espousing this approach (and who knows if it is the right fit for the US or not?) forgotten that they lost a presidential election to a buffoon whose mantra was "Jobs, jobs, jobs"?
Proposals that would apparently dismantle an entire industry (flawed as it is) and displace 500,000 plus workers are very, very poor optics in an election year - or in any year.
I hate to mention his name because he is basically an awful human being but Anthony Weiner was most eloquent when the Affordable Care Act was being debated in 2009. He was a guest on many news programs and asked a simple question to viewers - what does your health insurance actually do for you other than pay part of your bills and do you really care if a single payer system did the same?
The biggest problems I see with MFA is:
1 - ultimately medical care is rationed. Under a government single payer system the political interference in medical decisions potentially will be immense.
2 - similarly political pressure will be extreme in determining how much to pay doctors and hospitals.
1
The most obvious issue in this article is that Medicare lacks price controls and the government is unable to successfully monitor the system. A single payer model does not necessarily mean that insureance companies will not continue to be a function within the system. Medicare for All can mean that all are insured and that policy and cost controls are in place and that both the government (entitlement programs) and private/employer based insurance adhere to the same cost directives. This is how Medicare Advantage operates; Medicare pays the bill on Medicre regulated fees and the Advantage Plan oversees the providers and discretionary access which in turn controls costs.
Unfortunately insurance in the US is for profit model and that would need to change to a service based model where the insurance companies are rewarded for quality and paid based on performance and services they provide in terms of handling the volume of claims. This is how the current FI system works under CMS contracts.
Now 5 years into ACA the insurance lobby is still trying to undue the provisions that made the legislation work such as removing pre-existing conditions and extending coverage to young adults still at home. If the mandate had been left in place and more states had allowed for Medicaid expansion, we may have had the basic beginnings of a much better system but healthcare has become a consumer product and providers, physicians and insurance are all in it for profit.
1
Aww, my heart bleeds. I come from three generations of doctors and the idea of for-profit medical empires is an abomination that diverts money from treatment and builds empires that focus not on care and healing but medicine as a crank-turning commodity at best, the sort of evil drug-peddling of Purdue at worst with the profiteering of a basic inexpensively produced and life-essential drug like insulin somewhere in the middle. A plague on all of them, the sooner gone the better
4
on the one hand you print articles about the high cost of health care in america. on the other hand you print this article which states the us health insurance industry generates 1 trillion dollars of revenue annually. and there is the cost for every provider to deal with insurance billing. connect the dots, please.
3
More unemployment. Higher taxes taking free capital away from investment, education, and home building. VA type health care with long lines and rationing. Less personal responsibility to care of one's self by exercise, diet, smoking and drinking cessation. More hatred toward the federal government. Another scheme by virtue signalers to create wealth and income by legislation. Why not print money and give it to people.?
1
It wouldn't be so disruptive. Europe has both public and private. Everyone is covered. If you want a little extra, pay for it.
3
You know who else would suffer if the US adopted a single payer model? Health insurance executives. In 2017, the CEOs of the largest health insurance providers in the US "earned" a whopping $342.6 million. (The highest exec salary in that pool was $83 million.)
Personally, I find it disgusting--bordering on the amoral--that the authors would lament the "huge hit" to the stock prices of private insurance companies. You are talking about the health of your fellow citizens, not a hedge fund.
8
@Norman I would replace amoral with immoral---The equation seems to be x number of people must suffer and/or die so that the industry prospers. If that is not immoral I don't know what is.
1
Duh! That's the entire point, isn't it? Finally to make medicine focus on care rather than profit? I know capitalists will pronounce the idea on par with Armageddon, but hey - haven't they bled us long enough?
3
Medicare for all would not sweep away all private plans ...The elite would have their own health care system... And the taxpayer would still finance it.....The tax system is rigged in favour of the wealthy... so to would the dual health care system.
1
I'm a 68-years-young disabled Vietnam veteran who was in the military for 11 years...thus I have free healthcare for life...free glasses for life...free hearing aids for life...dental care based on one's % of disability...free behavioral and mental healthcare for life...free pain psychologists...At my hospital, we also have programs like MOVE for people wanting to lose weight, Tai Chi, chiropractors, acupuncture and so much more...And if there's a specialty my hospital doesn't have and the closest VA hospital is >40 miles away, I get to see a civilian doctor...Okay...There are over 9 million veterans enlisted in the VA Healthcare System...Oh, and by the way, we follow Medicare guidelines or policies...We are the Medicare-for-All for a select part of the population...Yes, there are problems, but they will be worked out...Just don't privatize the VA...please...I love my healthcare...and we're a family...
3
@LindaBrittain Agree - don’t privatize it or our veterans will be be paying the same ridiculously high healthcare costs like most of us. And for those who think Medicare is ‘socialized medicine’ you’re wrong. That’s the VA.
People have compared writing legislation to making sausages. Once our elected Sausage factory gets its hands on this one, there will be pleanty of loopholes, giveaways and clawbacks. The powerful will be fully protected and like Obamacare we will pay for the privilege. Actually getting care when you need it will be another matter.
In the last 5 years the top health insurers have seen their stock values SOAR above the S&P500. That is what our high health insurance premiums are paying for.
S&P500 up 51%
United Health up 202%
Humana up 141%
Cigna up 109%
Anthem up 203%
There's a tremendous amount of money to be made selling health insurance to Americans.
3
So you start with a lie.
There is no "abolish private health insurance" idea. The thing that is most clear about the Single Insurer idea known as Medicare For All is that no one has yet worked out how exactly it would be set up. None of the other nations who have single insurer health care for all have banned or ended private Health Insurance, why would we?
Shrinking it so that it can be drownt in a bathtub, that is nothing but good as far as I am concerned. All corporations should be kept that small.
The money private insurance "generates" is the problem.
Let me repeat that.
The money private insurance "generates" is the problem.
Had they not let greed lead them we would not be having this conversation. Where is the shame in making so much money off of human misery!? For causing deaths!? For any of this mess!?
Pricing is divorced from actual costs and that practice of charging exorbitant fees has permeated the entire medical field. This has been going on since the Nixon admin at least.
Fact is we are living in the results of a disaster today as far as medical care for the people. So like in all disasters you start to clean up and go on one step at at a time not knowing exactly how you will recover but knowing that you will. You put one foot in front of another and solve the problems as they come up.
The system needs to be shaken up and more than a few of those doctors need to be struck off and made into ditch diggers.
3
Private insurance and universal healthcare are not mutually exclusive. They can be extremely beneficial to each other and to coexist private insurance needs to provide choice and value for money.
Australia has had a 2-tier system with public and private healthcare since 1984. All citizens receive high quality “no frills” free public inpatient and outpatient hospital care, including free emergency department visits. General Practitioner visits and pharmaceuticals are also covered with some out of pocket expenses.
Approx 57% of Australians also choose to have private cover, which can supplement allied health services, optometry and dental and enable access to private hospitals with your choice of health care provider and reduced waiting times for elective procedures. If you want the “frills” - private room, choice of specialist, choice of timing you pay for it.
The government also provides a subsidy for private insurance costs to families using a sliding scale based on income to encourage uptake of private insurance which is beneficial to the public system.
So how does Australia manage to provide basic public services for all Australians? As well as being funded through general taxation, all Australians pay a 1.5% Medicare income tax levy. An additional levy of 1% is applied to high-income earners who choose not to take out private cover.
It is not perfect, but our system is a crucial element that holds together our social fabric and makes our society fair and just.
1
Too bad Republicans demonized Obamacare---they are now faced with even more extreme measures (for the US, not for the rest of the "first" world).
Is the insurance industry now going to be considered a welfare entity? Given the lack of empathy Republicans have shown for other welfare recipients, they may be in trouble.
1
Medicare now farms out their claims processing to private companies and I don't see why some of the people who now work in insurance wouldn't be able to work if Medicare for All was enacted. As it stands now some sources claim that 643,000 Americans go bankrupt every year because of medical costs. https://www.thebalance.com/medical-bankruptcy-statistics-4154729
1
There is an alternative– use the Australian model. Public health care (Medicare for all), paid with taxes, and sitting on top of that private health insurance for those who feel so inclined to pay more money for ‘better’ service such as 5-star style hospital rooms. Problem solved.
4
"But overall support diminishes by a third or more when people are told that the plan would involve eliminating private insurance, raising taxes, or requiring waits to obtain medical care, according to surveys from the Kaiser Family Foundation."
I wonder what would happen to support if people were told that the amount that companies paid for their health insurance would instead go directly to the employees in wages and salaries. That would be an enormous raise for most people. One person, Rob, who posted here said his company pays $20,000 for his health insurance. They would pay some of that back in taxes, but much less than the raise they received, because of the greater efficiency of the Medicare system.
2
In almost all countries with national healthcare, the wealthy can still buy additional insurance which pays for doctors not on the national register or cosmetic/elective medical procedures. We do the same here--we on Medicare can opt for medi-gap insurance. This article is unnecessarily alarmist.
4
Don't worry. The executives would get huge buyouts, and who cares about the peons anyway? When prohibition came, what happened to the workers? It can be done. Coal companies, steel companies, car companies, textile companies have all cut staff. It can be done. The only concern is profit.
1
Private health insurance companies do not provide health care. Their goal is to deny as many claims as possible, while encouraging providers to charge more so that they get a slice of an even bigger pie every year, all in the name of profits. It's a perverse system that runs counter to the inherent goals of health care. The half-million Aetna and Blue Cross workers who lose their jobs could go back to school, because nurses or lab technicians and help provide care to the 30 million Americans who've been unable to afford it for so long.
8
These objections to single payer are just "nitpicking".
Yes, it would be entail big changes in the healthcare system. This is what's needed.
Some firms would lose a lot. If you own stock in them, sell it now.
3
You can bet that Trump will use Medicare for All and the Green New Deal to paint Democrats as radicals, no matter the truth of the matters. His will be a campaign based on scaring people rather than a vision for the future.
5
I'll bet that if the many employees and especially the executives at the insurance companies were forced to accept the same compensation as Medicare employee at comparable levels of responsibilities, they would be quitting in droves.
Where was it ever written that these private companies should make billions off the backs of Americans.
6
(1) All Americans receive a free voucher each year from Uncle Sam to purchase, in full, an identical basic insurance plan from the insurer of their choice. The insurer, in turn, gets payment from Feds.
(2) Having a single plan (not ACA "choices") turns the provision of basic health insurance into an intensely competitive market, like that for wheat.
(3) The vouchers are based on one's pre-existing conditions; those with higher expected health care costs receive larger vouchers. Since the poor are in worse health than the rich, this plan is progressive.
(4) Making the vouchers equal to each person's expected health care costs means insurers will be able to make as much money insuring the sick as the healthy. Consequently, insurers will have no incentive to turn anyone away or avoid areas with sicker than average inhabitants. Moreover, no insurer could legally deny coverage.
(5) A panel of doctors sets the annual coverages of the basic plan subject to a strict budget, namely that the total cost of the vouchers not exceed 7 percent of GDP. That's what's currently being spent on Medicare, Medicaid, Obamacare, and the tax break to employer-based plans.
(6) Insurance companies compete and can incentivize their participants to improve their health.
(7) Participants could purchase supplemental insurance coverage from their basic plan provider.
(8) Medicare, Medicaid, Obamacare and tax breaks to employer-based insurance are eliminated.
Economist Kotlikoff has it right.
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A first step would be to get rid of employer provided health care plans so that everyone buys their health care on the exchanges. This would eliminate the thousands of risk pools, one for each employer, with a much smaller number. That would greatly trim insurance company profits. A buy in for medicare would also be a good first step.
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The MFA act as currently written does not eliminate private insurance. It prohibits private insurers from duplicating coverage. "Nothing in this Act shall be
construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, including additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents." (section 107).
I would encourage people to read the text of the act.
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Oh. A noncompete clause. Good thinking, that’ll not work. And is probably un-Cinstitutional.
I like the German model, which offers national health insurance that is mostly administered by many, many private insurers offering competing and affordable coverage. Very successful, very attractive and efficient. I lived in Germany many years and can't say enough about accessibility and quality of the care I was able to receive. That we in the US allow so many vested interests to hold the nation's citizens hostage to maintain a system that is first and foremost structured to keep hospitals, insurance and pharmaceutical companies and doctors well off - patients seem an afterthought - is inexcusable.
This is not about creating "socialism", which seems to send shivers down the spines of so many, most of whom don't even understand what they fear. Rather, consider how much better off the economy would be if people did not have to fear obtaining adequate healthcare or losing their life's earnings to a costly, non-transparent and inefficient system. People would be far more mobile, confident, and productive, and employers would have fewer challenges filling jobs as a result. I submit you would also see a material decline in psychological stress and its negative consequences.
Stand up to the vested interests and get moving.
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If "Medicare for All" is done in the same way it works now for the 65 and older population it will have plenty of room for private insurers: Medicare Advantage Plans, sometimes called Part C of Medicare, Medicare Supplement plans, designed to fill the gaps that MediCare Part A & B leaves, and Prescription Drug Plans. I know, because I sell these plans all year long...
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@Manfred Luedge If the acts are passed there will be no need for additional coverage. It’s built in, with additional benefits as well. The reason to eliminate private insurance is to maximize benefits while reducing costs. People will have more choice (no networks) and better care. They will be free to move from job to job and never lose coverage.
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@John Krumm so far I have not seen any specific legislation, only the slogan "Medicare for All". I believe if we interpret that slogan to mean expanding the current model for 65 and older folks to every age group we're offering a compromise solution that actually stands a chance of finding broad public support and to become the law of the land. There's a time to dream and a time to be practical...
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The a major theme of this piece seems to be that we have a positive ethical duty to support insurance companies (jobs) and the stock market (insurer's stock's). Nonsense. Our duty is to support a basic human right: namely, affordable health care for all. And at this, the insurance and pharma industry have failed miseably.
Even more concerning, key arguments in this article are factually misleading and, occasionally, outright falsehoods. For example, the statement "A third of Americans enrolled in Medicare..., now get their benefits from a private insurer" presumably refers to Medicare Advantage Plans. If so, it fails to mention that Advantage Plans receive huge sums from Medicare, without which these plans could not exist.
Finally, many medicare-for-all proposals are so poorly defined at this point, that making categorical statements about them is an exercise in futility. It is worth noting, also, thatMedicare itself does NOT "abolish private insurance"--there is a thriving industry in Medicare supplemental plans.
In short, this column seems to be a highly politicized critique of medicare-for-all proposals, with the conscious aim of defeating medicare-for-all proposals rather than illuminating them That is a shame, because the public good is greatly harmed. One might ask also: Where is the rebuttal to this columm ?
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Canada used to have different plans for different provinces. Saskatchewan finally made theirs universal. The Doctors threatened to quit, but that did not happen. The other provinces soon joined and we ended up with a government run plan. Some doctors left the country but most came back as they realized they were spending more time dealing with assorted medical systems and paying big dollars for protection from being sued. They came back to doing the job they were trained to do. BC( the place we live) was paying a monthly stipend for services. Once paid a sum of 150 dollars, now dropped to 75 dollars and going to zero by next year. That amount was for a month. So the poorly paid folks will not be paying the same as the rich guy as it"s scheduled from their tax statements. The provinces still allow a Doctor to opt out of the system so a flush with cash patient, or one in a big hurry. can leave. But they can't do both. Some outside the normal system occur but the province runs and pays for that. It really doesn't happen that much Can you imagine a guy getting two new hips and the bill is just for the cab fare home. No cost for the operations or supplies or the bed etc. Can't be done says the naysayers but I could show you the two new hips if you dropped over to our place .
Join the real world USA. Buy a few less aircraft carriers or other military hardware. President Eisenhower said" Don't let the military complex establishment run you .
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@DenisLove
How long did you wait for your hip surgery ?
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@Nancy
Hi Nancy, I got my first one three months after my first meeting, and second about five months after the first Giving time for rehab. Same surgeon, two different hospitals here in town. If the pain had been really unmanageable it would be a few days after my first visit.The waiting list will vary as worse cases get done first. Nobody goes broke with the Canadian system.
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Fascinating how the same conservatives who don't care about the hundreds of thousands of jobs lost by government workers due to shrinking government payrolls are so worried about insurance company employees losing jobs. As the article explains, our current health care system is inefficient and inconsistent. If every doctor's office and hospital didn't need a full fleet of staff just to process insurance claims and negotiate with the for-profit insurance companies, maybe health care costs would be a lot lower.
I feel bad about people losing their jobs, but I don't think their jobs are worth other people losing their lives - or their life savings - to maintain.
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I work for a health insurance company that made $6 billion last year. Six billion. Ironically, I took the job because I needed health insurance, and I would gladly give it up for the peace of mind of universal health care.
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It would mean an end to a system designed to skim 10s of millions of dollars off into profits for Wall Street, the pharmaceutical industry and executive wages. Then America would no longer be the only developed nation to offer substandard and excessively expensive health care for most and quality care for some. I personally don't support a total conversion into Medicare and would advocate for a more measured approach using both regulated private insurers and some version of Medicare and Medicaid to cover or supplement costs that to many Americans simply can not afford to pay. That the Affordable Care Act failed in so many ways is indicative of the financial and political power that big medicine holds in this country. Its that influence and the numerous disingenuous scams like the coding gimmicks, phony pay to play discounts and multiple charges for the same items and services that make most health care access onerous and financially painful. From personal experience I point to Epi-pens and asthma inhalers as examples of the disingenuous nonsense and profiteering that goes on. Then there's the numerous ways that coverage is affected by everything from out of network, co-pays & a glossary of terms and meanings that would take a PHD to understand. That is what drives the whole "Medicare for all" trope and its understandable. But the underlying gimmickry needs to be addressed so that it doesn't become just another wolf in sheep's clothing cheating us in a different way.
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A wholesale change to Medicare for all will never be enacted. The medical groups, insurance companies, and other businesses dependent on our current system are too powerful, the change would be to disruptive to our economy and society, and the initial costs would be excessive. However, what we have now isn’t working and will only get worse. What we need is a plan to move us to a universal plan incrementally with annual changes announced years in advance so everyone can anticipate and adjust. (Those proposing a quick change need to be active partners in this compromise and realize that perfect is the enemy of the good,)
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I have Medicare and I have supplemental insurance. Private insurance would not be eliminated with MFA. Nor would employers cease offering health insurance — rather they would provide supplemental plans that would cost them much less.
Medicare provides necessary health care, and sets pricing for visits and various procedures. This kind of cost containment is disparately needed, while I acknowledge that it can be restrictive to health care organizations. It is not a perfect system, but is a necessary one. Without MFA, the U.S. is experience a decrease in longevity and an increase in infant mortality (especially in minority communities). Here, our health care in our nation lags behind nearly all industrialized nations.
Health insurance doesn't fit within the model of any other type of affordable insurance. The model for affordable insurance is predicated on the notion that most of the insured will seldom if ever have to use it, and through safety and/or prevention can reduce or eliminate claims. Everyone needs to use health insurance and more so as we age. This is why Medicare was instituted for the elderly. It is time to expand Medicare to Medicare For All.
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Last time the Democrats took on the health insurance industry, they were rewarded with catastrophic Congressional losses in 2010. If they try and ram Medicare for All through, Democrats will be out of power for a generation.
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The main issue in the midterms was healthcare and the democrats did very well.
I lived and worked in the UK for five years and some unfortunate events required me to be transported to a hospital and treated. While I would rather have not had that event happen I can say that the response time was fast and any healthcare I received through the NHS was as good if not better than my experiences here. There were no questions about coverage nor was there any insane paperwork to be filled out like you have to here.
Most people take in stride of having to chase their insurance company to go back and approve rejected claims for silly reasons. Also finding out which practice you owe copayments too. I usually have to pay at least two different sources, three or more if it is pre-natal care. And now there are HSAs that even complicate it more. Once you find who you need to pay the HSAs seem to kick things back for fun, another thing to chase.
I admit do have really good insurance through my employer. My employer pays over $20K annually for my insurance. Why not pay that into a "national Insurance" aka Medicare? If all employers that pay health insurance paid into national insurance, would we really need more taxes?
Finally, rip off the Band-Aid! It'll hurt for a bit but in the end it will be better.
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"But overall support diminishes by a third or more when people are told that the plan would involve eliminating private insurance, raising taxes, or requiring waits to obtain medical care, according to surveys from the Kaiser Family Foundation." Another example of the straw dog arguments that are used in this debate.
What if people were told that private insurance would be available as a supplemental plan if they wished but the cost would be far lower than today" (as it is in many national health care systems); Or "the overall cost of health care will be substantially less"; "yes, some waits might be longer for elective care such as plastic surgery, but everyone will have access to care" (unlike 82 million Americans today who either lack health care insurance or have inadequate coverage). How about - "your prescriptions will cost far less. Or, "there will be no more personal bankruptcies due to lack of coverage". Or, "you can see the provider of your choice rather than the provider an insurance company choose for you". Or, "you will not need to stay in a job you don't like because that is the only way you can get health insurance". What would their opinions be then? Americans need honest information.
I don't feel sorry for the investor class. Half the problems in medicine can be traced to the deregulation of corporate medicine.
Perhaps the party is about to end.
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Several areas of this article seem to oversimplify the issues facing healthcare users, providers,and insurers in America. But lets not forget how bad things were before ACA regulations reigned in the health insurance industry. Maximum life time benefits, and pre existing conditions, and rating structures that penalized everyone but young white males just to name a few.
Insurance companies unwillingness to cover the elderly and the indigent created the need for Medicare and Medicaid in the first place.
Few will have much empathy for the insurance industry based on how badly they treated their clients up until just a few years ago. Lets all remember also, the insurance companies are acting as middlemen in the relation of client and doctors, they collect and disperse the money. Any other role they may play is superfluous, and medicare can fill that role just as well, they already do it now.
Many people viewed the ACA as a step toward Universal health care, and like Warren stated recently and Krugman stated yesterday there are many different paths we can follow toward that goal. I was hoping this article might illuminate the debate on which path will be best to follow, but sadly it does not.
Perhaps the NYTimes could enable the debate by publishing a series of articles expounding our choices in a comprehensive and coherent manner.
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Excellent comment
You don't need to abolish private health coverage. In Australia we have both government and private. In fact the additional private coverage is effectively compulsory for those on higher incomes. It enables wider choice (dental, optical etc.) and access to the private hospital system eliminating queues for standard procedures. Government health cover is available for everyone and allows universal public hospital access and doctor visits. Costs are covered by taxes and share of health in total GDP is about half what it is in US. Also...drugs are cheap. I pay $US 5 for monthly cholesterol prescription. Most are subsidised through mass purchase by federal government. US system is good but ridiculously expensive.
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The private insurance industry will NOT be abolished. They will continue serving the medical needs of millions of Americans to supplements the basic coverage by medicaid. This is essentially how the private insurance companies make money in other countries. For instance, if you are prone to cancer as it runs in your family and you want to be doubly prepare yourself for the disease, you could always purchase a cancer coverage from a private company on top of the basic health insurance provided the government. This way those who cannot afford health care at all could still be protected while those needing additional coverage could still benefit. Meanwhile the companies will start studying the market and diversify their products. The current system is broken and the only way to reform health care is universal medicaid. Period.
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There are other considerations. First is the moral and humanitarian benefit of moving to a care-based system. Second, wouldn't a healthier population be more productive? There would be less time off work and feeling better overall is bound to contribute to an increase in productivity. Third, money not going to health care conglomerates will become disposable income that consumers can save or spend according to their wants and needs. Certainly, that can't be bad for the economy.
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My wife has had congestive heart failure for 18 years. In December she was diagnosed with diabetes and in January she was in hospital for 9 days with kidney failure. In February she was back in hospital for 20 days with hypotension (very low blood pressure) which almost killed her and for an upgraded defibrillator for cardiac resynchronization benefits. Of the 29 days in hospital she was in ICU for 12 of them. She sees a cardiologist once a month and an endocrinologist, eye doctor for cataracts, diabetes clinic as well as her family doctor. We do not have private insurance. If we lived in the States we would most certainly be bankrupt by now and would not be able to afford additional care. Even if we did have private insurance in the United States, after 18 years of this chronic condition she would most likely have been cut off and have been uninsurable for everything that happened this winter. But we live in Canada. She had the best of care throughout the horrors of this past winter and she is now recovering slowly at home getting stronger and better every day. All of this exemplary care has been covered as basic health coverage and we've only paid for hospital parking and some meals to avoid atrocious hospital food. I do not know what the outcome would have been this winter or over the past 18 years had we needed to struggle with private insurance companies to get paid or worse to pay for everything ourselves, but most likely much worse. Medicare for all saved us
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